不定愁訴患者に対する当院総合診療医の対応

Abstract

There are many patients presenting at the outpatient clinic of General Medicine with non-specific complaints. It is reported that non-specific complaints are sometimes indicative of undiagnosed depressive illness. We investigated our assessment of the patients who presented with non-specific complaints in our outpatient clinic of General Medicine. Methods : We retrospectively investigated 23 patients (6 males and 17 females, aged 19-75 years; median age, 32 years) who presented at our department for an evaluation of non-specific complaints between December 2002 and November 2005. We initially reviewed the patient's medical records, and then investigated the patient's current status by means of a telephone interview. Results : In order to make diagnosis of physical disorder, 14 cases were investigated by screening examinations, including laboratory studies, chest X-rays, and physical examinations. In 9 cases, a further investigation was conducted by computed tomography, endoscopy, and other tests. On the other hand, in order to accurately diagnose the presence of depression, all cases were investigated through a patient interview. None of the cases were investigated by the next step, the administration of a depression screening test. The outcomes included the following: "observation" in 14 cases, and "non-attendance for further follow-up" in 6 cases. We were able to conduct a follow-up telephone interview with 12 of the patients, to determine their current status. The results were as follows: "the symptoms disappeared" in 9 cases; "the symptoms persisted but enduring" in 1 case; and the patient "continued doctor shopping" in 1 case. Conclusion : We tended to instruct the patients with non-specific complaints to conservatively observe their symptoms. However, we have to recognize the need to encourage patients to return for further evaluations when their symptoms continue, as there was a tendency for the patients with non-specific complaints not to return for further evaluation.