全科医疗会诊：保持积极态度有意义吗？
General practice consultations: is there any point in being positive?
作者信息
Thomas K B
出版信息
Br Med J (Clin Res Ed). 1987 May 9;294(6581):1200-2. doi: 10.1136/bmj.294.6581.1200.
Abstract
A group of 200 patients who presented in general practice with symptoms but no abnormal physical signs and in whom no definite diagnosis was made were randomly selected for one of four consultations: a consultation conducted in a "positive manner," with and without treatment, and a consultation conducted in a "non-positive manner," called a negative consultation, with and without treatment. Two weeks after consultation there was a significant difference in patient satisfaction between the positive and negative groups but not between the treated and untreated groups. Similarly, 64% of those receiving a positive consultation got better, compared with 39% of those who received a negative consultation (p = 0.001) and 53% of those treated got better compared with 50% of those not treated (p = 0.5).
摘要
一组200名患者，他们在全科医疗中表现出症状但无异常体征且未做出明确诊断，被随机分配到四种会诊之一：以“积极方式”进行的会诊，分为接受治疗和未接受治疗两种情况；以及以“非积极方式”进行的会诊，称为消极会诊，也分为接受治疗和未接受治疗两种情况。会诊两周后，积极组和消极组患者的满意度存在显著差异，但治疗组和未治疗组之间没有差异。同样，接受积极会诊的患者中有64%病情好转，而接受消极会诊的患者中这一比例为39%（p = 0.001），接受治疗的患者中有53%病情好转，未接受治疗的患者中这一比例为50%（p = 0.5）。
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本文引用的文献
1
The Problem of Defining the Extent of Morbidity in General Practice.全科医疗中界定发病程度范围的问题。
J Coll Gen Pract Res Newsl. 1959 May;2(2):119-139.
2
THE WORK OF THE GENERAL PRACTITIONER: AN ANALYTICAL SURVEY OF STUDIES OF GENERAL PRACTICE.全科医生的工作：对全科医疗研究的分析性调查
J Coll Gen Pract. 1963 Aug;6(3):408-35.
3
Patient satisfaction and the content of general practice consultations.患者满意度与全科医疗咨询的内容
J R Coll Gen Pract. 1983 Dec;33(257):769-71.
4
Can the clinical course of acute otitis media be modified by systemic decongestant or antihistamine treatment?全身用减充血剂或抗组胺药治疗能否改变急性中耳炎的临床病程？
Br Med J (Clin Res Ed). 1983 Sep 3;287(6393):654-6. doi: 10.1136/bmj.287.6393.654.
5
Temporarily dependent patient in general practice.全科医疗中的临时依赖患者。
Br Med J. 1974 Mar 30;1(5908):625-6. doi: 10.1136/bmj.1.5908.625.
6
Low back pain.腰痛
J R Coll Gen Pract. 1968 Feb;15(2):128-36.
7
From paternalism to patient autonomy. Can legislation stimulate change?从家长式医疗到患者自主。立法能推动变革吗？
Practitioner. 1985 Dec;229(1410):1087-9.
8
Randomised controlled trial of antibiotics in patients with cough and purulent sputum.咳嗽伴脓性痰患者使用抗生素的随机对照试验
Br Med J. 1976 Sep 4;2(6035):556-9. doi: 10.1136/bmj.2.6035.556.
9
The consultation and the therapeutic illusion.会诊与治疗错觉。
Br Med J. 1978 May 20;1(6123):1327-8. doi: 10.1136/bmj.1.6123.1327.
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