“不能解释的躯体症状”患者医患互动的调查

A survey of doctor-patient interaction in patients with medically unexplained symptoms

关键词:  医学无法解释的症状  医患互动  求医行为

Key words:  medically unexplained symptoms  doctor-patient interaction  health seeking behavior

摘要:

目的探讨以＂不能解释的躯体症状＂就诊于综合医院的患者医患互动的特点,了解影响＂不能解释的躯体症状＂患者医患互动的相关因素。方法在综合医院心身科、中医科、神经内科、妇产科调查以躯体主诉就诊但没有发现器质性原因的患者,纳入标准为躯体形式障碍筛查量表（SOMS）≥9分且排除躯体器质性疾病及精神病性障碍者,收集到研究样本98名。对患者和主治医生分别进行问卷测评,问卷包括：治疗满意度调查、病因及治疗问卷（IPQ）、医院焦虑/抑郁情绪量表（HADS）。结果 42%的患者人均求医次数超过12次,40%的患者认为医生不理解自己;焦虑在界值分（〉9分）以上的患者比例为72.8%,抑郁在界值分（〉9分）以上的患者比例为55.4%;患者认为自己症状最可能的3个病因是情绪问题（70.1%）、过度劳累（68.4%）和年龄增长（61.2%）;患者认为最重要的3个病因是压力及担心（30.6%）,情绪问题（26.5%）,年龄增长（21.4%）;患者对于当前治疗过程的评价,好于医生认为患者对于当前治疗过程的评价,差异具有统计学意义（t=2.82,P〈0.05）;不同科室患者当前治疗满意度和治疗评价的差异有统计学意义（t=3.73,P〈0.05）。结论医患之间对患者病因的认知以及治疗过程满意度有差异;＂不能解释的躯体症状＂患者多伴有明显的焦虑抑郁症状。

Abstract:

Objective To investigate the doctor-patient interaction of patients with medically unexplained symptoms（MUS） in general hospital and to improve diagnostic and therapeutic service for patients with MUS.Methods The out-patients,who had been in psychosomatic department,Chinese traditional medicine department,gynecology department and neurology department of general hospital, were asked to complete the Screening for Somatoform Symptoms（SOMS）.Ninty-eight patients whose scores of SOMS≥9 and their doctors were participated in this study.The research tools were employed to patients and physicians separately.Patients and physicians were asked to complete questionnaire such as＂Treatment Satisfaction of This Time＂,＂Iateria and Pathogeny Questionnaire（IPQ）＂and＂Hospital Anxiety and Depression Scale（HADS）＂.Results There were 42%of the patients sought help in hospitals more than 12 times and 40%of them thought that their doctors didn＇t really understand them. 72.8%patients＇ HADS scores of anxiety were higher than cut-point,55.4%patients＇ HADS scores of depression were higher man cut-point.Patients believed that 3 factors were the most possible causes of the symptoms：problem of emotion（70.1%）,too hard works（68.4%）,and aging（61.2%）.Patients believed that 3 factors were the most important causes of symtoms：stress and worry（30.6%）, problem of emotion（26.5%）,and aging（21.4%）.With respect to evaluation of current therapeutic process,the evaluation of the patients was better than physician＇s evaluation,and the difference was statistically significant（t = 2.82,P0.05）.The patients＇ treatment satisfaction of their conditions was different among the four departments（t = 3.73,P0.05）.Conclusion Patients＇ evaluation of current therapeutic process are different from the physicians＇ evaluation.Most patients with medically unexplained symptoms have complications of anxiety and depression.