1. Background of the study.
Insights from outpatient clinics: Patients are always seen in outpatient clinics taking out a piece of paper, “Doctor, I’m afraid I’ll forget, write it down, I’ll look at these questions”. There are long and short notes written. Simple is the list of entries, there are written in the medical record book, complex tells the process of seeking medical treatment, more sophisticated, there are drawn charts, and edited outline, and then printed out. From this, we can see that the actual needs of clinical treatment require the active participation of patients.
The actual clinical contradictions and problems: doctors and patients focus on different directions, doctors focus on patients’ symptoms while paying more attention to the status of objective indicators, while patients are more concerned about the improvement of their own symptoms, which is sometimes unified and sometimes separated in clinical practice, and symptoms and actual conditions are not always parallel, which is a realistic contradiction.
The reality of clinical efficacy evaluation research: the evaluation of clinical efficacy is a key issue for the development of medical science and a major concern for new drug development and health care. With the development of medical science, from the concern of quality of life to the development of the Patient Report Outcome Indicator (PRO, Patient Report Outcome) scale, more medical scientists have turned their attention to patients’ feelings, and the main indicators of efficacy evaluation are also tilting toward patients’ feelings, how to evaluate the effectiveness of interventions, and the need, to integrate both physician-patient The need for evaluation indicators that integrate both physician-patient aspects is emerging. At the same time, it is clear from the current study that a more comprehensive evaluation of clinical efficacy can be achieved by emphasizing the value of the patient’s perceptions, however, it is not possible to generalize entirely by virtue of patient evaluation. The establishment of a clinical efficacy evaluation system by integrating physician-patient evaluations may help to evaluate efficacy in a comprehensive and objective manner. Whether a more comprehensive efficacy evaluation method can be established by using the evaluation of both doctors and patients is a question that needs to be studied.
Evidence-based medical treatment model: The thinking and concept of evidence-based medicine leads the current world medical trend, and its three elements include doctors’ experience, the best current treatment measures and patients’ value orientation, which are equally important without one another. How to reflect the patient’s value orientation in the diagnosis and treatment is also a problem for our doctors to think about. The record of the diagnosis and treatment, oriented by the doctor’s record, is objective from a professional perspective and requires more attention to the patient’s feelings.
Physician aspect.
The physician’s experience aspect is an irreplaceable and important element of medical care, vital in clinical practice, related to human, social and psychological, difficult to quantify and objective.
Physicians’ concerns about the best current treatment measures are mainly derived from the results of high-quality systematic reviews meta-analyses, especially the results of Cochrane’s systematic reviews translated into clinical evidence. In recent years, the Methodology Group of the Cochrane Collaboration has introduced Overviews of reviews (Overviews) and the GREAD evaluation system. The evaluation and recommendation levels of clinical evidence have been developed to a more scientifically sound and mature aspect.
Patient side.
For patient feelings, famous doctors and scientists of clinical efficacy evaluation also gradually formed a consensus, and began to pay more attention to the evaluation of patients themselves, called PRO (Patient-Report-Outcome) scale, while paying attention to physical and chemical examinations. The main focus is on the patient’s feelings to evaluate the effectiveness of medical measures, more realistic, more relevant and more humanistic. Regardless of the index, the patient’s feeling is also important. In other words, we should not just consider the reduction of some indicators in the treatment process, each person is different, we should comprehensively assess the effect of interventions, so that the patient’s whole body is healthier and more comfortable, is the first thing doctors do.
Patients themselves write all sorts of things, and this randomness is exactly what scientific research needs to be true to the original records. The goal of this research effort is to make a good interactive doctor-patient record and to use evidence-based concepts to focus on patient health from multiple perspectives.
The rise of narrative medicine: In 2000, Rita Charon, a Columbia University physician, was the first to develop a narrative medical record. In 2000, Rita Charon, a Columbia University physician, first introduced the concept of “narrative medicine”. Narrative medicine is the practice of medicine with the ability to narrate and understand highly complex narrative situations with physicians, patients, colleagues and the public. In short, it trains physicians to witness the suffering of patients and to tell the full story of illness.
The Canadian physician and scholar William Osler has said, “The practice of medicine is a very important part of our lives. Osler has said, “The practice of medicine is an art based on science. It is a profession, not a trade; it is a vocation, not a trade; by its very nature, it is a vocation, a social vocation, an expression of good humanity and fraternal feelings.”
As a result, medical education abroad is gradually focusing on the cultivation of humanistic spirituality, with more than 70% of medical schools offering such courses. For example, special attention is given to listening to patients about their illnesses; to appreciating famous paintings to help identify the subtle details of their conditions; to simulating illnesses with the help of role plays and experiencing hospital stays overnight to get a first-hand taste of what it is like to be a patient, etc. One of the skills developed to recognize, absorb, interpret and be moved by the “story of illness” is “narrative medicine”.
In this regard, it integrates the concept of “respecting patients’ values” in evidence-based medicine, which makes clinical medicine more humanistic and spiritual, and also reflects real-world research in the evaluation of efficacy.
