未分化疾病的全科诊疗思维与策略

General practice thinking and strategy of diagnosis and treatment of undifferentiated diseases

随着医疗保障体系的完善和居民健康意识的增强,因未分化疾病或亚健康问题就诊的患者日渐增多。这类问题不同于传统意义上的慢性病,诊断和治疗上缺乏规范和指南,全科医生在处理上存在随意性,患者满意度不高,医疗服务质量难以评价。间接导致过度检查和转诊,不合理消耗医疗资源,甚至影响分级诊疗的顺利实施。本文在参考国内外主要相关研究成果的基础上,进行综述分析和经验分享,并举例说明一些常见症状的全科诊疗思维和对完善全科医疗制度的意义。通过分析亚健康和各种功能性症状与社会心理因素的关系,以及医患双方不同的认知特点,丰富了未分化疾病的内涵,并进一步阐述有效处理未分化疾病,对加强基层医疗的重要性。首先,从未分化疾病的病情特点出发,探讨了其不同于普通疾病的诊断思路:通过识别预警症状进行疾病风险排查,并结合与症状相关的社会心理线索的查找来支持判断。在处理上则采用症状改善、生活方式管理和风险监控等综合措施,并通过有针对性的解释和咨询,推动医患共同决策。其次,通过建立未分化疾病患者的就诊行为模型,说明全科医生在处理这类疾病所处的核心地位,及其守门人角色对医疗改革的重要意义。最后,建议全科医生应重视该类疾病的研究和学习,特别是需要综合运用临床医学、预防医学、社会行为学等多学科的理念与方法,提升以患者为中心、需求为导向的医疗服务能力。

With the improvement of the medical care system and the enhancement of residents’ health awareness,the number of patients seeking treatment for undifferentiated diseases or sub-health problems is increasing.This type of problem is different from chronic diseases in the traditional sense.Norms and guidelines in diagnosis and treatment are lacking.General practitioners are arbitrary in handling,and the patients’ satisfaction is low.In addition,the quality of medical services is difficult to evaluate,thereby leading to excessive examination and referral,unreasonable consumption of medical resources and an important factor affecting the smooth implementation of graded diagnosis and treatment.Based on relevant research results at home and abroad,this article conducted a review analysis and experience sharing and provided examples of common symptoms of general practice thinking and the significance of improving the general practice system.Analysing the relationship between sub-health and various functional symptoms and psychosocial factors,as well as the different cognitive characteristics of doctors and patients,enriches the connotation of undifferentiated diseases and elaborates the importance of effective treatment of undifferentiated diseases for strengthening primary medical care.Firstly,starting from the characteristics of undifferentiated diseases,the diagnosis ideas that are different from ordinary diseases are discussed: disease risk investigation is conducted by identifying early warning symptoms and combined with the search for symptom-related psychosocial clues to support judgment.With regard to treatment,comprehensive measures such as symptom improvement,lifestyle management and risk monitoring are adopted,and targeted explanations and consultations are used to promote joint decision-making between doctors and patients.Secondly,by establishing a model of the medical treatment behaviour amongst patients with undifferentiated diseases,we illustrate the core position of general practitioners in dealing with such diseases,and the importance of their role as gatekeepers to medical reform.Finally,general practitioners should pay attention to the research and learning of such diseases.In particular,the concepts and methods of clinical medicine,preventive medicine,social behaviour and other disciplines must be comprehensively applied to enhance patient-centred and demand-oriented medical service capabilities.