全科医学临床诊疗思维研究——白带异常

Clinical Diagnostic and Therapeutic Perspectives in Primary Care Practice:a Case Study of Abnormal Leucorrhea

本文报道全科医生接诊1例白带异常患者时,从全科医学视角出发,采用约翰·莫塔教授的临床安全策略——临床5问思维法:(1)引起白带异常的常见疾病有哪些?(2)哪些重要疾病不能忽视?(3)是否有潜在的常被掩盖的疾病?(4)有哪些容易被遗漏的疾病?(5)是不是有什么话还没有说?结合病史、查体、辅助检查和RICE问诊,综合分析,确诊淋病和应激相关生理反应。本案例的启示:(1)全科医生在接诊伴有心理问题的患者时,在给予药物解决躯体问题的同时,还要站在患者的角度,聆听患者的心声,了解患者的烦恼,关注患者的情感,让患者感受到来自医生的支持;(2)RICE问诊像听诊器一样,可以全面了解患者的就医背景,以生物-心理-社会的医学模式确认现存问题,体现全人照顾的全科医疗特点。

We reported the diagnostic process of a case of abnormal leucorrhea using John Murtagh’s safe diagnostic strategy-a method of five clinical questions was adopted:(1)What most common diseases can cause abnormal leucorrhea ?(2)What serious problems can not be ignored ?(3)Could the patient have an underlying disease ?(4)What conditions are easily missed ?(5)Is the patient trying to say something ? The patient was diagnosed with gonorrhea with physiological response to stress based on a comprehensive analysis of medical history,physical examination,auxiliary examination and consultation with the safe diagnostic strategy as well as RICE(Reason-Idea-Concern-Expectation)skills.The merits derived from this diagnosis are as follows:(1)When encountering a abnormal leucorrhea patient with psychological problems,besides giving medication for somatic problems,the general practitioner should attentively listen to the patienttrategy as well as RICE(Reason-Idea-Concern-Expectation)skills. The merits derived from this diagnosis are as c support by the patient.(2)Just like the auscultation with a stethoscope,by the consultation using RICE skills,the causes of healthcare seeking can be acquired,and the patient’s current health problems can be identified by using the bio-psycho-social approach,showing the features of whole-person care.