Academician Wang Yongyan pointed out in “Strengthening the concept of medical humanities and learning narrative medicine in the face of the new medical reform” that “narrative medicine and evidence-based medicine cannot be neglected and jointly promote the development of medicine and humanities”, and that “the main practice form of narrative medicine is the parallel pathological writing paradigm in medical activities. ” so that “medical humanities has a real clinical procedures and evaluation indicators”. In this process of, to record the patient’s suffering in the language of the non-medical profession. Both the doctor’s record and the patient’s record should truly reflect the clinical process from two dimensions, so as to realize the empathy of the doctor or for the diagnosis and treatment and efficacy evaluation.
Future medical development.
The value of using systematic evaluation of evidence-based medicine in the clinic is becoming increasingly evident, and individualized treatment is bound to become the future trend. The narrative medicine evidence-based model of doctor-patient mutual help diagnosis and treatment is a balance of these two points, interpreting the connotation of health from two perspectives of doctors and patients, and the efficacy evaluation is also balanced in both objective and subjective aspects, from the medical records, the patient’s attention and enthusiasm can be given full play, and the doctor will guide, so that health problems can return to nature completely.
Health issues should not be underestimated, and in the face of increasing doctor-patient mistrust and patients’ desperate desire to understand themselves, the doctor-patient co-construction of evidence-based medical records can better form a doctor-patient alliance, a mechanism that facilitates mutual trust between doctors and patients and the accurate and smooth conduct of treatment.
The development of medicine is a matter of national importance and medical treatment is happening all around us all the time, while domestic and foreign research focuses on clinical and biological basis, medical treatment is one individual health recovery after another. Evidence-based medicine tells us that medical research is moving from individual observation to group rules, and then the commonalities summarized from the group are applied to the individual. The future trend must be individualized evidence-based decision making following credible medical clinical evidence, which is imperative for accurate assessment of efficacy, combined with the method of joint evaluation by doctors and patients, which has a broad development space and the value of scientific research exploration.
2. Research content and hypothesis.
The purpose of the doctor-patient co-constructed evidence-based medical record is to change the doctor-led model in conventional medical records, set a certain format, conduct and patient feelings combined with respect for the patient’s value orientation, and doctor-patient co-recorded medical record documents. The doctor-patient co-constructed medical record of spleen and stomach diseases is oriented to gastroenterology, and a doctor-patient co-constructed medical record of common diseases in gastroenterology is established. This study explores this medical record documentation and establishes the hypothesis that the physician-patient co-constructed medical record documentation, as a new assessment method, can better reflect the true clinical outcome than the traditional physician-recorded medical record, as well as the patient PRO scale.
3. Research objectives.
To clarify the effectiveness of current interventions for reflux esophagitis and gastric precancerous lesions, which are common diseases in gastroenterology; to organize and summarize the best current efficacy evaluation methods; to establish a physician-patient co-constructed medical record for common diseases in gastroenterology in cooperation between Chinese and Western medicine, and to explore new efficacy evaluation methods and systems.
4. Research methods.
Pubmed and other major databases were searched, using “narrative medicine” and “patient-physician co-construction” as keywords and subject terms. We consulted experts in gastroenterology and evidence-based medicine to draft a study protocol for a doctor-patient co-constructed medical record from the perspective of a methodological clinical observation of the medical record, so that the protocol may be more conducive to assessing the patient’s condition and better evaluate the clinical efficacy of the intervention on chronic gastritis. Introducing the concept of evidence-based medicine, especially respecting patients’ values, using Cochrane systematic reviews and re-evaluations of systematic reviews, summarizing interventions for chronic gastritis, developing and improving re-evaluations of systematic reviews, exercising the GRADE grading system, assessing recommendation levels, and conducting comparative studies of efficacy evaluation indicators for interventions with high recommendation levels. Extract these indicators, integrate the content of narrative medicine patient records, and conduct the development of a doctor-patient co-constructed medical record format.
5. Research protocol and steps.
First aspect Theoretical exploration
In the first step, evidence-based search of Cochrane systematic reviews and re-evaluation of systematic reviews for reflux esophagitis and gastric precancerous lesions. In the second step, for the re-evaluation of systematic reviews that were already available, the analysis was performed directly, and for those that were not, the re-evaluation of systematic reviews was performed. The re-evaluation of systematic evaluation was obtained. In the third step, the GRADE software was used to grade the recommendation for the efficacy of the outcome indicators. In the fourth step, the studies with high recommendation grade were selected, re-read, and the efficacy evaluation methods in them were summarized. Develop indicators for the physician-patient co-constructed medical record, integrate the concept of narrative medicine, conduct theoretical discussions, and consult experts to develop the format of the physician-patient co-constructed medical record.
Second aspect Clinical practice research
In the first step, we initially set up a medical record observation format according to the clinical process, combined with the obtained indicators, and established a template for the doctor-patient co-constructed medical record; in the second step, we conducted 30 cases of clinical observation and trial filling, from which we found the deficiencies of the medical record format and the areas that should be improved. In the third step, the entries were revised and a formal chart format was developed; in the fourth step, 360 cases of doctor-patient co-constructed charts were filled in, while the traditional structured charts and PRO scale were used for evaluation; in the fifth step, the efficacy evaluations in the three chart formats were compared. The data mining method was used to test the validity reliability of the medical record entries and explore the best efficacy evaluation method. To assess whether the physician-patient record can better reflect the efficacy as the latest efficacy evaluation scheme.