Bergh K D
Department of Family Practice and Community Health, University of Minnesota, Minneapolis, USA.
J Fam Pract. 1998 Feb;46(2):153-8.
Agreement between physician and patient on the nature of the patient's illness problem is an important goal in primary care consultations. Unfortunately, both patient and doctor are often uncertain about the cause of the problem. The patient's satisfaction with a visit may be correlated with his or her agreement with the physician's differential diagnosis.
Patients' diagnostic concerns elicited by interview just prior to and during 17 visits to family physicians for cough were compared with the doctors' differential diagnoses expressed during and after the visits using qualitative methods.
Patients expressed a mean of 6.5 possibilities, of which a mean of 2.8 were also among the doctors' differential diagnoses. While many concerns were related to widely recognized popular ideas about disease, some patients had idiosyncratic, unpredictable diagnostic concerns about serious illness based on experiences in their families. Concerns were often expressed very indirectly during the visits.
The physician's exploration of patients' uncertainty about the nature of their illnesses may help to elicit unexpected concerns that might otherwise prevent agreement on the nature of the problems.
医患双方就患者疾病问题的性质达成共识是基层医疗会诊的一个重要目标。不幸的是，患者和医生往往都不确定问题的原因。患者对就诊的满意度可能与他或她对医生鉴别诊断的认同度相关。
采用定性方法，将在17次因咳嗽就诊家庭医生的过程中及就诊前通过访谈引出的患者诊断关注点，与就诊期间及就诊后医生表达的鉴别诊断进行比较。
患者平均提出6.5种可能性，其中平均有2.8种也在医生的鉴别诊断范围内。虽然许多关注点与广泛认可的疾病流行观点有关，但一些患者基于其家庭经历，对严重疾病有独特的、不可预测的诊断关注点。在就诊期间，这些关注点往往表达得非常间接。
医生对患者疾病性质不确定性的探究可能有助于引出那些否则可能会妨碍就问题性质达成共识的意外关注点。
