TheRole,PrinciplesandCompetenciesofFamilyMedicine

家庭醫(yī)學(xué)的作用、原則和能力ChrisJenkins,MD克里斯.金肯醫(yī)學(xué)博士April201120011年4月整理課件1TheRole,PrinciplesandCompe

我們是誰(shuí)？

Whoarewe?Cheung醫(yī)生Dannemiller醫(yī)生Heffron醫(yī)生

Jenkins醫(yī)生Leu醫(yī)生Rudd醫(yī)生Zhou周仲華醫(yī)生GuJian谷建醫(yī)生Joseph金世紅醫(yī)生

整理課件2我們是誰(shuí)？

Whoarewe?Cheun

我們是誰(shuí)？

Whoarewe?Baer醫(yī)生Chan醫(yī)生Heffron醫(yī)生

Jenkins醫(yī)生Leu醫(yī)生Schackow醫(yī)生Zhou周仲華醫(yī)生Gujian谷建醫(yī)生Longan醫(yī)生GuJian谷建醫(yī)生Joseph金世紅醫(yī)生

整理課件3我們是誰(shuí)？

Whoarewe?Baer醫(yī)

我們是誰(shuí)？

Whoarewe?Baer醫(yī)生Heffron醫(yī)生

Jenkins醫(yī)生PangYan醫(yī)生Burgos醫(yī)生GuJian谷建醫(yī)生Joseph金世紅醫(yī)生

整理課件4我們是誰(shuí)？

Whoarewe?Baer醫(yī)GoalsofTalk演講的目的Whygeneralpracticeisanimportantspecialtyinamedicalsystem為什么全科醫(yī)學(xué)是醫(yī)療體系里的一個(gè)重要?？芖hatdoGPsdo全科醫(yī)生做什么DiscusswhypostgraduateGPtrainingisimportant討論為何畢業(yè)后的全科培訓(xùn)很重要Whatarethebenefitstothecommunityandindividualpatients對(duì)社區(qū)和病人個(gè)體有什么益處整理課件5GoalsofTalk演講的目的WhygeneralWhatisFamilyMedicine?ItDependsonWhoYouAsk!

家庭醫(yī)學(xué)是什么？看你問(wèn)誰(shuí)！British英國(guó)Swedish瑞典Australia澳大利亞HongKong香港Canada加拿大America美國(guó)整理課件6WhatisFamilyMedicine?ItDeFamilyMedicineinChina

中國(guó)的家庭醫(yī)學(xué)NewinmodernChina是當(dāng)代中國(guó)的新生物Developinganewmodel發(fā)展一個(gè)新模式Thegovernmentandentiremedicalsystemrecognizeneedforgeneralpractice政府和整個(gè)醫(yī)學(xué)界認(rèn)識(shí)到對(duì)全科的需要TheMinistryofHealthhasnowprovidedamodelforgeneralpracticeandtrainingItisbeingimplementedacrossChina

衛(wèi)生部指出了全科醫(yī)療及其培訓(xùn)的模式

-全國(guó)都在實(shí)施整理課件7FamilyMedicineinChina

中國(guó)的家庭FamilyMedicineinChina

中國(guó)的家庭醫(yī)學(xué)PrinciplesofFMhassimilaritieswithsomeaspectsoftraditionalChinesemedicine家庭醫(yī)學(xué)的原則與傳統(tǒng)中醫(yī)的某些方面有相似之處Careforthewholefamily照顧整個(gè)家庭Youngandold年輕者和年長(zhǎng)者M(jìn)aleandfemale男性和女性Allorgansystems所有的器官系統(tǒng)Listentopatients傾聽患者Taketimewiththepatients花時(shí)間與病人在一起整理課件8FamilyMedicineinChina

