Smirnova Alina, Bell Stephanie H, Tracy C Shawn, Upshur Ross E G
Department of Family and Community Medicine, Primary Care Research Unit, Sunnybrook Health Sciences Centre, Toronto, Canada.
BMJ Case Rep. 2011 Sep 13;2011:bcr0520114247. doi: 10.1136/bcr.05.2011.4247.
This report presents the case of a 90-year-old female with a 54-year history of dizziness, which has been exhaustively investigated. Over the years, the patient made 59 visits to her family doctor and 18 visits to various specialists, as well as emergency department visits and hospitalisations. In detailing the exhaustive investigations and referrals that the patient has undergone over many years (with inconclusive results), this case illustrates the myriad challenges in diagnosing and treating chronic dizziness in the older. The authors suggest that, in complex cases characterised by multimorbidity and polypharmacy, a function-oriented approach is indicated. In place of the conventional 'diagnose and treat' model, a functional approach to ongoing care emphasises the symptom management, improvement of function and quality of life. To optimise patient outcomes, an interprofessional team approach is preferred.
本报告介绍了一位90岁女性的病例,她有54年的头晕病史,已经接受了详尽的检查。多年来,该患者曾59次就诊于家庭医生,18次就诊于各科专科医生,还去过急诊科并住院治疗。在详细描述该患者多年来所接受的详尽检查和转诊情况(结果均不明确)时,本病例说明了老年慢性头晕诊断和治疗中存在的众多挑战。作者建议,在以多种疾病并存和多种药物治疗为特征的复杂病例中,应采用以功能为导向的方法。持续护理的功能方法取代了传统的“诊断和治疗”模式,强调症状管理、功能改善和生活质量。为了优化患者的治疗效果,多专业团队方法更为可取。