diff --git a/ry-vue3/src/components/DoctorDeptSelect.vue b/ry-vue3/src/components/DoctorDeptSelect.vue
index 1f6e502..81f7bd4 100644
--- a/ry-vue3/src/components/DoctorDeptSelect.vue
+++ b/ry-vue3/src/components/DoctorDeptSelect.vue
@@ -1,55 +1,161 @@
 <template>
-  <dict-select
-    v-model="selected"
-    :dict-type="DICT_TYPE.DEPARTMENT"
-    :value-field="valueField"
-    :placeholder="placeholder"
-    :disabled="disabled"
-    :clearable="clearable"
-    :filterable="filterable"
-    :multiple="multiple"
-    class="doctor-dept-select"
-    @change="handleChange"
-  />
+  <!--
+    公共科室下拉控件 (带"其他"逃生口)
+
+    行为契约 (前端控件自管理, 父组件无感知):
+      - 标准字典项: 用户从下拉选 → v-model = 字典 label/value
+      - 选 "其他" (控件自己虚拟追加, 不来自后端字典): 下方出现 el-input → v-model = input 内容
+      - 回填: modelValue 不在字典里 → 自动按 "其他 + input" 显示, input 预填原值
+
+    用法 (与之前一样, 父组件不变):
+      <doctor-dept-select v-model="form.department" value-field="label" filterable placeholder="搜索科室" />
+  -->
+  <div class="doctor-other-select">
+    <el-select
+      v-model="selectedKey"
+      :placeholder="placeholder"
+      :disabled="disabled"
+      :clearable="clearable"
+      :filterable="filterable"
+      :loading="loading"
+      style="width: 100%"
+      @change="handleSelectChange"
+      @clear="handleClear"
+    >
+      <el-option
+        v-for="o in displayOptions"
+        :key="o.key"
+        :label="o.label"
+        :value="o.key"
+      />
+    </el-select>
+    <el-input
+      v-if="showOtherInput"
+      v-model="otherText"
+      :placeholder="otherPlaceholder"
+      class="other-input"
+      maxlength="50"
+      @input="emitValue"
+    />
+  </div>
 </template>
 
 <script setup>
-import { ref, watch } from 'vue'
-import DictSelect from '@/components/DictSelect.vue'
-import { DICT_TYPE } from '@/api/dict'
+import { ref, computed, watch, onMounted } from 'vue'
+import { getActiveDict, DICT_TYPE } from '@/api/dict'
 
-/**
- * 公共科室下拉控件 (医生/科室字典, 与 RuoYi sys_dept 区分)
- * v-model 默认绑 ID (deptId), 也可改为绑 name 字符串
- *
- * 用法:
- *   <dept-select v-model="form.deptId" />
- *   <dept-select v-model="form.department" value-field="label" filterable placeholder="搜索科室" />
- */
 const props = defineProps({
-  modelValue: { type: [String, Number, Array], default: null },
-  /** 'value' (deptId) 或 'label' (科室名称) */
-  valueField: { type: String, default: 'value' },
+  modelValue: { type: [String, Number], default: null },
+  /** 'value' (ID) 或 'label' (科室名称字符串) */
+  valueField: { type: String, default: 'label' },
   placeholder: { type: String, default: '请选择科室' },
+  otherPlaceholder: { type: String, default: '请输入其他科室' },
   disabled: { type: Boolean, default: false },
   clearable: { type: Boolean, default: true },
-  filterable: { type: Boolean, default: false },
-  multiple: { type: Boolean, default: false }
+  filterable: { type: Boolean, default: false }
 })
 
 const emit = defineEmits(['update:modelValue', 'change'])
 
-const selected = ref(props.modelValue ?? (props.multiple ? [] : null))
-watch(() => props.modelValue, v => {
-  selected.value = v ?? (props.multiple ? [] : null)
+// "其他" 虚拟项的内部 key — 不暴露给父组件, 仅用于区分 selectedKey 状态
+const OTHER_KEY = '__other__'
+
+// 原始后端字典项 (label/value/sort/...)
+const rawOptions = ref([])
+const loading = ref(false)
+
+// el-select 内部绑定的 key (可能 = 字典值, 可能 = OTHER_KEY)
+const selectedKey = ref(props.modelValue ?? null)
+
+// "其他" 输入框独立内容
+const otherText = ref(props.modelValue ?? '')
+
+// 是否显示下方 input
+const showOtherInput = computed(() => selectedKey.value === OTHER_KEY)
+
+// 给 el-select 渲染的 options (raw + 末尾追加 "其他" 虚拟项)
+const displayOptions = computed(() => {
+  const raw = rawOptions.value.map(o => ({
+    key: props.valueField === 'label' ? o.label : o.value,
+    label: o.label
+  }))
+  return [...raw, { key: OTHER_KEY, label: '其他' }]
 })
 
