Harvard Medical School Center for Primary Care, 635 Huntington Ave, Boston, MA, 02115, USA.
Healthcare Systems Engineering Institute, Northeastern University, Boston, USA.
J Gen Intern Med. 2023 Mar;38(4):1054-1058. doi: 10.1007/s11606-022-07886-7. Epub 2022 Nov 22.
Reliable systems that track the continuation, progression, or resolution of a patient's symptoms over time are essential for reliable diagnosis and ensuring that patients harboring more worrisome diagnoses are safely followed up. Given their first-contact role and increasing stresses on busy primary care clinicians and practices, new processes that make these tasks easier rather than creating more work for busy clinicians are especially needed.Some symptoms are sufficiently worrisome that they demand an urgent diagnosis and treatment while others result in a differential that can be more safely explored over time, or less differentiated and worrisome that they are best managed with the "test of time" to see if they resolve, worsen, or evolve into symptoms that are more worrisome. Regardless, it is essential that clinicians are able to reliably track symptoms over time, yet this capacity is rarely available or explicit. Working with systems engineers, we are developing prototypes for such systems and are working on their implementation and evaluation. In this commentary, we describe approaches to this essential, but underappreciated, problem in primary care.
可靠的系统对于可靠的诊断和确保患有更令人担忧的诊断的患者得到安全随访至关重要，这些系统可以跟踪患者的症状在时间上的延续、进展或解决情况。鉴于初级保健临床医生和实践的首要接触角色以及日益增加的压力，需要新的流程来简化这些任务，而不是为忙碌的临床医生增加更多的工作。一些症状非常令人担忧，需要紧急诊断和治疗，而另一些症状则导致差异，可以随着时间的推移更安全地探索，或者差异较小且不那么令人担忧，最好通过“时间考验”来管理，看看它们是否会缓解、恶化或发展成更令人担忧的症状。无论如何，临床医生必须能够可靠地跟踪症状随时间的变化，但这种能力很少或根本没有明确。我们与系统工程师合作，正在为这些系统开发原型，并致力于它们的实施和评估。在这篇评论中，我们描述了在初级保健中解决这一基本但未被充分认识的问题的方法。
