医患共同决策:一种新型医疗模式

2021-01-17 网络 网络

一、什么是SDM

一、什么是SDM 医患共同决策,Shared Decision Making (SDM)是指在进行医疗决策时,医务人员首先充分告知患者及其家属(或监护人等)各种治疗方法的利弊,患者及其家属(或监护人等)通过权衡这些利弊,与医务人员充分沟通,最后共同作出决策。 历经四十多年的研究和临床实践,其在欧美等发达国家的发展已相当成熟,不仅建立了较为完善的理论体系,设计出应用于临床决策的辅助模型和规范流程,同时也逐步建立起保障SDM实施的配套法律和政策。尽管我国和欧美国家的国情以及医疗环境不尽相同,但以“患者为中心”的理念是共通的。因此,对国外SDM的研究发展进行一个完整和系统的梳理回顾,将为我国医疗界对于SDM的研究、实施和应用提供非常有益的借鉴。 二、SDM的应用举例 以SDM在美国退伍军人事务部(United States Department of VeteransAffairs,VA)的应用为例。该部门成立于1989年,专门为美国退伍军人及家属提供服务的内阁部门。这个机构对SDM应用的介绍如下:SharedDecision Making (SDM) is acollaborative,

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    2021-06-23 崔公子

    学习了,很棒

    0

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    2021-06-23 ms4000001760817265

    医患共同决策有利于提高患者依从性

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1677731, encodeId=673816e773181, content=<a href='/topic/show?id=524c350e166' target=_blank style='color:#2F92EE;'>#医疗模式#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35071, encryptionId=524c350e166, topicName=医疗模式)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=281527575887, createdName=yangwen5718, createdTime=Sun May 02 13:10:16 CST 2021, time=2021-05-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=976315, encodeId=f23f9e631559, content=学习了,很棒, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLHU8LgopPRSB5ppDANbqiclVOib4VuVs4JoIy6W48ETjIPJdq65H1MpjVjKt1qQicYbICcOCtqLm8yg/132, createdBy=302d2504595, createdName=崔公子, createdTime=Wed Jun 23 20:37:58 CST 2021, time=2021-06-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=976067, encodeId=3e7b9e60671c, content=医患共同决策有利于提高患者依从性, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=88395449657, createdName=ms4000001760817265, createdTime=Wed Jun 23 09:28:18 CST 2021, time=2021-06-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=970678, encodeId=80169e0678a5, content=共享决策, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=44fe5439426, createdName=ms1000000930555142, createdTime=Thu Jun 03 19:53:08 CST 2021, time=2021-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=921453, encodeId=57489214531c, content=2, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f5535457366, createdName=ms9000001547738369, createdTime=Sat Jan 30 21:22:46 CST 2021, time=2021-01-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=919322, encodeId=9922919322cf, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Sat Jan 23 23:57:14 CST 2021, time=2021-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=918192, encodeId=b5b49181920d, content=1, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ed075310648, createdName=14887f61m75暂无昵称, createdTime=Tue Jan 19 21:02:28 CST 2021, time=2021-01-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1284752, encodeId=bf321284e5269, content=<a href='/topic/show?id=da9934342b5' target=_blank style='color:#2F92EE;'>#医患#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=34342, encryptionId=da9934342b5, topicName=医患)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c0e3195, createdName=millore, createdTime=Tue Jan 19 11:10:16 CST 2021, time=2021-01-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1541871, encodeId=38db15418e1e6, content=<a href='/topic/show?id=e8ca3108823' target=_blank style='color:#2F92EE;'>#决策#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31088, encryptionId=e8ca3108823, topicName=决策)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e76e13331157, createdName=ms2999106592497887, createdTime=Tue Jan 19 11:10:16 CST 2021, time=2021-01-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=917685, encodeId=e43391e6857d, content=医患共同决策<a href='/topic/show?id=1238104156fe' target=_blank style='color:#2F92EE;'>#医患共同决策#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=104156, encryptionId=1238104156fe, topicName=医患共同决策)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59321624668, createdName=zb1235672, createdTime=Mon Jan 18 10:05:30 CST 2021, time=2021-01-18, status=1, ipAttribution=)]
    2021-06-03 ms1000000930555142

