fix: 全面修复 - 实时通讯、报告AI流程、健康概览、用药运动提醒

- SignalR Hub消息持久化+防重复+跨端广播
- 报告VLM+LLM真实AI流程(验证→提取→解读)
- 医生审核页重构(严重程度/建议模板/综合评语)
- 健康概览五合一趋势图(fl_chart+指标切换)
- 用药提醒时区修复+跨午夜+过期提醒
- 运动打卡DayOfWeek映射修复+计划覆盖查询
- 体重与其他四指标同级(Abnormal检查/确认卡牌)
- AI Agent支持多种类多时段批量录入
- 删除硬编码假数据(张三/假医生/假AI解读)
- 随访/报告审核数据链路全部打通

health_app/lib/providers/consultation_provider.dart

@@ -164,9 +164,13 @@ class ConsultationChatNotifier extends Notifier<ConsultationChatState> {
               : DateTime.now(),
         );
 
-        // 去重
-        final existingIds = state.messages.map((m) => m.id).toSet();
-        if (!existingIds.contains(msg.id)) {
+        // 去重：按 ID + 内容+时间窗口（防止本地消息和服务器消息重复）
+        final isDuplicate = state.messages.any((m) =>
+            m.id == msg.id ||
+            (m.senderType == msg.senderType &&
+             m.content == msg.content &&
+             msg.createdAt.difference(m.createdAt).inSeconds.abs() < 3));
+        if (!isDuplicate) {
           state = state.copyWith(messages: [...state.messages, msg]);
         }
       });
@@ -220,8 +224,9 @@ class ConsultationChatNotifier extends Notifier<ConsultationChatState> {
   Future<void> sendMessage(String text) async {
     if (text.trim().isEmpty || state.isSending || state.consultationId == null) return;
 
+    final localId = '${DateTime.now().millisecondsSinceEpoch}';
     final userMsg = ConsultationMsg(
-      id: '${DateTime.now().millisecondsSinceEpoch}',
+      id: localId,
       senderType: 'User',
       content: text,
       createdAt: DateTime.now(),
@@ -234,13 +239,50 @@ class ConsultationChatNotifier extends Notifier<ConsultationChatState> {
     try {
       // 优先通过 SignalR 发送
       if (_hub != null && _hub!.state == HubConnectionState.Connected) {
-        await _hub!.invoke('SendMessage',
+        final result = await _hub!.invoke('SendMessage',
             args: <Object>[state.consultationId!, 'User', '', text]);
+        // 用服务器返回的真实 ID 更新本地消息，防止后续轮询重复
+        if (result != null) {
+          final serverId = (result as Map<String, dynamic>)['id']?.toString();
+          if (serverId != null && serverId != localId) {
+            final updated = state.messages.map((m) {
+              if (m.id == localId) {
+                return ConsultationMsg(
+                  id: serverId,
+                  senderType: m.senderType,
+                  senderName: m.senderName,
+                  content: m.content,
+                  createdAt: m.createdAt,
+                );
+              }
+              return m;
+            }).toList();
+            state = state.copyWith(messages: updated);
+          }
+        }
       } else {
         // 回退到 HTTP
         final api = ref.read(apiClientProvider);
-        await api.post('/api/consultations/${state.consultationId}/messages',
+        final res = await api.post('/api/consultations/${state.consultationId}/messages',
             data: {'content': text});
+        // 用服务器返回的真实 ID 更新本地消息
+        final dataMap = res.data['data'] as Map<String, dynamic>?;
+        final serverId = dataMap?['id']?.toString();
+        if (serverId != null && serverId != localId) {
+          final updated = state.messages.map((m) {
+            if (m.id == localId) {
+              return ConsultationMsg(
+                id: serverId,
+                senderType: m.senderType,
+                senderName: m.senderName,
+                content: m.content,
+                createdAt: m.createdAt,
+              );
+            }
+            return m;
+          }).toList();
+          state = state.copyWith(messages: updated);
+        }
       }
     } catch (_) {
       // 静默失败，消息已显示在本地