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Jingdong book

北京协和医院内科大查房(一)

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北京协和医院内科大查房(一)

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现在举国在讨论医改,都希望改变政府不满意,医务人员不满意,患者也不满意的状态。这其中重要一环就是关注临床医学二个方面的发展。即:专科与综合的发展并重。只有两个方面都得到发展才能真正解决看病难,也很大程度降低了就医的费用。
本册书本中所描述的每一个病历都是北京协和医院内科病历讨论中的真实病历。读者从这些病历中可以体会到,当一个疾病在一个病人身上出现,往往伴随很多教科书上无法完全描述的各种表现。而这些表现所能反映出的疾病也错综复杂,有时可能是单一疾病的不同表现,也可能是一个病人同时患几种疾病,而交织在一起的表现,这时候,往往需要非常有临床经验的医师进行分析才能得出准确的结论,这种经验和医学知识只有理论联系实际,通过对大量的疑难病例进行广泛的疾病认识和细致的分析,才能逐渐达到这样的水准。在这些病例的讨论中,集众多医师的集体智慧,使众多病人的疾病得到了正确的诊治,也使我们的医师对疾病有了更深的认识。本书选取了一些病历,把他编书成册。
Catalogue

感染科
间断发热3月余

呼吸科
间断胸痛伴憋气1年余
发热13天,呼吸困难8天
间断发热、干咳、活动后气短1年

免疫科
口腔溃疡4年,视物模糊、皮疹9月,发热、呼吸困难半月
间断鼻出血10年,腹痛6月,双下肢水肿1月
间断发热、皮疹4年余,再发3月
反复腹痛、全身淋巴结肿大1年余
口眼干10年,间断发热1年余,腹痛6月
间断皮疹伴发热3年余,加重伴头痛1月

普内科
头晕、头痛4月,双眼视力下降、右下肢肿胀2月余
发现胆红素水平升高1年,皮肤黄染、牙龈出血3月
皮肤变黑9年,反复腹水7年,右下肢肿胀4月余
面部肿胀、发热、张口受限2年,上睑下垂1年

肾内科
间断发热伴肉眼血尿2月,双下肢水肿1月余
间断双下肢水肿15年
双下肢水肿1个月,加重伴抽搐1天
上腹部胀痛、上眼睑肿胀10年,双下肢水肿半年
水肿、少尿、黄疸3月
尿中泡沫增多9月,双下肢水肿5月,加重1月余

消化科
四肢水肿10余年,双侧胸腔积液2年余,腹围增加8月余
发热、咳嗽1年余,皮肤溃疡5月,腹泻1月
咳嗽、咳痰、发热2月余,腹胀50天
尿色加深3月余,腹痛伴皮肤巩膜黄染2月
乏力伴尿色加深5月,皮肤、巩膜黄染2月

心内科
体检发现心功能不全2周
反复一过性意识丧失3月余
双下肢水肿1年余,四肢肌无力6月
双下肢水肿3年,咳嗽近2年,活动后憋喘1年余
发现血压升高、胸闷5月,喘憋2月

血液科
左下肢疼痛2月余,腹痛1月
皮肤变黑5年余,乏力、心悸10月
全身皮肤瘙痒6月余,发现淋巴结肿大1月余
口干、多饮、多尿3年余,骨痛3月

附录 缩略词表
Introduction

自1921年北京协和医院建院以来,内科每周一次的疑难病例讨论一直传承至今。一代代协和医生从这项医疗实践工作中终生获益,掌握了对临床病例的分析和解决问题的方法,医疗水平也因此不断提高。他们中很多人成为各个医疗学科的知名医师及学科带头人。严格意义上讲,临床医学就是实践科学,没有实践就不能产生真正的医生。医学书本知识要与医学实践相结合,否则书本读得再好,也难以正确的诊治一个病人。
当今医学快速发展,临床医学更是分科不断细化,不仅有内外科等等,根据不同的系统又划分为三级科系,比如:内科的心血管内科、呼吸内科、消化内科等,甚至在有些医院已经细划到专病。这样的划分,有利于专科医生对所从事学科的专业化,研究更深入,能把握国内外进展,对疾病的诊治也更精准。但也随之出现了另外一个问题。一个患者绝不可能都知道自己患了什么样的疾病,一个疾病也可以同时有多种表现或不同表现,一个人也可能同时患几种疾病。那么这个时候由谁来为他们诊治,首诊由谁来进行。特别是首诊医师,无论是否为专科医生都应对病人做出相应的准确诊断,完成最基本的诊疗过程,然后为病人指引一个明确的就医路线,避免让病人延误诊断和治疗,而走很多弯路,浪费很多时间和金钱。
试想,在大型综合医院中,专科发展深入,每个专科医师只关心本专业疾病,遇到与本专业不符的病人就一推了之,或者遇到出现其他系统损伤,哪怕一点小问题也都要请专科会诊,病人看一个病可能要找几个科室,几个医师才能得到有效的诊治,如果这样我们的医疗体制将是一个什么样的局面。
现在举国在讨论医改,都希望改变政府不满意,医务人员不满意,患者也不满意的状态。这其中重要一环就是关注临床医学二个方面的发展。即:专科与综合的发展并重。只有两个方面都得到发展才能真正解决看病难,也很大程度降低了就医的费用。
本册书本中所描述的每一个病历都是北京协和医院内科病历讨论中的真实病历。读者从这些病历中可以体会到,当一个疾病在一个病人身上出现,往往伴随很多教科书上无法完全描述的各种表现。而这些表现所能反映出的疾病也错综复杂,有时可能是单一疾病的不同表现,也可能是一个病人同时患几种疾病,而交织在一起的表现,这时候,往往需要非常有临床经验的医师进行分析才能得出准确的结论,这种经验和医学知识只有理论联系实际,通过对大量的疑难病例进行广泛的疾病认识和细致的分析,才能逐渐达到这样的水准。在这些病例的讨论中,集众多医师的集体智慧,使众多病人的疾病得到了正确的诊治,也使我们的医师对疾病有了更深的认识。我们选取了一些病历,把他编书成册。而且,我们将把《北京协和医院内科大查房》办成系列丛书,提供给读者,就是希望我们的读者能通过对这些病例的认识从中获益。

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