-function handleChange(val, opt) {
-  emit('update:modelValue', val)
-  emit('change', val, opt)
+// 检测 modelValue 是否在 rawOptions 里
+function isValueInOptions(v) {
+  if (v == null || v === '') return false
+  return rawOptions.value.some(o => (props.valueField === 'label' ? o.label : o.value) === v)
 }
+
+// 从外部 modelValue 同步 → 内部 selectedKey + otherText
+function syncFromModelValue(v) {
+  if (v == null || v === '') {
+    selectedKey.value = null
+    otherText.value = ''
+    return
+  }
+  if (isValueInOptions(v)) {
+    selectedKey.value = v
+    otherText.value = ''
+  } else {
+    // 不在字典里 → 走 "其他" 路径
+    selectedKey.value = OTHER_KEY
+    otherText.value = v
+  }
+}
+
+// 内部状态 → emit 给父组件
+function emitValue() {
+  let v
+  if (selectedKey.value === OTHER_KEY) {
+    v = otherText.value || ''
+  } else if (selectedKey.value == null) {
+    v = ''
+  } else {
+    v = selectedKey.value
+  }
+  emit('update:modelValue', v)
+  emit('change', v)
+}
+
+function handleSelectChange(key) {
+  // 切换到 "其他" 时, 若原 selectedKey 不是 OTHER_KEY (即之前不是 "其他"), 清空 otherText 让用户从零输入
+  if (key === OTHER_KEY && selectedKey.value !== OTHER_KEY) {
+    otherText.value = ''
+  }
+  selectedKey.value = key
+  emitValue()
+}
+
+function handleClear() {
+  selectedKey.value = null
+  otherText.value = ''
+  emitValue()
+}
+
+async function load() {
+  loading.value = true
+  try {
+    rawOptions.value = await getActiveDict(DICT_TYPE.DEPARTMENT)
+  } catch (e) {
+    console.warn('[DoctorDeptSelect] load failed', e)
+  } finally {
+    loading.value = false
+  }
+}
+
+onMounted(async () => {
+  await load()
+  // 字典加载完后再做一次同步: 避免初始 modelValue 在字典未加载时被错判为 "其他"
+  syncFromModelValue(props.modelValue)
+})
+
+watch(() => props.modelValue, v => syncFromModelValue(v))
+watch(() => rawOptions.value, () => syncFromModelValue(props.modelValue))
 </script>
 
 <style scoped>
-.doctor-dept-select { width: 100%; }
+.doctor-other-select { display: flex; flex-direction: column; gap: 6px; width: 100%; }
+.other-input { width: 100%; }
 </style>
\ No newline at end of file
diff --git a/ry-vue3/src/components/DoctorTitleSelect.vue b/ry-vue3/src/components/DoctorTitleSelect.vue
index cb6f5de..e6f3e16 100644
--- a/ry-vue3/src/components/DoctorTitleSelect.vue
+++ b/ry-vue3/src/components/DoctorTitleSelect.vue
@@ -1,55 +1,155 @@
 <template>
-  <dict-select
-    v-model="selected"
-    :dict-type="DICT_TYPE.TITLE"
-    :value-field="valueField"
-    :placeholder="placeholder"
-    :disabled="disabled"
-    :clearable="clearable"
-    :filterable="filterable"
-    :multiple="multiple"
-    class="doctor-title-select"
-    @change="handleChange"
-  />
+  <!--
+    公共医生职称下拉控件 (带"其他"逃生口)
+
+    行为契约 (前端控件自管理, 父组件无感知):
+      - 标准字典项: 用户从下拉选 → v-model = 字典 label/value
+      - 选 "其他" (控件自己虚拟追加, 不来自后端字典): 下方出现 el-input → v-model = input 内容
+      - 回填: modelValue 不在字典里 → 自动按 "其他 + input" 显示, input 预填原值
+
+    用法 (与之前一样, 父组件不变):
+      <doctor-title-select v-model="form.title" value-field="label" filterable placeholder="搜索职称" />
+  -->
+  <div class="doctor-other-select">
+    <el-select
+      v-model="selectedKey"
+      :placeholder="placeholder"
+      :disabled="disabled"
+      :clearable="clearable"
+      :filterable="filterable"
+      :loading="loading"
+      style="width: 100%"
+      @change="handleSelectChange"
+      @clear="handleClear"
+    >
+      <el-option
+        v-for="o in displayOptions"
+        :key="o.key"
+        :label="o.label"
+        :value="o.key"
+      />
+    </el-select>
+    <el-input
+      v-if="showOtherInput"
+      v-model="otherText"
+      :placeholder="otherPlaceholder"
+      class="other-input"
+      maxlength="50"
+      @input="emitValue"
+    />
+  </div>
 </template>
 
