应对未分化疾病:从过度诊断走向医患共同决策  

Coping with Undifferentiated Diseases:from Over-diagnosis to Shared Decision Making

作　　者：叶康丽 徐志杰 杜亚平[3] 任菁菁[1] YE Kangli;XU Zhijie;DU Yaping;REN Jingjing(Department of General Practice,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China;Department of General Practice,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310016,China;Institute of Social Medicine and General Medicine,Zhejiang University,Hangzhou 310058,China)

机构地区：[1]浙江大学医学院附属第一医院全科医疗科,浙江省杭州市310003 [2]浙江大学医学院附属邵逸夫医院全科医学科,浙江省杭州市310016 [3]浙江大学社会医学与全科医学研究所,浙江省杭州市310058

出　　处：《中国全科医学》2020年第36期4541-4547,共7页Chinese General Practice

摘　　要：未分化疾病指医学上无法解释的躯体症状或疾病尚处于早期而未能明确归属于某一系统的疾病,但诊治这类疾病常需消耗过量医疗资源并带来更多的医疗和社会问题。本文通过归纳未分化疾病的特点,指出了未分化疾病的过度诊断问题,并就造成未分化疾病过度诊断的主要原因结合患者、医生、技术、行业四个因素进行了深入分析,认为医患共同决策是解决这一问题的有效途径。此外,临床医生提供专业建议,充分考虑患者诉求并建立契约式诊疗关系是实践未分化疾病医患共同决策的有效方法。Undifferentiated disease is defined as medically unexplained physical symptoms or the disease which is still in the early stage and not clearly attributed to a specific system.In the diagnosis and treatment of such diseases,excessive medical resources are often consumed,resulting in more medical and social problems.This article summarizes the characteristics and overdiagnosis of undifferentiated diseases,then deeply analyzes four major factors(of patient-,physician-,medical examination techniques-and medical industry-related)associated with over-diagnosis,and proposes that shared decision making is an effective way to solve these over-diagnosis problems.In addition,to achieve effective shared decision making for intervening such diseases,clinicians should provide patients with professional advice,and deliver interventions based on fully considering the patient’s demands as well as develop a contractual mode of physician-patient relationship.

关 键 词：体征和症状 躯体型障碍 未分化疾病 医学无法解释的躯体症状 诊断 决策 争鸣 

分 类 号：R441[医药卫生—诊断学] R749.2[医药卫生—临床医学]