    共享决策

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1677731, encodeId=673816e773181, content=<a href='/topic/show?id=524c350e166' target=_blank style='color:#2F92EE;'>#医疗模式#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35071, encryptionId=524c350e166, topicName=医疗模式)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=281527575887, createdName=yangwen5718, createdTime=Sun May 02 13:10:16 CST 2021, time=2021-05-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=976315, encodeId=f23f9e631559, content=学习了,很棒, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLHU8LgopPRSB5ppDANbqiclVOib4VuVs4JoIy6W48ETjIPJdq65H1MpjVjKt1qQicYbICcOCtqLm8yg/132, createdBy=302d2504595, createdName=崔公子, createdTime=Wed Jun 23 20:37:58 CST 2021, time=2021-06-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=976067, encodeId=3e7b9e60671c, content=医患共同决策有利于提高患者依从性, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=88395449657, createdName=ms4000001760817265, createdTime=Wed Jun 23 09:28:18 CST 2021, time=2021-06-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=970678, encodeId=80169e0678a5, content=共享决策, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=44fe5439426, createdName=ms1000000930555142, createdTime=Thu Jun 03 19:53:08 CST 2021, time=2021-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=921453, encodeId=57489214531c, content=2, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f5535457366, createdName=ms9000001547738369, createdTime=Sat Jan 30 21:22:46 CST 2021, time=2021-01-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=919322, encodeId=9922919322cf, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Sat Jan 23 23:57:14 CST 2021, time=2021-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=918192, encodeId=b5b49181920d, content=1, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ed075310648, createdName=14887f61m75暂无昵称, createdTime=Tue Jan 19 21:02:28 CST 2021, time=2021-01-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1284752, encodeId=bf321284e5269, content=<a href='/topic/show?id=da9934342b5' target=_blank style='color:#2F92EE;'>#医患#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=34342, encryptionId=da9934342b5, topicName=医患)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c0e3195, createdName=millore, createdTime=Tue Jan 19 11:10:16 CST 2021, time=2021-01-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1541871, encodeId=38db15418e1e6, content=<a href='/topic/show?id=e8ca3108823' target=_blank style='color:#2F92EE;'>#决策#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31088, encryptionId=e8ca3108823, topicName=决策)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e76e13331157, createdName=ms2999106592497887, createdTime=Tue Jan 19 11:10:16 CST 2021, time=2021-01-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=917685, encodeId=e43391e6857d, content=医患共同决策<a href='/topic/show?id=1238104156fe' target=_blank style='color:#2F92EE;'>#医患共同决策#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=104156, encryptionId=1238104156fe, topicName=医患共同决策)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59321624668, createdName=zb1235672, createdTime=Mon Jan 18 10:05:30 CST 2021, time=2021-01-18, status=1, ipAttribution=)]
    2021-01-30 ms9000001547738369

    2

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1677731, encodeId=673816e773181, content=<a href='/topic/show?id=524c350e166' target=_blank style='color:#2F92EE;'>#医疗模式#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35071, encryptionId=524c350e166, topicName=医疗模式)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=281527575887, createdName=yangwen5718, createdTime=Sun May 02 13:10:16 CST 2021, time=2021-05-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=976315, encodeId=f23f9e631559, content=学习了,很棒, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLHU8LgopPRSB5ppDANbqiclVOib4VuVs4JoIy6W48ETjIPJdq65H1MpjVjKt1qQicYbICcOCtqLm8yg/132, createdBy=302d2504595, createdName=崔公子, createdTime=Wed Jun 23 20:37:58 CST 2021, time=2021-06-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=976067, encodeId=3e7b9e60671c, content=医患共同决策有利于提高患者依从性, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=88395449657, createdName=ms4000001760817265, createdTime=Wed Jun 23 09:28:18 CST 2021, time=2021-06-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=970678, encodeId=80169e0678a5, content=共享决策, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=44fe5439426, createdName=ms1000000930555142, createdTime=Thu Jun 03 19:53:08 CST 2021, time=2021-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=921453, encodeId=57489214531c, content=2, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f5535457366, createdName=ms9000001547738369, createdTime=Sat Jan 30 21:22:46 CST 2021, time=2021-01-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=919322, encodeId=9922919322cf, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Sat Jan 23 23:57:14 CST 2021, time=2021-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=918192, encodeId=b5b49181920d, content=1, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ed075310648, createdName=14887f61m75暂无昵称, createdTime=Tue Jan 19 21:02:28 CST 2021, time=2021-01-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1284752, encodeId=bf321284e5269, content=<a href='/topic/show?id=da9934342b5' target=_blank style='color:#2F92EE;'>#医患#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=34342, encryptionId=da9934342b5, topicName=医患)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c0e3195, createdName=millore, createdTime=Tue Jan 19 11:10:16 CST 2021, time=2021-01-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1541871, encodeId=38db15418e1e6, content=<a href='/topic/show?id=e8ca3108823' target=_blank style='color:#2F92EE;'>#决策#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31088, encryptionId=e8ca3108823, topicName=决策)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e76e13331157, createdName=ms2999106592497887, createdTime=Tue Jan 19 11:10:16 CST 2021, time=2021-01-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=917685, encodeId=e43391e6857d, content=医患共同决策<a href='/topic/show?id=1238104156fe' target=_blank style='color:#2F92EE;'>#医患共同决策#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=104156, encryptionId=1238104156fe, topicName=医患共同决策)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59321624668, createdName=zb1235672, createdTime=Mon Jan 18 10:05:30 CST 2021, time=2021-01-18, status=1, ipAttribution=)]
    2021-01-23 1209e435m98(暂无昵称)