中國(guó)的家庭FamilyMedicineinChina

中國(guó)的家庭醫(yī)學(xué)SomedifferencesbetweenGPandtraditionalChinesemedicine:全科醫(yī)學(xué)和傳統(tǒng)中醫(yī)的區(qū)別Understandingofcausesofdisease對(duì)病因的理解GPsemphasizefamily,socialandenvironmentalinfluences全科強(qiáng)調(diào)家庭、社會(huì)和環(huán)境的影響GPsrelyonscienceincludingevidencebasedmedicine全科醫(yī)學(xué)更依賴科學(xué)包括循證醫(yī)學(xué)HistoryandphysicalexamaredonemorethoroughlybyGPs全科醫(yī)生采集病史和體格檢查更全面徹底。整理課件9FamilyMedicineinChina

中國(guó)的家庭WhatisFamilyMedicineintheUSA?

美國(guó)的家庭醫(yī)學(xué)是什么？Medicalspecialty醫(yī)學(xué)專業(yè)RecognizedasspecialtyintheUSsince1969自從1969年起在美國(guó)被認(rèn)定為一種醫(yī)學(xué)專業(yè)Over80,000familyphysiciansintheUS在美國(guó)有超過(guò)80,000多名全科醫(yī)生整理課件10WhatisFamilyMedicineintheWhatisFamilyMedicineintheUSA?

美國(guó)的家庭醫(yī)學(xué)是什么？Over420trainingprograms(residencies)withover9,000residents

超過(guò)420個(gè)住院醫(yī)師培訓(xùn)項(xiàng)目,超過(guò)9,000名住院醫(yī)生Cantreat85-90%ofmedicalproblems

能夠治療85-90%的醫(yī)學(xué)問(wèn)題整理課件11WhatisFamilyMedicineinthe

WhatisFamilyPracticeintheUnitedStates?在美國(guó)家庭醫(yī)學(xué)是什么樣的?

12%ofallUSdoctorsarefamilypracticedoctors

12%的美國(guó)醫(yī)生是家庭醫(yī)生But25%ofallofficevisitsintheUSaretofamilydoctors!

但是美國(guó)25%的就診都是看全科醫(yī)生！

整理課件12

WhatisFamilyPracticeinthWhereDoWeWork?

我們?cè)谀睦锕ぷ?？Clinic門診Hospital醫(yī)院EmergencyDepartment急診室NursingHomes養(yǎng)老院Other其他整理課件13WhereDoWeWork?

我們?cè)谀睦锕ぷ鳎緾linPhilosophicalFocusofFamilyMedicine

家庭醫(yī)學(xué)的理念Continuityofcare照顧的持續(xù)性Managementofcare健康照顧管理Treatingpatientincontextoffamily在家庭背景下治療病人Preventivecare預(yù)防保健Teamapproach團(tuán)隊(duì)探討EBM循證醫(yī)學(xué)整理課件14PhilosophicalFocusofFamilyContinuityofCare

照顧的持續(xù)性

Seeingpatientsoveranextendedperiodoftime長(zhǎng)時(shí)間內(nèi)照顧病人Developingthedoctor-patientrelationship發(fā)展醫(yī)患關(guān)系Familiaritywithpatienthealthstatus熟悉病患的健康狀態(tài)Developingtrust發(fā)展信任關(guān)系整理課件15ContinuityofCare

照顧的持續(xù)性

SeeiManagementofCare

保健管理EvaluationofthePatient病人病情的評(píng)估Diagnostictests診斷檢查Involvementofspecialists?？漆t(yī)生參與Treatmentplans診療計(jì)劃整理課件16ManagementofCare

保健管理EvaluatPatientCareintheContextoftheFamily

以家庭為背景的病人保健Homeenvironment家庭環(huán)境Familydynamics家庭動(dòng)力學(xué)Familyhealthbeliefsandpractices家庭的健康理念和實(shí)踐Social,work,andreligioussettings社會(huì)環(huán)境，工作環(huán)境和宗教環(huán)境整理課件17PatientCareintheContextofPreventiveMedicine

預(yù)防醫(yī)學(xué)Patienteducation病人教育Lifestylemodification生活方式的調(diào)整Ageandgenderspecificdiseasescreening根據(jù)年齡和性別而特異的疾病篩查Medicalintervention醫(yī)療干預(yù)整理課件18PreventiveMedicine

