Spitzer W O, Brown B P
Ann Intern Med. 1975 Aug;83(2):257-63. doi: 10.7326/0003-4819-83-2-257.
The periodic health examination in its application as a screening procedure in asymptomatic, ostensibly healthy persons is explored with a focus on the following issues: (a) the impact on health, (b) the content of a beneficial health examination, and (c) the effect of the examination on the physician-patient relation. The application discussed is distinct from use of the examination as a tool for diagnosis, prognosis, or therapeutic planning for patients with a specific illness. The discussion also shows a relatively recent change in the goal for the clinical assessment. There has been a shift in emphasis from establishing a diagnosis as the main outcome event of the periodic "checkup" to the identification of an intervention of value to the patient. Evidence from various studies that throw some light on related questions is considered. Special ethical issues surrounding the unsolicited medical assessment are identified. Finally, some ground rules for decisions about the periodic health examination are proposed.
探讨了定期健康检查作为一种针对无症状、表面健康人群的筛查程序的应用情况，重点关注以下问题：（a）对健康的影响；（b）有益健康检查的内容；（c）检查对医患关系的影响。所讨论的应用与将检查用作特定疾病患者的诊断、预后或治疗规划工具不同。讨论还显示了临床评估目标的一个相对较新的变化。重点已从将确立诊断作为定期“体检”的主要结果事件，转向识别对患者有价值的干预措施。考虑了来自各项研究的、对相关问题有所启示的证据。确定了围绕主动式医学评估的特殊伦理问题。最后，提出了关于定期健康检查决策的一些基本规则。
