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"协和临床思维"太牛了,竟是这样炼成的!

2017-09-25 常青 《协和医事》

在现代医学分科日趋细密的当下,协和如何尽己所能,深度锻造临床思维赋予医学更多的整体观,如何培养医生的跨科思维、更整体的观念,使得医生成为“医家”而非“医匠”。

张孝骞诊断过这么一个疑难病例:一位老年妇女,腹部极度膨出,皮肤被绷得亮光光的。别的医生诊断为冠心病、肝硬化,但老太太入院已经很久,经过各种检查和试验性治疗,腹水的原因一直没有查出,各部分主要脏器均受到影响,生命危在旦夕。

张孝骞看了病人,和病人交谈,发现她表情淡漠、反应迟钝,极像甲状腺功能低下病人的症状。他翻阅了入院以来的病例,马上诊断,这个病人的腹水是甲状腺功能低下引起的。他告诉主管医生,这种少见的疾病,国内外只有少量报道,相关的资料在什么书籍、什么杂志的第几页,书和杂志在图书馆哪个书架的什么位置。

腹水和甲状腺有什么关系呢?张孝骞解释说:“做好临床工作,必须警惕机械唯物主义的倾向,不能只看各种检查、化验结果,不看病人,不亲自接触病人。因为病人的情况不同,同一种病在不同人身上的表现千差万别,临床医生要把自己的基点放在认识每一个具体不同的病人身上。”

一位女病人,住院时口唇、下巴长着明显的黑胡子。她患黄疸,低血糖,有饥饿、心慌、盗汗的症状。可这和胡子有什么关系?张孝骞经过认真的查问说,这个病人得了胆道肿瘤。看着面露惊奇的大夫们,他解释:“这是一种能分泌肽物质的肿瘤,所以造成低血糖、黄疸和长胡子。你们去查一下图书馆的文献,那上面有这类病例的记载。”经过超声检查和X光透视,完全证实了张孝骞的诊断。

张孝骞从医一生,有着丰富的实践和理论,但他更强调正确的临床思维。董炳琨概括张孝骞的临床思维方法:“两个突出之点,一是全面和辩证,二是发展和变化。”从协和创立到今天,医学科学发生了巨大变化,但老协和的某些特色,却不因技术的改变而改变。


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    2017-09-27 luominglian113

    学习了.受益非浅.谢谢分享

    0

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    2017-09-26 戒馋,懒,贪

    谢谢分享.学习了

    0

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    2017-09-26 wylj

    受益匪浅

    0

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    2017-09-26 Medsci0421

    非常有启发.刻意练习.不仅是日常工作的重复.更重要的是临床思维的锤炼

    0

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    2017-09-25 明心见性

    学习了.谢谢分享

    0

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    2017-09-25 12027a9am17暂无昵称

    诊断肝硬化的依据是什么?

    0

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    2017-09-25 楠博One

    看的多经验多

    0

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