 <script setup>
-import { ref, watch } from 'vue'
-import DictSelect from '@/components/DictSelect.vue'
-import { DICT_TYPE } from '@/api/dict'
+import { ref, computed, watch, onMounted } from 'vue'
+import { getActiveDict, DICT_TYPE } from '@/api/dict'
 
-/**
- * 公共医生职称下拉控件
- * v-model 默认绑 ID (titleId), 也可改为绑 name 字符串
- *
- * 用法:
- *   <title-select v-model="form.titleId" />
- *   <title-select v-model="form.doctorTitle" value-field="label" placeholder="选职称" />
- */
 const props = defineProps({
-  modelValue: { type: [String, Number, Array], default: null },
-  /** 'value' (titleId) 或 'label' (职称名称) */
-  valueField: { type: String, default: 'value' },
+  modelValue: { type: [String, Number], default: null },
+  /** 'value' (ID) 或 'label' (职称名称字符串) */
+  valueField: { type: String, default: 'label' },
   placeholder: { type: String, default: '请选择医生职称' },
+  otherPlaceholder: { type: String, default: '请输入其他职称' },
   disabled: { type: Boolean, default: false },
   clearable: { type: Boolean, default: true },
-  filterable: { type: Boolean, default: false },
-  multiple: { type: Boolean, default: false }
+  filterable: { type: Boolean, default: false }
 })
 
 const emit = defineEmits(['update:modelValue', 'change'])
 
-const selected = ref(props.modelValue ?? (props.multiple ? [] : null))
-watch(() => props.modelValue, v => {
-  selected.value = v ?? (props.multiple ? [] : null)
+// "其他" 虚拟项的内部 key — 不暴露给父组件, 仅用于区分 selectedKey 状态
+const OTHER_KEY = '__other__'
+
+// 原始后端字典项
+const rawOptions = ref([])
+const loading = ref(false)
+
+// el-select 内部绑定的 key
+const selectedKey = ref(props.modelValue ?? null)
+
+// "其他" 输入框独立内容
+const otherText = ref(props.modelValue ?? '')
+
+// 是否显示下方 input
+const showOtherInput = computed(() => selectedKey.value === OTHER_KEY)
+
+// 给 el-select 渲染的 options (raw + 末尾追加 "其他" 虚拟项)
+const displayOptions = computed(() => {
+  const raw = rawOptions.value.map(o => ({
+    key: props.valueField === 'label' ? o.label : o.value,
+    label: o.label
+  }))
+  return [...raw, { key: OTHER_KEY, label: '其他' }]
 })
 
-function handleChange(val, opt) {
-  emit('update:modelValue', val)
-  emit('change', val, opt)
+function isValueInOptions(v) {
+  if (v == null || v === '') return false
+  return rawOptions.value.some(o => (props.valueField === 'label' ? o.label : o.value) === v)
 }
+
+function syncFromModelValue(v) {
+  if (v == null || v === '') {
+    selectedKey.value = null
+    otherText.value = ''
+    return
+  }
+  if (isValueInOptions(v)) {
+    selectedKey.value = v
+    otherText.value = ''
+  } else {
+    selectedKey.value = OTHER_KEY
+    otherText.value = v
+  }
+}
+
+function emitValue() {
+  let v
+  if (selectedKey.value === OTHER_KEY) {
+    v = otherText.value || ''
+  } else if (selectedKey.value == null) {
+    v = ''
+  } else {
+    v = selectedKey.value
+  }
+  emit('update:modelValue', v)
+  emit('change', v)
+}
+
+function handleSelectChange(key) {
+  if (key === OTHER_KEY && selectedKey.value !== OTHER_KEY) {
+    otherText.value = ''
+  }
+  selectedKey.value = key
+  emitValue()
+}
+
+function handleClear() {
+  selectedKey.value = null
+  otherText.value = ''
+  emitValue()
+}
+
+async function load() {
+  loading.value = true
+  try {
+    rawOptions.value = await getActiveDict(DICT_TYPE.TITLE)
+  } catch (e) {
+    console.warn('[DoctorTitleSelect] load failed', e)
+  } finally {
+    loading.value = false
+  }
+}
+
+onMounted(async () => {
+  await load()
+  syncFromModelValue(props.modelValue)
+})
+
+watch(() => props.modelValue, v => syncFromModelValue(v))
+watch(() => rawOptions.value, () => syncFromModelValue(props.modelValue))
 </script>
 
 <style scoped>
-.doctor-title-select { width: 100%; }
+.doctor-other-select { display: flex; flex-direction: column; gap: 6px; width: 100%; }
+.other-input { width: 100%; }
 </style>
\ No newline at end of file