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Authors' Reply Teaching Health Workers Malaria Diagnosis 英文参考文献
Open access, freely available online
Correspondence
Medical Decision Making:
The Family–Doctor–Patient Triad
some considering patients and families as one [5]. One
worry regarding communication of harm is of losing patients
to other physicians with a more reassuring “nothing will
go wrong” attitude [5]. It is also said that more time and
patience are required to explain things to the illiterate. It
is perhaps impractical, therefore, to expect overworked
and underpaid physicians to practice risk communication
according to the book.
Thus, the concept of individual centrality that is so
elementary in the West stands challenged in the East.
Research is needed to formulate appropriate strategies of
risk communication. Areas needing research include the
patient’s concept of autonomy, the role of the family as
perceived by patients and doctors, the existing practices
of medical decision making, and the training of doctors in
communicating risk.
Fawad Aslam, Omar Aftab, Naveed Z. Janjua
The importance of a person-centred approach and the
intricacies of risk communication have recently been well
described in PLoS Medicine [1,2]. The applicability of the
patient-centred approach to Eastern countries, however, has
cultural, religious, and practical impediments that demand
careful consideration. The bulk of the world population
lives outside the United States and western Europe. Unlike
in the West where the patient takes centre stage by both
tradition and law, the family–doctor–patient triad is the
norm in Eastern states, in general, and Pakistan in particular
[3–8].
Pakistan is a predominantly Muslim country of 150 million
people. About half the population is uneducated, and
more than a third lives below the poverty line. There is one
doctor for every 1,432 patients, compared to one doctor for
every 390 patients in the US. The health-insurance system
is virtually nonexistent, and there is no concept of assisted-
care living, with the care of the elderly
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