Wensaas Knut-Arne, Langeland Nina, Rørtveit Guri
Seksjon for allmennmedisin, Institutt for samfunnsmedisinske fag, Universitetet i Bergen, 5020 Bergen.
Tidsskr Nor Laegeforen. 2007 Sep 6;127(17):2222-5.
There was a large community outbreak of giardiasis in Bergen in the autumn of 2004 that was acknowledged about two months after the first patients became ill. The aim of this article is to describe the diagnostic approach of clinicians faced with an unexpected problem, and how they reacted when communicable disease was detected.
A focus group interview was conducted with six of the 18 doctors who had requested stool examinations from patients in October 2004 with the aim of detecting parasites. This was after the first patients became ill, but before the outbreak was widely recognized.
Discussions among doctors were instrumental, both in reaching the correct diagnosis, and in acknowledging a possible outbreak in the community. There was no uniform approach to reaching the diagnosis, but rather a common unravelling of a mutual problem. Doctors contacted or tried to make contact with public health authorities when at least one case was confirmed and this case was linked to other patients with diarrhoeal disease.
Clinicians need meeting places where they can discuss problems that arise in everyday practice. Public health authorities and clinicians need better procedures for warning, reception and follow-up when outbreaks of communicable diseases are suspected.
2004年秋季,卑尔根市发生了大规模贾第虫病社区疫情,在首批患者发病约两个月后才得到确认。本文旨在描述临床医生面对突发问题时的诊断方法,以及在检测到传染病时他们的反应。
对2004年10月要求对患者进行粪便检查以检测寄生虫的18名医生中的6名进行了焦点小组访谈。这是在首批患者发病之后,但在疫情被广泛认识之前。
医生之间的讨论有助于做出正确诊断,并认识到社区可能爆发疫情。对于做出诊断没有统一的方法,而是共同解决一个共同的问题。当至少确诊一例病例且该病例与其他腹泻病患者有关联时,医生会联系或试图联系公共卫生当局。
临床医生需要有场所来讨论日常实践中出现的问题。当怀疑发生传染病疫情时,公共卫生当局和临床医生需要更好的预警、接收和后续跟进程序。