甲状腺癌、乳腺癌临床指南与实践碰撞的哲学解析

A Philosophical Analysis of the Conflicts between Thyroid Cancer and Breast Cancer Clinical Guidelines and Practice

通过对乳腺癌及甲状腺癌相关领域共识、指南或规范与临床实践相关碰撞进行总结,探索并思考在日常临床工作中如何合理运用及遵循指南,包括乳腺癌筛查、甲状腺微小乳头状癌诊疗等问题,以期在碰撞中求共识,明确其优化之道。在临床实践工作中,建议以循证医学为理论依据,共识、指南和规范为指引方向,结合医者临床经验及患者意愿,制定出最适合患者的诊疗康复方案为指导思想。强调遵循指南规范,却又不拘泥指南规范,诊疗康复方案的制定要顾及人文关怀,达到医学理论与临床实践的辩证统一。

This paper summarized the relevant conflicts between the consensus,guidelines or standards and the clinical practice in the field of breast and thyroid cancer.It also explored how to properly use and follow guidelines in daily clinical work to deal with the screening of breast cancer,diagnosis and treatment of papillary thyroid microcarcinoma,etc.,so as to seek consensus in the conflicts and to clarify an optimization method.In clinical practice,it is suggested to follow the principles of evidence-based medicine,guided by consensus,guidelines and standards,integrated with doctors'clinical experience and patients'preferences,to develop the most sound treatment and rehabilitation plan for patients.It is emphasized to adhere to guidelines,but not to restrict to guidelines.The formulation of diagnosis,treatment and rehabilitation plan should take into account the humanistic care and achieve the dialectical unity of both medical theory and clinical practice.