Abstract：
OBJECTIVE:To characterize the informed consent process in routine, primary care office practice. DESIGN:Cross-sectional, descriptive evaluation of audiotaped encounters. SETTING:Offices of primary care physicians in Portland, Oregon. PARTICIPANTS:Internists (54%) and family physicians (46%), and their patients. MEASUREMENTS AND MAIN RESULTS:Audiotapes of primary care office visits from a previous study of doctor-patient communication were coded for the number and type of clinical decisions made. The discussion between doctor and patient was scored according to six criteria for informed decision making: description of the nature of the decision, discussion of alternatives, discussion of risks and benefits, discussion of related uncertainties, assessment of the patient's understanding and elicitation of the patient's preference. Discussions leading to decisions included fewer than two of the six described elements of informed decision making (mean 1.23, median 1.0), most frequent of these was description of the nature of the decision (83% of discussion). Discussion of risks and benefits was less frequent (9%), and assessment of understanding was rare (2%). Discussions of management decisions were generally more substantive than discussions of diagnostic decisions (p = .05). CONCLUSIONS:Discussions leading to clinical decisions in these primary care settings did not fulfill the criteria considered integral to informed decision making. Physicians frequently described the nature of the decision, less frequently discussed risks and benefits, and rarely assessed the patient's understanding of the decision.
journal_name
J Gen Intern Medjournal_title
Journal of general internal medicineauthors
Braddock CH 3rd,Fihn SD,Levinson W,Jonsen AR,Pearlman RAdoi
10.1046/j.1525-1497.1997.00057.xsubject
Has Abstractpub_date
1997-06-01 00:00:00pages
339-45issue
6eissn
0884-8734issn
1525-1497journal_volume
12pub_type
杂志文章abstract：OBJECTIVE:To examine how Asian race/ethnicity affects patients' health care experiences and satisfaction with care. DESIGN:Telephone interview using random-digit dialing, stratified to over-sample adults living in areas with disproportionately large numbers of minorities. PARTICIPANTS AND SETTING:White (N = 3,205) an...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1111/j.1525-1497.2004.30143.x
更新日期：2004-02-01 00:00:00
abstract：BACKGROUND:Little is known about whether more experience with an electronic health record (EHR) makes it easier for providers to meaningfully use EHRs. OBJECTIVE:To assess whether the length of time that small practice providers have been using the EHR is associated with greater ease in performing meaningful use-relat...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-014-2891-0
更新日期：2014-10-01 00:00:00
abstract：BACKGROUND:Medical management of acute pain among hospital inpatients may be enhanced by mind-body interventions. OBJECTIVE:We hypothesized that a single, scripted session of mindfulness training focused on acceptance of pain or hypnotic suggestion focused on changing pain sensations through imagery would significantl...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,随机对照试验
doi：10.1007/s11606-017-4116-9
更新日期：2017-10-01 00:00:00
abstract：:To train more generalist physicians, structural changes must be made along the continuum of medical education. Future generalists require in-depth exposure to primary care practice, with substantive experience in the longitudinal management of patient panels and the opportunity to work with successful generalist role ...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,评审
doi：10.1007/BF02598115
更新日期：1994-04-01 00:00:00
abstract：INTRODUCTION:US adults with serious mental illness (SMI), compared to those without SMI, have a higher prevalence of smoking, which contributes to a shorter life expectancy. This study compared current smoking and quitting-related characteristics of low-income US adults with and without SMI who received healthcare at f...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-019-04857-3
更新日期：2019-06-01 00:00:00
abstract：BACKGROUND:Sudden death is a public health problem with major impact on society. Coronary artery disease (CAD) is believed to underlie 60-80% of these deaths. While deaths from CAD have decreased in the recent decades, sudden death rates remain unacceptably high. OBJECTIVE:We aimed to assess the prevalence of CAD and ...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-019-05486-6
更新日期：2020-02-01 00:00:00
abstract：BACKGROUND:Consumer-directed health plans are increasingly common, yet little is known about their impact on physician decision-making and preventive service use. OBJECTIVE:To determine how patients' deductible levels and socioeconomic status may affect primary care physicians' recommendations for colorectal cancer sc...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,随机对照试验
doi：10.1007/s11606-008-0714-x
更新日期：2008-10-01 00:00:00
abstract：BACKGROUND:There is inadequate evidence of long-term benefit from opioid medications for chronic pain and substantial evidence of potential harms. For patients, dose reduction may be beneficial when implemented voluntarily and supported by a multidisciplinary team but experts have advised against involuntary opioid red...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-020-06294-z
更新日期：2020-12-01 00:00:00
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更新日期：2013-07-01 00:00:00
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journal_title：Journal of general internal medicine
pub_type： 杂志文章,多中心研究
doi：10.1007/s11606-013-2389-1
更新日期：2013-08-01 00:00:00
abstract：:Because of the financial incentives of prepaid care, the quality of care for Medicare enrollees in Health Maintenance Organizations (HMOs) is a concern. Therefore, the care in 150 newly diagnosed cases of colorectal cancer in eight HMOs was compared with that in 180 similar fee-for-service (FFS) cases. As part of the ...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/BF02600509
更新日期：1990-03-01 00:00:00
abstract：:The authors evaluated the perceptions and adjustments of surviving spouses following patient deaths. Of 128 married patients dying in a university hospital in 1983, the surviving spouses of 105 (82%) were personally interviewed a year after the death. The physicians' perspectives were recorded through chart review. Ha...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/BF02596210
更新日期：1986-09-01 00:00:00