預(yù)防醫(yī)學(xué)PatienTeamApproachtoHealthCare

健康照顧的團(tuán)隊(duì)合作

Involvementofotherhealthcareproviders

其它醫(yī)療保健工作者的參與

Medicalandsurgicalspecialists

內(nèi)外科專家

Behavioralmedicine

行為醫(yī)學(xué)Physical,occupational,hometherapists

物理治療，職業(yè)理療師，家庭治療師Dietitians

營(yíng)養(yǎng)學(xué)家

整理課件19TeamApproachtoHealthCare

健EvidenceBasedMedicine

循證醫(yī)學(xué)Knowingthequestionstoask知道要問(wèn)的問(wèn)題Identifyingthebestevidencetoanswerthequestions找出回答問(wèn)題的最好依據(jù)Assessingtheevidenceforvalidityandusefulness評(píng)估證據(jù)的有效性和有用性Applyingtheresultstoclinical/hospitalpractice將結(jié)論應(yīng)用于門診或住院醫(yī)療Evaluatingtheresults

評(píng)估結(jié)果整理課件20EvidenceBasedMedicine

循證醫(yī)學(xué)KnGeneralPracticeCompetencies

全科醫(yī)學(xué)的能力ThereisawiderangeofpossibleskillsforGPs全科醫(yī)生可掌握的臨床技巧很廣泛Differentcountrieschoosedifferentskillstomeettheirownneeds不同的國(guó)家根據(jù)本國(guó)的需要選擇不同的臨床技巧ThebasicroleofGPremainsthesameineachcountry全科醫(yī)生的基本任務(wù)在每個(gè)國(guó)家仍然是一致的ThisnextsectionwillshowyousomeoftheskillswetrainGPstodointheUSA下一部分將向您介紹美國(guó)全科醫(yī)生被訓(xùn)練的部分技能整理課件21GeneralPracticeCompetencies

Whomandwhatdowetreat?

我們給誰(shuí)治療，治療什么？

AllagesandBothsexes

所有的年齡和性別整理課件22Whomandwhatdowetreat?

我們給Obstetrics

產(chǎn)科學(xué)

(Willgointomoredetailoneacharealaterifdesired

如果愿意我們將在后面詳細(xì)介紹每一方面的內(nèi)容)Ultrasound

超聲

Dating確定預(yù)產(chǎn)期

Fetalviability胎兒變異度

Placentaposition胎位

Abnormalities畸形Vacuumextraction胎頭吸引Episiotomies側(cè)切Externalfetalheart胎心監(jiān)護(hù)

monitoringTocomonitor

宮縮監(jiān)護(hù)PlacementofscalpandIUPC頭皮電極放置及胎兒宮內(nèi)檢測(cè)LeopoldManeuver臀位分娩助產(chǎn)術(shù)Reductionofshoulderdystocia

解除肩難產(chǎn)Laborinduction

引產(chǎn)整理課件23Obstetrics

產(chǎn)科學(xué)

(WillgointoPediatrics...

兒科學(xué)整理課件24Pediatrics...

兒科學(xué)整理課件24InternalMedicine

內(nèi)科學(xué)ButAllOtherSpecialtiesasWell及所有其他專業(yè)整理課件25InternalMedicine

內(nèi)科學(xué)ButAllODiagnosticModalitiesandLaboratoryEvaluations

診斷模式和實(shí)驗(yàn)室結(jié)果評(píng)估Laboratorystudies實(shí)驗(yàn)室檢查

CBC血常規(guī)

Chemistries生化檢查

LFTs肝功

Cultures培炎

Lipids血脂

TSH促甲狀腺素

Manyothers很多其他的RoentgeninterpretationMicroscopy顯微鏡檢查

Wetprep

白帶常規(guī)

Parasites

寄生蟲

Other

其他Rapidtests快速檢測(cè)

