Medical Decision Making The Family–Doctor–Patient Triad 英文参考文献.docVIP

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 elder