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普通内科医生对C反应蛋白测量的认知:关于诊断价值、临床困境及职业成长的定性研究

Perceptions of C-reactive Protein Measurement Among General Physicians: A Qualitative Study on Diagnostic Value, Clinical Dilemmas, and Professional Growth.

作者信息

Ohta Ryuichi, Yakabe Toshihiro, Sano Chiaki

机构信息

Community Care, Unnan City Hospital, Unnan, JPN.

Family Medicine, Unnan City Hospital, Unnan, JPN.

出版信息

Cureus. 2024 Jul 2;16(7):e63695. doi: 10.7759/cureus.63695. eCollection 2024 Jul.

Abstract

Introduction C-reactive protein (CRP) is a widely used laboratory test for assessing infections, inflammatory diseases, and malignancies, playing a critical role in clinical diagnosis and management. Despite its utility, CRP measurement practices vary among physicians, often influenced by training and clinical experience. This study explores general physicians' perceptions of CRP measurement in clinical practice, focusing on its diagnostic value, associated dilemmas, and impact on clinical growth and decision-making. Methods This qualitative study employed thematic analysis to examine the perceptions of general physicians at Unnan City Hospital, Unnan, Japan regarding CRP measurement. Sixteen general physicians were selected through purposive sampling and participated in one-on-one semi-structured interviews. The interviews were conducted in Japanese, recorded, transcribed verbatim, and analyzed inductively to identify themes. The analysis involved iterative coding and extensive discussion among the research team to ensure the reliability and validity of the findings. Results Three main themes emerged from the analysis: the usefulness of CRP for diagnosis and collaboration, dilemmas associated with CRP usage, and clinical growth through reconsideration of CRP's importance. Physicians highlighted CRP's value in distinguishing inflammatory from non-inflammatory diseases, predicting clinical courses, and facilitating communication with specialists. However, dilemmas arose from discrepancies between CRP levels and clinical symptoms, the influence of various non-specific factors, and habitual testing driven by training, leading to unnecessary tests and diminished clinical skills. Participants recognized the need to view CRP as one of many diagnostic tools, cultivate a habit of questioning its necessity, and reflect on its use to enhance clinical reasoning and professional growth. Conclusions CRP measurement is a valuable diagnostic tool, but effective use requires a balanced and critical approach. Discrepancies between CRP levels and clinical symptoms can lead to over-reliance on laboratory results and unnecessary testing. General physicians should integrate CRP within a broader diagnostic framework, combining it with patient history, physical examination, and other tests. Reflecting on the necessity and implications of CRP measurements can improve clinical reasoning and decision-making, ultimately enhancing patient care and resource management. Future research should explore similar perceptions in diverse healthcare settings and develop strategies to optimize CRP use in clinical practice.

摘要

引言

C反应蛋白(CRP)是一种广泛用于评估感染、炎症性疾病和恶性肿瘤的实验室检查,在临床诊断和管理中发挥着关键作用。尽管其具有实用性,但医生之间的CRP测量方法存在差异,这通常受到培训和临床经验的影响。本研究探讨了全科医生在临床实践中对CRP测量的看法,重点关注其诊断价值、相关困境以及对临床成长和决策的影响。

方法

本定性研究采用主题分析法,以考察日本云南市立医院的全科医生对CRP测量的看法。通过目的抽样选取了16名全科医生,并参与了一对一的半结构化访谈。访谈以日语进行,录音后逐字转录,并进行归纳分析以确定主题。分析过程包括反复编码和研究团队之间的广泛讨论,以确保研究结果的可靠性和有效性。

结果

分析得出三个主要主题

CRP在诊断和协作方面的有用性、与CRP使用相关的困境以及通过重新审视CRP的重要性实现临床成长。医生们强调了CRP在区分炎症性疾病和非炎症性疾病、预测临床病程以及促进与专科医生沟通方面的价值。然而,困境源于CRP水平与临床症状之间的差异、各种非特异性因素的影响以及培训导致的习惯性检测,从而导致不必要的检查和临床技能的下降。参与者认识到需要将CRP视为众多诊断工具之一,养成质疑其必要性的习惯,并反思其使用以增强临床推理和专业成长。

结论

CRP测量是一种有价值的诊断工具,但有效使用需要一种平衡且批判性的方法。CRP水平与临床症状之间的差异可能导致对实验室结果的过度依赖和不必要的检查。全科医生应将CRP纳入更广泛的诊断框架,将其与患者病史、体格检查和其他检查相结合。反思CRP测量的必要性和影响可以改善临床推理和决策,最终提高患者护理质量和资源管理水平。未来的研究应探索不同医疗环境中的类似看法,并制定优化CRP在临床实践中使用的策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7cfe/11293839/08d62e299c06/cureus-0016-00000063695-i01.jpg

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