Strep

鏈球菌

Mono

單核細(xì)胞

Infulenza

流感

HemoglobinandHct血紅蛋白和血紅蛋白壓積

Bloodsugar

血糖

H.Pylori

幽門螺旋桿菌

Others

其他整理課件26DiagnosticModalitiesandLaboProcedures:Injections,Dermatologicalprocedures,andFineneedleaspirations

操作：注射，皮膚病方面的操作，和細(xì)針抽吸Biopsies:活檢

Punch剔除法

Shave刮除法

Excision切除法Jointaspiration關(guān)節(jié)液吸出和腔內(nèi)注射

andinjectionTendoninjections肌腱注射Cryotherepy冷凍Hyfercation/cautery電切術(shù)Cystandlipomaremoval囊腫和脂肪瘤切除Foreignbodyremoval去除異物

Eyes眼睛

Ears耳朵

Nose鼻子

Other其他Suturing/lacerationrepair縫合/裂傷修補(bǔ)Castingsimplefractures簡(jiǎn)單骨折的固定術(shù)Splinting打夾板整理課件27Procedures:Injections,Dermat整理課件28整理課件28Colposcopy,Exercisestresstesting,Flexiblesigmoidoscopy,

andmanymore!

陰道鏡檢查，運(yùn)動(dòng)負(fù)荷實(shí)驗(yàn)，纖維乙狀結(jié)腸鏡檢查，還有更多！ECG心電圖ExerciseStressTest運(yùn)動(dòng)負(fù)荷試驗(yàn)Holter/eventmonitors動(dòng)態(tài)心電監(jiān)護(hù)Cardioversionwithdefibrillator除顫儀除顫Colposcopy陰道鏡Cryotherepy冷凍Thoracentesis胸穿Paracentesis腹穿Lumbarpuncture胸穿Intubation氣管插管Cardio-pulmonaryresuscitation心肺復(fù)蘇Endoscopy內(nèi)鏡Vascectomy輸精管切除術(shù)Circumscision

包皮環(huán)切術(shù)整理課件29Colposcopy,ExercisestressteNotonlyTreatmentofDiseasebutalsoPrevention

不但治療疾病而且預(yù)防疾病Cancer

screening癌癥篩查Vaccinations預(yù)防接種Lifestylemodification生活方式的改變整理課件30NotonlyTreatmentofDiseaseCooperationwithotherspecialists-healthcareprofessionals

與其他?？漆t(yī)生合作整理課件31CooperationwithotherspecialTheImportanceof

PostGraduateTraining畢業(yè)后培訓(xùn)的重要性Medicalschoolaloneisnotenough僅醫(yī)學(xué)院是不夠的Medicalinformationisincreasingrapidly醫(yī)學(xué)信息飛速增加GPsneedtoknowhowtodiagnoseandtreatcommondiseases,notjustbookknowledge全科醫(yī)生需要知道如何診斷和治療常見病，不僅是知道書本的知識(shí)Residencyprovides住院醫(yī)生培訓(xùn)提供：Developmentofdiagnosticandproceduralskills診斷和操作能力的發(fā)展Awarenessofdevelopmentsinotherspecialties了解其它專業(yè)的發(fā)展Knowledgeofhowtousetheentiremedicalsystemtobenefittheirpatients知道如何使用整個(gè)醫(yī)療體系以使病人受益Understandingofwholepersoncare:bio-psycho-social-spiritualmodelofhealth理解全人的照顧：健康的生物-心理-社會(huì)-精神模式整理課件32TheImportanceof

PostGraduaGPisNewinManyCountries

全科醫(yī)學(xué)在許多國(guó)家是新生事物NewSpecialty新的專科Challengeofdecidingwhatitwillbelike決定全科醫(yī)學(xué)的模式是一個(gè)挑戰(zhàn)IntegratingGPwithexistingmedicalsystem將全科醫(yī)學(xué)和現(xiàn)有的醫(yī)療系統(tǒng)一體化Gainingacceptancewithdoctorsandpatients得到醫(yī)生和患者的接受Becominganattractivespecialtytomedicalstudents成為對(duì)醫(yī)學(xué)生有吸引力的專業(yè)整理課件33GPisNewinManyCountries

