Goff Iain, Wise Elspeth Mary, Coady David, Walker David
Department of Rheumatology, Newcastle upon Tyne Hospitals Foundation Trust, Newcastle upon Tyne, UK.
Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
Clin Rheumatol. 2016 Feb;35(2):507-11. doi: 10.1007/s10067-014-2767-z. Epub 2014 Sep 6.
Musculoskeletal conditions are common in general practice, but clinicians express poor self confidence in dealing with them. Training in general practice relies on clinical exposure to a range of presentations in order to gain competence. It has been suggested that trainees are exposed to a different case mix from qualified general practices (GPs), due to seeing more minor illness and less chronic disease and that this may be responsible in part for their subsequent lack of confidence. The aims of this study were to analyse the case mix of musculoskeletal conditions encountered by general practice trainees and to compare this to the overall population consulting behaviour. This is a prospective observational study. Thirteen general practices in North East England were recruited. Musculoskeletal disorders encountered by 13 GP trainees (7 junior and 6 senior) were prospectively recorded using a handheld diary. Disorders were classified according to working diagnosis or body region if diagnosis was unclear. Musculoskeletal (MSK) disorders comprised 17 % of consultations, and the distribution of diagnoses of these was in proportion to epidemiological studies of MSK disorders in the UK as they present in primary care. Back pain was the most frequent label with 141 (29 %) consultations with a further 43 (9 %) for neck pain. Inflammatory arthritis accounted for the same number 43 (9 %). Individual joint problems were 115 (24 %) with knee being most common. A specific diagnosis was more likely to be applied when symptoms were more distal and less likely when axial. Trainees are exposed to the same spectrum of MSK disorders as are present in the population as a whole. Case mix does not appear to be a significant factor in low confidence levels in dealing with MSK disorders.
肌肉骨骼疾病在普通医疗实践中很常见，但临床医生在处理这些疾病时表现出信心不足。普通医疗实践培训依赖于临床接触一系列病例表现以获得能力。有人提出，由于实习医生看到的轻症更多、慢性病更少，他们接触到的病例组合与合格的全科医生（GP）不同，这可能部分导致了他们随后缺乏信心。本研究的目的是分析普通医疗实习医生遇到的肌肉骨骼疾病的病例组合，并将其与总体人群的就诊行为进行比较。这是一项前瞻性观察研究。招募了英格兰东北部的13家普通诊所。13名全科医生实习生（7名初级和6名高级）遇到的肌肉骨骼疾病使用手持日记进行前瞻性记录。如果诊断不明确，疾病根据工作诊断或身体部位进行分类。肌肉骨骼（MSK）疾病占会诊的17%，这些疾病的诊断分布与英国初级保健中MSK疾病的流行病学研究比例相符。背痛是最常见的诊断，有141例（29%）会诊，颈部疼痛另有43例（9%）。炎性关节炎的病例数相同，为43例（9%）。单个关节问题有115例（24%），其中膝关节最常见。当症状更靠近肢体远端时，更有可能做出具体诊断；当症状在轴向时，则可能性较小。实习医生接触到的MSK疾病谱与整个人口中的相同。病例组合似乎不是处理MSK疾病时信心水平低的一个重要因素。
