Krummel S, Kathol R G
Gen Hosp Psychiatry. 1987 Jul;9(4):275-9. doi: 10.1016/0163-8343(87)90083-1.
Physical illness often initially manifests as a disturbance in thought, behavior, or mood; thus an important aspect of the psychiatric evaluation is differentiating organic disease from "functional" psychiatric disorders. A group of clinically oriented psychiatrists were surveyed about their attitudes and practices regarding medical evaluation in psychiatric patients. Thirty-seven percent of those surveyed performed physical examinations in 60%-100% of their inpatients whereas only 5% performed such examinations on outpatients. Of the 123 respondents, 63 did not perform physical examinations on any of their patients. Twenty-four percent of those who did not perform physicals also did not utilize internists or family practitioners to exclude the possibility of organic disease as a complicating factor in the psychiatric presentation. Those who considered themselves "biologically oriented" were twice as likely to include a physical examination in their inpatient evaluation as those who described themselves as "eclectic" psychiatrists; however, 30% still did no physical examinations in their practice. These findings suggest that though the ability to identify organic illness as a cause for psychiatric symptoms is considered important, psychiatrists often do not utilize the physical examination as a technique in uncovering physical disease.
身体疾病最初常常表现为思维、行为或情绪的紊乱；因此，精神病学评估的一个重要方面是区分器质性疾病和“功能性”精神障碍。一组以临床为导向的精神科医生接受了关于他们对精神病患者进行医学评估的态度和做法的调查。37% 的受访者对60% - 100% 的住院患者进行了体格检查，而只有5% 的人对门诊患者进行了此类检查。在123名受访者中，63人没有对任何患者进行体格检查。在那些没有进行体格检查的人中，24% 的人也没有利用内科医生或家庭医生来排除器质性疾病作为精神症状复杂因素的可能性。那些认为自己“以生物学为导向”的人在住院患者评估中进行体格检查的可能性是那些将自己描述为“折衷主义”精神科医生的两倍；然而，仍有30% 的人在实践中没有进行体格检查。这些发现表明，尽管识别器质性疾病作为精神症状病因的能力被认为很重要，但精神科医生通常不会将体格检查作为发现身体疾病的一项技术。
