McDowell I
Department of Epidemiology and Community Medicine, University of Ottawa.
CMAJ. 1987 Dec 15;137(12):1095-100.
The symptoms that a patient presents to the doctor are often not the underlying concern that prompted the consultation. The success of consultations involving a hidden diagnosis depends on how well the patient can express his or her concerns to the doctor and on how skilfully the doctor can encourage this. This study tested the feasibility and acceptability of having patients complete a brief health index questionnaire designed to help them describe their underlying concerns to the doctor. In two family medicine centres 996 patients were asked to complete a questionnaire while waiting to see the doctor; 724 (73%) did so. An evaluation of their responses showed the method to be acceptable to most. The doctors judged that it added valuable information in 41% of all consultations and in 73% of consultations in which the patient presented with psychologic complaints. There was, nevertheless, considerable variation among the physicians in their acceptance of the approach. This variability is discussed in the light of alternative models of how, in practical terms, to treat the psychosocial dimensions of a patient's complaint.
患者向医生呈现的症状往往并非促使其前来咨询的根本问题。涉及隐匿性诊断的咨询能否成功，取决于患者向医生表达自身担忧的能力，以及医生鼓励患者表达担忧的技巧。本研究测试了让患者填写一份简短健康指数问卷的可行性和可接受性，该问卷旨在帮助患者向医生描述其根本担忧。在两家家庭医疗中心，996名患者在候诊时被要求填写问卷，724名（73%）患者照做了。对他们回答的评估表明，大多数人认为该方法是可接受的。医生判断，在所有咨询中，该问卷在41%的咨询中提供了有价值的信息，在患者提出心理问题的咨询中，这一比例为73%。然而，医生们对这种方法的接受程度存在很大差异。根据在实际中如何处理患者诉求的心理社会层面的替代模型，对这种变异性进行了讨论。
