Charlson M E, Cohen R P, Sears C L
Am J Med. 1983 Jul;75(1):121-8. doi: 10.1016/0002-9343(83)91175-0.
The 564 consultations performed by a general medicine consultation service during its first year were analyzed in order to provide a concrete definition of this new academic domain. Of the consultations, 52 percent were for patients on the surgical service. Among these patients, the most common reason for consultation was the preoperative management of chronic illness, specifically, hypertension, diabetes, and angina; 47 percent of such patients had two or more chronic illnesses. The service recommended cancellation of planned surgery in 2 percent and postponement in 9 percent of the 210 patients seen preoperatively. Patients on the psychiatric service accounted for 47 percent of the consultations. In this group, diagnostic issues were the most common reasons for consultation, that is, abdominal pain, dementia, and the suspicion of thyroid disease. Only 12 percent of the patients were seen for prognostic reasons, usually related to the planned use of electroconvulsive therapy or tricyclic antidepressants. The service was evaluated by the referring physicians who rated the service favorably on its "mechanics," as well as on its qualitative performance. However, complaints of triviality were voiced when the average length of the list of recommendations seemed disproportionate to the complexity of the problems. The service was also evaluated by the residents who had provided consultations. From their perspective, the service was more successful in teaching the "art" of consultation than the "science." This experience provides an operational definition of the work facing a general medicine consultation service as well as data useful in focusing future educational programs and research efforts.
为了给这个新的学术领域提供一个具体的定义，我们分析了普通内科会诊服务在其第一年进行的564次会诊。在这些会诊中，52%是针对外科病房的患者。在这些患者中，会诊的最常见原因是慢性病的术前管理，具体而言，是高血压、糖尿病和心绞痛；47%的此类患者患有两种或更多种慢性病。该服务建议在210例术前就诊患者中，2%的患者取消计划手术，9%的患者推迟手术。精神科病房的患者占会诊的47%。在这组患者中，诊断问题是会诊的最常见原因，即腹痛、痴呆和甲状腺疾病的疑似病例。只有12%的患者是出于预后原因就诊，通常与计划使用电休克疗法或三环类抗抑郁药有关。转诊医生对该服务进行了评估，他们对该服务的“运作方式”以及定性表现给予了好评。然而，当建议清单的平均长度似乎与问题的复杂性不成比例时，有人抱怨其过于琐碎。参与会诊的住院医师也对该服务进行了评估。从他们的角度来看，该服务在传授会诊“艺术”方面比传授“科学”更成功。这一经验为普通内科会诊服务所面临的工作提供了一个操作性定义，以及有助于确定未来教育项目和研究工作重点的数据。
