基于“生物-心理-社会”模式的甲状腺癌术后患者一例报道及全科诊疗思路  

Postoperative Diagnosis and Treatment of One Case of Thyroid Cancer:a Biopsychosocial Perspective

作　　者：谢兴伟 刘春梅 刘书仙 申航 张道龙 钟丽萍 孔令伟 XIE Xingwei;LIU Chunmei;LIU Shuxian;SHEN Hang;ZHANG Daolong;ZHONG Liping;KONG Lingwei(Beijing Jiaotong University Community Health Center,Beijing 100044,China;Beijing Information Science&Technology University,Beijing 100192,China;Department of Psychiatry,University of Illinois at Chicago,Chicago Illinois 60612,USA;Franciscan Alliances 1225 E Coolspring,Suite 2D,Michigan City,Indiana 46360,USA)

机构地区：[1]北京交通大学社区卫生服务中心,北京市100044 [2]北京信息科技大学,北京市100192 [3]Department of Psychiatry,University of Illinois at Chicago,Chicago Illinois 60612 USA [4]Indiana,Franciscan Alliances 1225 E Coolspring,Suite 2D,Michigan City 46360 USA

出　　处：《中国全科医学》2020年第5期623-628,共6页Chinese General Practice

基　　金：首都发展科研专项项目（2018-3P-7045）

摘　　要：以患者为中心的医疗之家,通过健康团队的形式将各领域的专业人员集中在一起,整合生物、心理、社会的各方面来评估治疗患者,这是非常优化的全科医学模式,同时也对全科医生提出了巨大挑战。本文报道1例31岁女性患者,以"月经不规律13年,甲状腺癌术后6个月,想了解如何全面治疗"为主诉于2018-12-07就诊于北京交通大学社区卫生服务中心医疗之家,本例患者甲状腺癌术后,同时患有多囊卵巢综合征、2型糖尿病,性格上追求完美,自我要求高,有生育需求。从这个真实的患者身上,能看到全科医生的重要性。患者不仅需要生物层面对症治疗,还需要心理疏导,同时协调家庭、单位的资源。这是全科医生与专科医生的最大区别,全科医生以系统观看待患者,层层剖析复杂的病情,基于生物-心理-社会医学模式提出治疗方案。The patient-centered medical home(PCMH) is an optimized model used for delivering general care from biological,psychological and social perspectives by the healthcare team consisting of professionals in various fields.How to appropriately use this kind of biopsychosocial approach to treat patients is a great challenge to general practitioners(GPs).We reported a 31-year-old female patient who was admitted to the PCMH,Beijing Jiaotong University Community Health Center on December 7,2018,and was given treatment using a biopsychosocial approach.This case mainly complained of 13-year irregular menstruation,six months after thyroid cancer surgery,and requiring comprehensive treatment.Moreover,she was found with polycystic ovary syndrome,type 2 diabetes,temperaments of pursuing perfection and high self-esteem,and fertility needs.Instead of treating patients by some specialists only from the biological perspective,GPs should systematically and comprehensively analyze the patients’ complex conditions,and recognize that the patient needed biological treatment,psychological counseling,and support from her family and work unit,and then develop treatment regimen using a biopsychosocial approach.

关 键 词：甲状腺肿瘤 多囊卵巢综合征 全科医学 生物-心理-社会 

分 类 号：R736.1[医药卫生—肿瘤] R711.75[医药卫生—临床医学]