Knox J D
Baillieres Clin Rheumatol. 1987 Dec;1(3):601-22. doi: 10.1016/s0950-3579(87)80047-x.
Patients with rheumatic complaints are the subject of some 10% of the general practitioner's work. Approximately half of this work is related to the hitherto relatively neglected group of varied soft-tissue conditions, most of which are self-limiting and of a minor nature. Against a background of such diagnostic 'noise', the general practitioner has to remain alert for the fainter 'signal' of serious disease--rheumatic and non-rheumatic--at an early stage. Continuity of care calls on special qualities, behaviours and abilities in the doctor to boost and maintain morale, to coordinate management and to participate in team care. In addition to more traditional therapeutic measures, including analgesics, NSAIDs, disease-modifying drugs and physiotherapy, joint replacement is seen as a significant contribution. There is room for improvement in the structure process and outcomes of delivery of care as it may relate to rheumatic diseases. A simple illustration, based on a general practice audit of gout, is suggested as a possible model by which quality of care could be enhanced at the level of individual patients. While there is not a great deal of scope afforded to the general practitioner in the exercise of primary prevention of the rheumatic diseases, early diagnosis and timely support for carers of patients suffering from chronic rheumatic diseases are areas worth attention. Promotion of self-help is seen as a worthwhile activity in humanitarian and economic terms, though it calls for an appropriate balance to be struck.
患有风湿性疾病的患者约占全科医生工作量的10%。这项工作中约有一半与迄今相对被忽视的各种软组织疾病有关，其中大多数是自限性的，病情较轻。在这种诊断“噪音”的背景下，全科医生必须在早期阶段对严重疾病（风湿性和非风湿性）较微弱的“信号”保持警惕。持续护理需要医生具备特殊的品质、行为和能力，以提升和维持患者的士气，协调管理并参与团队护理。除了更传统的治疗措施，包括镇痛药、非甾体抗炎药、改善病情的药物和物理治疗外，关节置换也被视为一项重要贡献。在与风湿性疾病相关的护理提供的结构、过程和结果方面仍有改进空间。基于对痛风的全科医疗审计给出了一个简单示例，作为在个体患者层面提高护理质量的可能模式。虽然全科医生在风湿性疾病一级预防方面的空间不大，但早期诊断以及对慢性风湿性疾病患者护理人员的及时支持是值得关注的领域。从人道主义和经济角度来看，促进自助被视为一项有价值的活动，尽管这需要把握适当的平衡。
