醫病共享決策應用於骨科微創手術

Shared Decision Making in Minimally Invasive Surgery in Orthopedics

醫病共享決策（shared decision making, SDM），公認最早出現在1982年美國以病人為中心照護的共同福祉計畫中，為促進醫病相互尊重與溝通而提出。SDM的精神兼具溝通、知識與尊重。鼓勵病人勇敢表達對於疾病及治療的疑問和想法，讓醫療人員能夠了解病人的需求及想法（溝通），並在幫助病人充分了解各種醫療選項後（知識），保障病人有能力選出最適合自己治療方式的過程和權利（尊重）。相較於傳統開放手術，微創手術的優點是：（1）術中出血較少；（2）降低術後住院天數及疼痛，可以更早回到正常生活及工作；（3）恢復較快。因此選擇合適的病人進行微創手術，以醫病共享決策的方式進行，更能讓病人做一個合適的選擇。本文選擇骨科中，利用微創手術的三個情境，板機指、外傷骨盆骨折、老年骨鬆骨盆骨折為例，醫師選擇合適的病人，利用醫病共享決策的模式，幫助病人選擇合適的治療，以期待將來更多的骨科手術，可以以醫病共享決策的方式進行。

Shared decision making (SDM) was first conducted in the USA in 1982. Patient centered care is the main theme of health care. For improving the doctor-patient relationship with mutual respect and communication, SDM was proposed and conducted. SMD is based on choice, option and decision talk. In SDM, we encourage patients to expression their questions about the disease and treatment. It will let the health providers to know more about patients’ need and thought. It will also help patients to choose the most proper choice with all related medical knowledge acquired. Compared to the traditional open surgery, the benefits of minimally invasive surgery are (1) Less blood loss. (2) Less pain and hospitalization day so the patients can return to normal daily life and work earlier. (3) Faster recovery. Therefore, conducting SMD in suitable patients with minimally invasive surgery can help these patients choose a proper choice. In this article, we use three conditions which minimally invasive surgery are possible including trigger finger, traumatic pelvic fracture, osteoporotic pelvic fracture. With SDM, the patients can get a proper choice for them. We are looking forward to applying more SDM in Orthopedic surgery.