Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
J Gen Intern Med. 2009 Jun;24(6):739-41. doi: 10.1007/s11606-009-0980-2. Epub 2009 Apr 24.
BACKGROUND/OBJECTIVE: "By-the-way" syndrome, a new problem raised by the patient at an encounter's closure, is common, but little is known about how physicians respond when it occurs. We analyzed the content of the syndrome, predictors of its appearance, and the physician response.
DESIGN/PARTICIPANTS: Cross-sectional study of 92 videotaped encounters in an academic primary care clinic.
The syndrome occurred in 39.1% of observed encounters. Its major content was bio-psychosocial (39%), psychosocial (36%), or biomedical (25%), whereas physician responses were mostly biomedical (44%). The physician response was concordant with the patient's question in 61% of encounters if the content of the question was psychosocial, 21% if bio-psychosocial, and 78% if biomedical; 32% of physicians solicited the patient's agenda two times or more in the group without, versus 11% in the group with, the syndrome (P = 0.02). In 22% of the encounters, physicians did not give any answer to the patient's question, particularly (38.5%) if it was of psychosocial content.
"By-the-way" syndrome is mainly bio-psychosocial or psychosocial in content, whereas the physician response is usually biomedical. Asking about the patient's agenda twice or more during the office visit might decrease the appearance of this syndrome.
背景/目的：“顺便说一句”综合征是患者在就诊结束时提出的一个新问题，较为常见，但目前对于医生在遇到这种情况时的反应知之甚少。我们分析了该综合征的内容、出现的预测因素以及医生的反应。
设计/参与者：横断面研究，对学术初级保健诊所的 92 次视频就诊进行分析。
观察到的就诊中有 39.1%出现了该综合征。其主要内容是生物心理社会（39%）、心理社会（36%）或生物医学（25%），而医生的反应主要是生物医学（44%）。如果问题的内容是心理社会问题，医生的反应与患者问题的相关性为 61%；如果是生物心理社会问题，相关性为 21%；如果是生物医学问题，相关性为 78%；在没有该综合征的组中，有 32%的医生在两次或更多次询问患者的就诊意愿，而在有该综合征的组中，这一比例为 11%（P=0.02）。在 22%的就诊中，医生没有回答患者的问题，尤其是心理社会内容的问题（38.5%）。
“顺便说一句”综合征的主要内容是生物心理社会或心理社会方面的，而医生的反应通常是生物医学方面的。在就诊过程中两次或多次询问患者的就诊意愿可能会减少该综合征的出现。
