Faculty of Life and Health Sciences, University of Ulster, Coleraine, Northern Ireland.
Fam Pract. 2012 Jun;29(3):272-82. doi: 10.1093/fampra/cmr101. Epub 2012 Feb 3.
This is a review of the literature on the role of symptoms in family practice, with a focus on the diagnostic approach in family medicine (FM). We found two, contrasting, approaches to reducing symptoms presented by patients in primary care, especially those which do not immediately allow the definition of a disease-label diagnosis. Years of research into 'medically unexplained symptoms' (MUS) has failed to support an international body of knowledge and cannot convincingly support the philosophy on which the reduction itself is based. This review supports the approach of researching reasons for encounter as they present to the family doctor, without artificial mind-body metaphors. The medical model is shown to be an incomplete reduction of FM, and the concept of MUS fails to improve this situation. A new model based on a substantial paradigm shift is needed. That model should be the biopsychosocial model, reflected in the philosophical concepts of the International Classification of Primary Care and the value of the patient's 'reason for encounter'. There is more to life than medicine may diagnose, and FM should strive to move closer to the lives of our patients than the medical model alone could allow.
这是一篇关于症状在家庭医学中的作用的文献综述，重点介绍了家庭医学中的诊断方法。我们发现了两种截然不同的方法来减轻初级保健中患者出现的症状，尤其是那些不能立即确定疾病标签诊断的症状。多年来对“无法解释的医学症状”（MUS）的研究未能支持国际知识体系，也不能令人信服地支持减少症状本身所依据的理念。这篇综述支持了在家庭医生面前研究出现的就诊原因的方法，而不使用人为的身心隐喻。医学模型被证明是 FM 的不完全简化，而 MUS 的概念并不能改善这种情况。需要基于实质性范式转变的新模型。该模型应该是生物心理社会模型，反映在初级保健国际分类的哲学概念和患者“就诊原因”的价值中。生活不仅仅是医学可以诊断的，家庭医学应该努力更接近患者的生活，而不仅仅是医学模型本身所能允许的。
