關於 EBM 與法律 -- Merenstein, JAMA 2004 以後的相關討論

Shared decision making

• Why is evidence-based medicine the legal standard of practice? [Medscape J Med. 2008]
• A reader and author respond to "Why is evidence-based medicine the legal standard of practice?". [Medscape J Med. 2008]
• Part 2: A reader and author respond to "Why is evidence-based medicine the legal standard of practice?". [Medscape J Med. 2008]
• Evidence-based medicine on trial. [JAMA. 2004]
• Evidence-based medicine on trial. [JAMA. 2004]
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法律案件後醫生行為的改變

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How Physicians Approach Prostate Cancer Screening Before and After Losing a Lawsuit

¹ Department of Family Medicine, Fairfax Family Practice Residency, Virginia Commonwealth University, Fairfax, Va
² Departments of Family Medicine, Epidemiology, and Community Health, Virginia Commonwealth University, Fairfax, Va
³ Departments of Family Medicine and Biostatistics, Virginia Commonwealth University, Fairfax, Va

CORRESPONDING AUTHOR: Alex Krist, MD, MPH, Department of Family Medicine, Virginia Commonwealth University, 3825 Charles Stewart Dr, Fairfax, VA 22033, ahkrist@vcu.edu

PURPOSE In 2004, a commentary by Merenstein was published in JAMA describing how he was sued for engaging a patient in shared decision making for prostate cancer screening. The article sparked considerable debate on the impact of litigation on medical care. A natural experiment (a study assessing shared decision making under way at the practice that was sued) enabled us to evaluate whether physicians changed their prostate cancer screening behavior after the lawsuit.

METHODS As part of a randomized controlled trial conducted between January 2002 and November 2004, patients and physicians completed exit questionnaires about prostate cancer screening discussions after health maintenance examinations. We compared responses before, during, and after physicians became aware of the lawsuit.

RESULTS A total of 432 of 497 patients completed questionnaires (180 before the practice became aware of the lawsuit, 87 as knowledge of the case diffused through the practice, and 165 after publication of Merenstein’s commentary). Comparing patients’ responses over the 3 time periods, there were no changes in the average locus of decision-making control, time spent discussing screening, number of screening topics discussed, knowledge scores, or decisional conflict. The frequency with which physicians reported performing prostate-specific antigen testing increased (before vs after: 84% vs 90%; P = .03), and physicians were more likely to report that they, rather than the patients, had made the screening decision (before vs after: 3.3% vs 11.1%; P = .003).

CONCLUSIONS The physicians in closest proximity to this well-known legal case continued to engage patients in shared decision making and to let patients decide whether to be screened. Prostate-specific antigen testing increased during this period.

Key Words: Prostatic neoplasms • decision making • malpractice • guideline adherence/statistics & numerical data • prostate-specific antigen/blood • mass screening/methods

				K. C. Stange and W. R. Phillips In This Issue: Real Change Is Real Hard in the Real World Ann. Fam. Med, March 1, 2007; 5(2): 98 - 100. [Full Text] [PDF]

A. H. Krist, S. H. Woolf, R. E. Johnson, and J. W. Kerns Patient Education on Prostate Cancer Screening and Involvement in Decision Making Ann. Fam. Med, March 1, 2007; 5(2): 112 - 119. [Abstract] [Full Text] [PDF]