abstract：OBJECTIVE:To compare the efficacies and cost-effectiveness of four strategies for the management of suspected pedal osteomyelitis in the setting of vascular impairment: 1) therapeutic trial of short-term antibiotics for presumed cellulitis without osteomyelitis (short); 2) technetium bone scanning followed by either sh...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/BF02599133
更新日期：1994-01-01 00:00:00
abstract：:The authors surveyed 112 recent alumni and 92 current residents (70% responded) at a residency program that requires original research. Most alumni felt that the research project was a valuable learning experience, particularly in improving their abilities to critically review the medical literature. Almost a third fe...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/BF02599759
更新日期：1993-03-01 00:00:00
abstract：:Elderly veterans who visit our Veterans Affairs (VA) Medical Center primary care clinic often mention they are enrolled in HMOs. Approximately 20% of patients hospitalized at our facility report health insurance coverage. Of 1,000 hospitalizations during a 6-month period in which veterans reported insurance coverage, ...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1046/j.1525-1497.1997.012004247.x
更新日期：1997-04-01 00:00:00
abstract：BACKGROUND:Little is known about the quality of the patient-physician relationship for terminally ill African Americans. OBJECTIVE:To compare the quality of the patient-physician relationship between African-American and white patients and examine the extent to which relationship quality contributes to differences in ...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-007-0370-6
更新日期：2007-11-01 00:00:00
abstract：BACKGROUND:Length of stay at US acute care hospitals has been steadily decreasing since 1960, and there is ongoing concern that increasing financial pressures on hospitals with high proportions of Medicaid patients may be causing unduly short lengths of stay. OBJECTIVE:To study temporal trends in hospital utilization ...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-010-1370-5
更新日期：2010-09-01 00:00:00
abstract：CONTEXT:Understanding students' perceptions of and responses to lapses in professionalism is important to shaping students' professional development. OBJECTIVE:Utilize realistic, standardized professional dilemmas to obtain insight into students' reasoning and motivations in "real time." DESIGN:Qualitative study usin...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1111/j.1525-1497.2003.21247.x
更新日期：2003-12-01 00:00:00
abstract：BACKGROUND:A number of practice guidelines and recommendations call for the assessment of childhood abuse history among adult medical patients. The cultural sensitivity of screening questions, however, has not been examined. OBJECTIVE:To assess whether questions that inquire about childhood abuse history function diff...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-006-0026-y
更新日期：2007-03-01 00:00:00
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journal_title：Journal of general internal medicine
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doi：10.1007/s11606-008-0693-y
更新日期：2008-10-01 00:00:00
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journal_title：Journal of general internal medicine
pub_type： 杂志文章,评审
doi：10.1007/s11606-010-1347-4
更新日期：2010-07-01 00:00:00
abstract：BACKGROUND:Use of electronic health records (EHRs) is associated with physician stress and burnout. While emergency departments and subspecialists have used scribes to address this issue, little is known about the impact of scribes in academic primary care. OBJECTIVE:Assess the impact of a scribe on physician and pati...
journal_title：Journal of general internal medicine
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更新日期：2018-07-01 00:00:00
abstract：OBJECTIVES:1) To describe the prevalence of eight injury-prone behaviors (IPBs) and the associations of these behaviors with ten standard chronic disease and sociodemographic risk factors (CDSRFs) among internal medicine patients and 2) to identify a subset of patients with multiple IPBs who might be at particularly hi...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/BF02599194
更新日期：1992-11-01 00:00:00
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journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-010-1363-4
更新日期：2010-09-01 00:00:00
abstract：SPECIFIC AIM:Although the Department of Veterans Affairs (VA) has made significant organizational changes to improve diabetes care, diabetes self-management has received limited attention. The purpose of this study is to assess factors influencing diabetes self-management among veterans with poorly controlled diabetes....
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-006-0053-8
更新日期：2007-04-01 00:00:00
abstract：OBJECTIVE:To assess a new technique for the detection of free pleural fluid. DESIGN:118 consecutive inpatients with radiologic evidence of free pleural fluid and a control group of 175 randomly selected inpatients were examined over a three-year period in a prospective blind study by auscultatory percussion (AP) for e...
journal_title：Journal of general internal medicine
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1007/BF02600204
更新日期：1994-02-01 00:00:00
abstract：BACKGROUND:The use of androgen deprivation therapy (ADT) for prostate cancer has increased substantially in recent years, exposing more men to potential treatment complications, including osteoporosis and fractures. OBJECTIVE:To determine whether men treated with ADT for prostate cancer received osteoporosis screening...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-007-0291-4
更新日期：2007-09-01 00:00:00
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journal_title：Journal of general internal medicine
pub_type： 临床试验,杂志文章,随机对照试验
doi：10.1046/j.1525-1497.2000.01079.x
更新日期：2000-01-01 00:00:00
abstract：BACKGROUND:The many challenges in health care today create a special need for great leadership. However, traditional criteria for physicians' advancement to leadership positions often regard academic and/or clinical accomplishments rather than the distinctive competencies needed to lead. Furthermore, physicians' traini...
journal_title：Journal of general internal medicine
pub_type： 杂志文章,评审
doi：10.1007/s11606-009-1007-8
更新日期：2009-07-01 00:00:00
abstract：BACKGROUND:Medical student interest in internal medicine is decreasing. Whether the internal medicine sub-internship affects intent to pursue internal medicine is unknown. OBJECTIVE:Determine the immediate and longer-term effect of the medicine sub-internship on students' decision to pursue internal medicine residency...
journal_title：Journal of general internal medicine
pub_type： 杂志文章
doi：10.1007/s11606-010-1263-7
更新日期：2010-05-01 00:00:00