全科ConsiderChangesintheMedicalSystem醫(yī)學(xué)界在考慮的變革Needforadjustmentsinthepracticeofmedicine醫(yī)療領(lǐng)域里需要調(diào)整之處Moretimeperpatient每個(gè)病人更多的時(shí)間Historytaking采集病史Accuratediagnosisandmanagementofpatient準(zhǔn)確的診斷和治療Preventivecare預(yù)防性照顧Patienteducation病人教育，Etcetera等Needadjustmentsinhowdoctorsarereimbursed醫(yī)生收入來(lái)源需要調(diào)整Complexity復(fù)雜性Time時(shí)間整理課件34ConsiderChangesintheMedicaTheNeedforaGoodModel

一個(gè)好的全科醫(yī)學(xué)模式的需求Meetspatientsprimaryhealthcareneeds滿足病人初級(jí)衛(wèi)生保健的需要Professionallysatisfying職業(yè)的滿意度Highqualitytraining高質(zhì)量的培訓(xùn)RespectofColleagues同行的尊敬TrustofPatients病人的信任Financiallyrewarding薪酬上的回報(bào)整理課件35TheNeedforaGoodModel

一個(gè)好的MajorLessons–AppropriateModel

重要的教訓(xùn)–合適的模式modelmustbeappropriatetotheregion模式必須和地區(qū)相適應(yīng)Transplantingmodelswithoutmodificationdoesn’tworkwell不做調(diào)整而直接移植模式不能有效運(yùn)行OneSpecialty,Manymodels一個(gè)專業(yè)，很多模式AmericanModel美國(guó)模式BritishModel英國(guó)模式Knowledgebaseandtechnology/proceduresappropriatetothespecialtyandtheregion知識(shí)基礎(chǔ)、技術(shù)和操作要適合專業(yè)和地區(qū)整理課件36MajorLessons–AppropriateMConsequencesofanInadequateModel

不適當(dāng)模式的結(jié)果Nointerestonthepartofmedicalstudents

醫(yī)學(xué)生沒(méi)有興趣Inadequatetrainingforthejobassignment

對(duì)于分配的工作沒(méi)有得到充分的培訓(xùn)FeelingunpreparedinthosewhodoFPwork

那些要做全科醫(yī)療工作的人感覺(jué)沒(méi)有準(zhǔn)備好Lackofrespectfromcolleagues

缺乏同事的尊重Lackoftrustfrompatients

缺乏病人的信任Lowsalary

低薪酬Highdropoutrate

高的放棄率整理課件37ConsequencesofanInadequateKnowledgeBase

知識(shí)基礎(chǔ)FP’sknow20-30%ofeachoftheotherspecialtiesknowledge:

全科醫(yī)生應(yīng)該知道每一個(gè)專科知識(shí)的20-30%SpecialistsseeFPfromtheirperspective?？漆t(yī)生從他們的角度看待全科醫(yī)生FP’sknowlessthanthespecialistinhisarea在專科領(lǐng)域全科醫(yī)生的知識(shí)不如?？漆t(yī)生FP’sknowmorethanthespecialistinotherareas

在其他的領(lǐng)域全科醫(yī)生的知識(shí)多于?？漆t(yī)生整理課件38KnowledgeBase

知識(shí)基礎(chǔ)FP’sknow2Depthvs.BreadthofKnowledgeBase

知識(shí)基礎(chǔ)的深度與廣度對(duì)比0102030405060708090100Internist內(nèi)科Pediatrics兒科Ob-Gyn婦產(chǎn)科Surgery外科整理課件39Depthvs.BreadthofKnowledge0102030405060708090100FP全科Internist內(nèi)科Peds兒科Ob-gyn婦產(chǎn)科.Surgery外科TotalKnowledgeContent

總知識(shí)含量整理課件400102030405060708090100FP全科InteKnowledgeBase–ImportanttoEmphasize

知識(shí)基礎(chǔ)-重中之重Arethreeyearsoftrainingenough?

