从一例全身肌肉跳动患者谈全科医生4P问诊模式下的全人照顾

4P Model-based Consultation Pattern in Whole-person Care by the General Practitioner:Analysis of One Case of Generalized Muscle Beating

全科医生在临床中经常碰到难以解释的症状(MUS)患者,给医生带来诊疗挑战。本文报道1例因"全身肌肉不自主跳动2个月"于2019-07-13就诊于香港大学深圳医院全科门诊的年轻男性患者,通过其就诊及治疗过程,介绍全科医生如何系统地运用生物-心理-社会模型,从症状的易患因素、诱发因素、维持因素及保护因素4个层面(4P模型),采集病史,寻找线索,收集证据来解释患者的症状及让患者明白自己的问题,进行症状管理,改善患者预后,体现全科医生全人照顾的理念。

In clinical practice,general practitioners frequently encounter patients with medically unexplained symptoms(MUS),which evoke a great challenge for both diagnosis and management.In this paper,we presented a case of generalized involuntary muscle beating over a duration of 2 months admitted to Department of Family Medicine,the University of Hong Kong-Shenzhen Hospital on July 13,2019.The diagnostic and therapeutic process of this case demonstrated routine application of biopsychosocial model in primary care,and a systematic approach incorporating the 4P model(namely,predisposing,precipitating,perpetuating and protective factors)to history taking,finding the clues and collecting the evidence that helps to explain the symptoms to the patient in an assuring way,facilitate active management,improve clinical outcome,and ultimately deliver whole-person care.