安全网视角下全科未分化疾病随访计划的现状与优化

王剑强; 刘颖; 马方晖; 赵星星; 杨碧霄; 郭秀军

doi:10.16766/j.cnki.issn.1674-4152.004310

安全网视角下全科未分化疾病随访计划的现状与优化

doi: 10.16766/j.cnki.issn.1674-4152.004310

1.
北京大学第三医院第二门诊部, 北京 100191
2.
浙江大学医学院附属第一医院全科医学科, 浙江杭州 310003
3.
北京大学第三医院全科医学科

基金项目:

国家自然科学基金项目 72274169

详细信息

通讯作者:
郭秀军，E-mail：13126639248@163.com

中图分类号: R499
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- 文章访问数: 12
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- 被引次数: 0
出版历程
- 收稿日期: 2025-03-04
- 网络出版日期: 2026-03-13

Current situation and optimization of follow-up plans for undifferentiated diseases in general practice from the perspective of safety netting

1.
The Second Outpatient Department of Peking University Third Hospital, Beijing 100191, China

摘要

摘要: 管理临床不确定性，从而降低漏诊风险的一个有效方法是使用安全网建议(即向患者传达关于何时何地再次咨询医疗保健的结构化信息)。安全网已成为国际初级卫生保健中处理诊断不确定性的最佳实践。全科未分化疾病是国内诊断不确定性临床问题的典型代表，其随访计划的制订，在多大程度上符合处理诊断不确定性的基本原则目前尚不清楚。本文介绍和借鉴安全网的定义和内容，通过在CNKI、万方、维普、百度学术等平台检索相关文献，统计现有未分化疾病随访计划的现状，从诊断不确定性的医患沟通、预警症状监测、随访时间安排和随访计划的书面确认等4个方面，对其存在的问题进行比较分析。结果发现，纳入分析的28篇文献中，仅有10篇对诊后漏诊风险的随访有具体安排，内容亦不够全面，提示对诊断不确定状态下风险管理的重要性认识不足。在此基础上笔者参考安全网策略的基本原理，结合未分化疾病与传统疾病临床特征的差异，对随访计划的制定提出了优化建议，从临床思维的区别、不同类型症状在随访中的差异、个性化随访计划的制定、书面记录4个方面进行了具体探讨。结果表明对抗诊断不确定带来的疾病风险，进行过度检查追求明确诊断并非唯一范式，通过一系列风险管理计划的安排同样可以实现这一目标，并具有更好的可行性和经济性。
- 安全网 /
- 未分化疾病 /
- 随访
Abstract: An efficacious approach to the management of clinical uncertainty and the mitigation of the risk of diagnostic oversights are the utilization of safety net recommendations (i.e. conveying structured information to patients about when and where to consult healthcare again). The safety net has been established as the optimal approach for addressing diagnostic uncertainty in the context of international primary healthcare. General undifferentiated diseases are a paradigmatic example of clinical problems with diagnostic uncertainty in China. The extent to which the development of follow-up plans conforms to the basic principles of handling diagnostic uncertainty is unclear at present. The present article introduces and draws upon the definition and content of a safety net, and searches relevant literature on platforms such as CNKI, Wanfang, VIP and Baidu Scholar to analyze the current status of existing follow-up plans for undifferentiated diseases. A comparative analysis is conducted from four perspectives: communication between doctors and patients regarding diagnostic uncertainty, monitoring of warning symptoms, scheduling of follow-up time, and written confirmation of follow-up plans. The results demonstrate that, of the 28 articles included in the analysis, a mere 10 have made specific provisions for follow-up on the risk of a missed diagnosis after diagnosis, The content of these articles is found to be inadequate, indicating a deficiency in grasping the significance of risk management in the context of diagnostic uncertainty. On this basis, and with reference to the fundamental principles of safety net strategies, suggestions for the optimization of follow-up plans were proposed, with the aim of combining the differences in clinical characteristics between undifferentiated diseases and traditional diseases. The specific discussions were conducted from four perspective: differences in clinical thinking, differences in the types of symptoms experienced during follow-up, the development of personalized follow-up plans, and the maintenance of written records. This indicates that the pursuit of clear diagnoses through excessive examination is not the only paradigm for combating disease risks caused by uncertain diagnoses. The implementation of a series of risk management plans, is a strategy that has been demonstrated to facilitate the realization of this objective, while concurrently ensuring optimal feasibility and economic efficiency.
- Safety netting /
- Undifferentiated diseases /
- Follow-up

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图 1 未分化疾病接诊方式

Figure 1. Treatment approach for undifferentiated diseases

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