    学习了,谢谢分享

    0

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  8. [GetPortalCommentsPageByObjectIdResponse(id=1677731, encodeId=673816e773181, content=<a href='/topic/show?id=524c350e166' target=_blank style='color:#2F92EE;'>#医疗模式#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35071, encryptionId=524c350e166, topicName=医疗模式)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=281527575887, createdName=yangwen5718, createdTime=Sun May 02 13:10:16 CST 2021, time=2021-05-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=976315, encodeId=f23f9e631559, content=学习了,很棒, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLHU8LgopPRSB5ppDANbqiclVOib4VuVs4JoIy6W48ETjIPJdq65H1MpjVjKt1qQicYbICcOCtqLm8yg/132, createdBy=302d2504595, createdName=崔公子, createdTime=Wed Jun 23 20:37:58 CST 2021, time=2021-06-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=976067, encodeId=3e7b9e60671c, content=医患共同决策有利于提高患者依从性, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=88395449657, createdName=ms4000001760817265, createdTime=Wed Jun 23 09:28:18 CST 2021, time=2021-06-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=970678, encodeId=80169e0678a5, content=共享决策, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=44fe5439426, createdName=ms1000000930555142, createdTime=Thu Jun 03 19:53:08 CST 2021, time=2021-06-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=921453, encodeId=57489214531c, content=2, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f5535457366, createdName=ms9000001547738369, createdTime=Sat Jan 30 21:22:46 CST 2021, time=2021-01-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=919322, encodeId=9922919322cf, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7c592194322, createdName=1209e435m98(暂无昵称), createdTime=Sat Jan 23 23:57:14 CST 2021, time=2021-01-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=918192, encodeId=b5b49181920d, content=1, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ed075310648, createdName=14887f61m75暂无昵称, createdTime=Tue Jan 19 21:02:28 CST 2021, time=2021-01-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1284752, encodeId=bf321284e5269, content=<a href='/topic/show?id=da9934342b5' target=_blank style='color:#2F92EE;'>#医患#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=50, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=34342, encryptionId=da9934342b5, topicName=医患)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c0e3195, createdName=millore, createdTime=Tue Jan 19 11:10:16 CST 2021, time=2021-01-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1541871, encodeId=38db15418e1e6, content=<a href='/topic/show?id=e8ca3108823' target=_blank style='color:#2F92EE;'>#决策#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31088, encryptionId=e8ca3108823, topicName=决策)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=e76e13331157, createdName=ms2999106592497887, createdTime=Tue Jan 19 11:10:16 CST 2021, time=2021-01-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=917685, encodeId=e43391e6857d, content=医患共同决策<a href='/topic/show?id=1238104156fe' target=_blank style='color:#2F92EE;'>#医患共同决策#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=104156, encryptionId=1238104156fe, topicName=医患共同决策)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=59321624668, createdName=zb1235672, createdTime=Mon Jan 18 10:05:30 CST 2021, time=2021-01-18, status=1, ipAttribution=)]
    2021-01-19 millore
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    2021-01-18 zb1235672

    医患共同决策#医患共同决策#

    0