应读者要求,从本期开始增辟“进修讲坛”这一栏目。顾名思义,本专栏是为解决临床医师自我进修中,种种业务问题而设立的。经过努力,今天首次和读者见面了。肾脏病是一门较新的学科,近年发展较快,故要求进修该科,以免知识老化者颇众。虽然近年来不少医学院,省、市大医院开设了肾脏病进修班,但仍远远不能满足广大基层医务人员的需要。有鉴于此,我们拟先选这一课题。值得重视的是,我国著名的诊断学专家黄大有教授等,在“临床医师应重视诊断学的基本功”一文中呼吁临床医生,特别是医学生和青、中年医生一定要充分重视诊断学的基本功(黄大有等:中华内科杂志22(9):529,1983)。我们非常赞成这个提法,并推荐大家读一读这篇文章。诊断学中,物理诊断学是最不容忽视的部分。物理诊断学,是指医师利用自己的感觉器官和简单的工具(如听诊器),对病人的病变部位和整体进行系统的观察,结合病理解剖和病理生理学知识及实践经验,对病变的性质作出判断。由于这主要依靠医师的感觉器官的分析能力,其精确度随医师技术熟练程度和观察的敏锐程度而不同。当然,责任心问题任何时候都是不应该忽视的。因此,从本期起亦拟讨论物理诊断学中最有代表性的内容——心脏听诊。本专栏所有问题均为临床医师实际会碰得到的问题,编撰者不打算重复以往教科书的格式,大家一看便知。冀望每位读者亦能象“进修医师”一样,仿佛身临其境,从中得到教益。本栏连载新颖实用,颇合中、青年医师和实习医生阅读。连载完毕剪贴成册,置于案头,供临症、实习或带教学随手翻阅参考之用。 At the request of readers, from the beginning of this issue, an additional “forum for further studies” should be added. As the name suggests, this column is to solve the clinician self-learning, all kinds of business issues and set up. After hard work, I met my readers for the first time today. Nephrology is a relatively new subject and has developed rapidly in recent years. Therefore, it is required to further study the subject so as to avoid the knowledge aging people. Although many medical colleges, provincial and municipal hospitals have opened advanced classes of kidney disease in recent years, they still can not meet the needs of the majority of grassroots medical personnel. In view of this, we intend to first select this topic. It is worth noting that Professor Huang Dayou, a famous expert on diagnostics in China, urges clinicians, especially medical students and young and middle-aged doctors, to give full attention to diagnosis in the article “The Basic Skills of Clinicians Should Pay Attention to Diagnostics” (Huang Dayou et al .: Chinese Journal of Internal Medicine 22 (9): 529,1983). We very much agree with this formulation and recommend everyone to read this article. Diagnostics, physical diagnosis is the most important part. Physical diagnosis refers to physicians using their own sensory organs and simple tools (such as stethoscope), the patient’s lesion and the overall system of observation, combined with pathological anatomy and pathophysiology of knowledge and practical experience to judge the nature of the lesion . Since this relies mainly on the physician’s ability to analyze the sensory organs, their accuracy varies with the proficiency of the physician and the degree of sensitivity observed. Of course, the issue of responsibility should not be overlooked at any time. Therefore, from this issue it is also proposed to discuss the most representative part of physical diagnosis - heart auscultation. All the questions in this column are actually encountered by clinicians and the editors do not intend to repeat the format of previous textbooks. We hope that every reader will feel like being a “learning physician” as if he or she is immersed and will benefit from it. This column serial novel and practical, quite suitable, young physicians and interns reading. Serialized cut into books, placed in the desk, for the Provisional, internship or teaching readily available for reference.