The Murtagh safe diagnostic strategy proposed by renowned Australian general practitioner John Murtagh has been gradually used by general practitioners in clinical practice for diagnosis and treatment, mainly for initial diagnosis of common diseases, rapid identification of critical and severe diseases, analysis and judgment of the existence of diseases that can be easily overlooked, as well as to understand the patient's concerns and expectations. The general practice teaching clinic is an important training method for developing clinical thinking and enhancing diagnosis and treatment abilities of general practitioners. This article takes a patient with polymyalgia rheumatica (PMR) as a teaching case, applies the Murtagh safe diagnostic strategy to analyze the diagnosis and treatment ideas, analyzes the diagnosis and treatment process in combination with literature, summarizes diagnosis and treatment experience, guides general practitioners to think about disease diagnosis and treatment from multiple dimensions, trains general practice residents' general clinical thinking, improves the diagnosis and treatment level of PMR, so as to achieve the teaching purpose.
Family systems theory is a characteristic theory in general practice, which suggests that in the process of diagnosis and management of a patient, besides physiological problems, general practitioners should pay attention to the influence of family factors on the disease development and treatment as well as rehabilitation of the patient. We reported a case of depression treated with family therapy by the general practitioner after analyzing the impact of her family factors using biopsychosocial model and ideas of general medicine, hoping to improve general practitioners' capability of family-based disease management.
Intimate partner violence (IPV) is the most common type of domestic violence, which not only harms the victim's physical and mental health and life safety but also leads to the degradation of marriage, family, and children's development. IPV occurs among all socioeconomic, religious, and cultural groups. About a quarter of Chinese women have suffered some forms of IPV from their partner. Most patients will not present to the clinic with IPV. It is difficult yet essential for clinicians to quickly identify possible IPV among various non-specific symptoms and signs. There are no official guidelines for diagnosing and treating IPV in China, and the Chinese literature on IPV is scarce. This paper summarizes the evidence in English literature on IPV, focusing on the clinical outcome, identification, and management techniques of IPV, and attempts to discuss how this evidence can be applied to China.
Victims of domestic violence may be suffer from both physical threats and psychological trauma, leading them to consult general practitioners for a wide range of physical and psychological problems. When encountering victims of domestic violence, general practitioners need to identify patients timely, fully assess and properly deal with their conditions. But in clinical practice, general practitioners often choose to ignore or simply refer such patients because of many problems such as difficulty in starting, lack of asking skills and proper handling methods. Based on the analysis of domestic violence cases, this paper discusses the techniques that contribute to the use of patient-centered method and bio-social-psychological model in carrying out diagnosis and treatment activities. This fully reflects the value of general practitioners and extends the concept of family-based treatment.
Hematuria is a common clinical symptom, especially asymptomaticmicrohematuria (AMH) , which is more common in the first diagnosis in general practice clinics or primary health institutions. In this paper, we summarized the characteristics and evaluation contents of adults with hematuria by reviewing the relevant literatures. We conclude that the etiological treatment is fundamental, and it is important to follow-up for those whose cause is unknown. Hopefully, this paper can provide reference for the general practitioners to deal with adult hematuria.
Cronkhite-Canada syndrome (CCS) is currently considered to be a non-genetic disorder and a relatively rare clinical condition that is characterized endoscopically by multiple polyps in the gastrointestinal tract and clinically manifested by gastrointestinal symptoms, skin pigmentation, hair loss, and nail loss. In this paper, we analyzed the clinical characteristics and treatment procedures of three patients diagnosed with CCS at Qilu Hospital of Shandong University from August 2012 to September 2021 and reviewed the relevant literature. The diagnosis of CCS is based on medical history, physical examination, endoscopic findings of gastrointestinal polyps, and histopathology, with gastrointestinal endoscopy being the most direct means of examination. All three patients presented endoscopically with diffuse multiple polyps in the gastrointestinal tract, had hair and nail loss and were free of HP infection. Moreover, case 1 and case 3 both had reduced serum albumin levels; case 2 and case 3 were negative for antinuclear antibodies (ANA) , case 1 was not checked for ANA. Glucocorticoids and proton pump inhibitors (PPI) were the main pharmacological treatments for CCS. Case 1 was not treated with glucocorticoids, but only PPI and supportive treatment, and later developed bloody stools and intestinal necrosis and underwent total gastrectomy for gastric cancer 6 years after the onset of the disease. Cases 2 and 3 were improved after being treated with prednisone and PPI. Early diagnosis, glucocorticoid-based pharmacotherapy, regular gastrointestinal endoscopy, and new treatment options may contribute to a better prognosis, and the reduction in possibilities of missed diagnosis or misdiagnosis of CCS via improving clinicians' knowledge and understanding of the disease.
