Murtagh安全诊断策略联合思维导图构建临床思维在全科教学门诊中的应用  

Application of Murtagh Safe Diagnostic Strategy Combined with Mind Mapping for Establishing Clinical Thinking in General Practice Teaching Clinic

作　　者：杨玲[1] 杜雪平[1] YANG Ling;DU Xueping(Yuetan Community Health Service Center,Fuxing Hospital,Capital Medical University,Xicheng District,Beijing 100045,China)

机构地区：[1]北京市西城区首都医科大学附属复兴医院月坛社区卫生服务中心,100045

出　　处：《中国全科医学》2025年第6期673-680,共8页Chinese General Practice

摘　　要：全科教学门诊是培养住院医师规范化培训(简称住培)全科医生临床思维、提升全科诊疗能力的重要培训方法。本文用1例以乏力为主要表现的患者为教学案例,介绍全科教学门诊中采用澳大利亚著名全科医学专家John Murtagh提出的Murtagh安全诊断策略启发住培全科医生对乏力进行诊断与鉴别诊断:(1)引起乏力的常见疾病有哪些?(2)哪些重要疾病是不能忽视的?(3)乏力有什么容易被遗漏的疾病?(4)是否存在潜在的容易被掩盖的疾病?(5)患者是否有话没有说?结合病史、体格检查和实验室检查结果初步诊断为抗中性粒细胞胞浆抗体相关性血管炎引起急进性肾小球肾炎可能性大,及时转诊,肾病理检查确诊乏力的病因为抗中性粒细胞胞浆抗体相关性肾小球肾炎,取得满意疗效。带教老师基于Murtagh安全诊断策略帮助住培全科医生构建乏力鉴别、分析的系统知识框架,从而提升住培全科医生的临床逻辑思维能力和解决临床实际问题的能力;以思维导图为辅助工具,将Murtagh安全诊断策略诊断与鉴别诊断思路可视化、形象化,优化教学效果。General practice teaching clinic is an important training method to develop clinical thinking and improve general practice diagnosis and treatment ability of general practice residents.In this paper,we used a patient with fatigue as the main manifestation as a teaching case to introduce the Murtagh safe diagnostic strategy proposed by John Murtagh,a famous Australian general medicine expert,to inspire the diagnosis and differential diagnosis of fatigue for the general practice residents in the general practice teaching clinic:(1)What are the common diseases that cause fatigue?(2)What are the important diseases that should not be ignored?(3)What are the easily missed diseases of fatigue?(4)Are there underlying easily masked diseases?(5)Is there something the patient is not saying?Combined with the history,physical examination and laboratory findings,a preliminary diagnosis of antineutrophil cytoplasmic antibody-associated vasculitis causing rapidly progressive glomerulonephritis is highly probable.The timely referral got nephropathology which confirms the etiology of the fatigue was antineutrophil cytoplasmic antibody-associated glomerulonephritis,and achieved satisfactory outcome.Based on the Murtagh safe diagnostic strategy,the instructor helped the general practice residents to construct a systematic knowledge framework for the identification and analysis of fatigue,so as to improve their clinical logical thinking ability and the ability to solve practical clinical problems.Using the mind mapping as an auxiliary tool,the diagnosis and differential diagnosis of the Murtagh safe diagnostic strategy were concretized and visualized,so as to optimize the teaching effect.

关 键 词：全科医学 Murtagh安全诊断策略 思维导图 全科临床思维 乏力 抗中性粒细胞胞浆抗体相关性肾小球肾炎 

分 类 号：R-05[医药卫生]