Abstract: General practice teaching clinic is an important training method to develop clinical thinking and improve general practice diagnosis and treatment ability of general practice residents. In this paper，we used a patient with fatigue as the main manifestation as a teaching case to introduce the Murtagh safe diagnostic strategy proposed by John Murtagh，a famous Australian general medicine expert，to inspire the diagnosis and differential diagnosis of fatigue for the general practice residents in the general practice teaching clinic：（1）What are the common diseases that cause fatigue? （2）What are the important diseases that should not be ignored? （3）What are the easily missed diseases of fatigue? （4）Are there underlying easily masked diseases? （5）Is there something the patient is not saying? Combined with the history，physical examination and laboratory findings，a preliminary diagnosis of antineutrophil cytoplasmic antibody-associated vasculitis causing rapidly progressive glomerulonephritis is highly probable.The timely referral got nephropathology which confirms the etiology of the fatigue was antineutrophil cytoplasmic antibody-associated glomerulonephritis，and achieved satisfactory outcome. Based on the Murtagh safe diagnostic strategy，the instructor helped the general practice residents to construct a systematic knowledge framework for the identification and analysis of fatigue，so as to improve their clinical logical thinking ability and the ability to solve practical clinical problems. Using the mind mapping as an auxiliary tool，the diagnosis and differential diagnosis of the Murtagh safe diagnostic strategy were concretized and visualized，so as to optimize the teaching effect.

Key words: General practice, Murtagh safe diagnostic strategy, Mind mapping, General practice clinical thinking, Fatigue, Antineutrophil cytoplasmic antibody-associated glomerulonephritis

摘要： 全科教学门诊是培养规培全科医生临床思维、提升全科诊疗能力的重要培训方法。本文用1例以乏力为主要表现的患者为教学案例，介绍全科教学门诊中采用澳大利亚著名全科医学专家JohnMurtagh提出Murtagh安全诊断策略启发规培全科医生对乏力进行诊断与鉴别诊断：（1）引起乏力的常见疾病有哪些?（2）哪些重要疾病是不能忽视的？（3）乏力有什么容易被遗漏的疾病？（4）是否存在潜在的容易被掩盖的疾病？（5）患者是否有话没有说？结合病史、体格检查和实验室检查结果初步诊断为抗中性粒细胞胞浆抗体相关性血管炎引起急进性肾小球肾炎可能性大，及时转诊，肾病理确诊乏力的病因为抗中性粒细胞胞浆抗体相关性肾小球肾炎，取得满意疗效。带教老师基于Murtagh安全诊断策略帮助规培全科医生构建乏力鉴别、分析的系统知识框架，从而提升规培全科医生的临床逻辑思维能力和解决临床实际问题的能力；以思维导图为辅助工具，将Murtagh安全诊断策略诊断与鉴别诊断思路可视化、形象化，优化教学效果。

关键词: 全科医学, Murtagh 安全诊断策略, 思维导图, 全科临床思维, 乏力, 抗中性粒细胞胞浆抗体相关性肾小球肾炎