三年的培訓(xùn)足夠嗎？Knowwhatisneededtobeknown!

知道所需要知道的知識(shí)25-30%ofknowledgecove85-90%ofthediseases

“Rapidlyprogressingglomerulonephritis”nothighontheprioritylist25-30%知識(shí)覆蓋85-90%的疾病。急進(jìn)性腎小球腎炎不是最優(yōu)先需要學(xué)習(xí)的7/1,000,000發(fā)病率1/142,857=1/lifetimeofFP…Maybe!一個(gè)全科醫(yī)生可能在一生中就看一個(gè)這樣的病例Debateoveraddinga4thyear是否需要增加第四年的培訓(xùn)仍有爭(zhēng)議整理課件41KnowledgeBase–ImportanttoPrimaryCareImproves

CommunityHealth

初級(jí)保健使社區(qū)健康得到改進(jìn)Betterhealthoutcomes

健康結(jié)局更好

Increaseduseofdisease-focusedpreventivecare(e.g.,

bloodpressurescreening,mammograms,

papsmears,etc)疾病為中心的預(yù)防保健增多（如血

壓篩查，乳腺X片，宮頸防癌普查等）

Fewerpatientsadmittedforpreventablecomplicationsof

chronicdisease

更少的病人因可預(yù)防的慢性病并發(fā)癥而收入院Lowerallcausemortality全因死亡率降低Fewerconsultationswithspecialists專家會(huì)診減少Lessuseofemergencyservices

減少使用急救服務(wù)整理課件42PrimaryCareImproves

CommuniImprovedCommunityHealthwithPrimaryCare初級(jí)保健使社區(qū)保健得到改進(jìn)Lessre-hospitalization減少再入院Betterdetectionofadverseeffectsofinterventions更好地發(fā)現(xiàn)干預(yù)措施的不良反應(yīng)Betterunderstandingofpsychologicalaspectsofapatient’sproblem更好地理解病人問(wèn)題的心理方面Protectionagainstovertreatment避免過(guò)度治療Moreefficientuseofresources資源更有效地利用Bettercomplianceandlowerhospitalizationrate依從性更高，入院率更低Otherbenefitsaswell還有其它益處Allwelldocumented都被很好地記錄整理課件43ImprovedCommunityHealthwithGeneralPracticehasaUniqueandImportantRoleinHealthSystems

全科醫(yī)學(xué)在健康系統(tǒng)中有獨(dú)一無(wú)二的重要作用Advocateforpatientsinmedicalsystem在醫(yī)療體系中支持病人Managementofpatientcare病人保健的管理Preventivehealthcareandpatienteducation預(yù)防性的健康照顧和病人教育Provisionofcomprehensivehealthcareinasinglelocation在一個(gè)處所提供綜合性的健康照顧C(jī)areofentirefamiliesovertime整個(gè)家庭的長(zhǎng)期照顧Notlimitedtogender,age,organsystem不局限性別、年齡、器官系統(tǒng)整理課件44GeneralPracticehasaUniqueGeneralPracticehasaUniqueandImportantRoleinHealthSystems

全科醫(yī)學(xué)在保健體系中有獨(dú)一無(wú)二的重要作用Benefitstocommunitiesandindividuals對(duì)社區(qū)和個(gè)人的益處Doctorknowspatientwell醫(yī)生非常了解病人Patientstrusttheirdoctor病人信任醫(yī)生Increasedpatientsatisfaction病人滿意度提高Greatereaseofaccesstomedicalcare醫(yī)療照顧更有可及性Lowercost更低的費(fèi)用Fewermedicalmistakes更少的醫(yī)療錯(cuò)誤Emphasisonprevention強(qiáng)調(diào)預(yù)防SatisfyingprofessionalcareersforGPdoctors全科醫(yī)生對(duì)職業(yè)感到滿意整理課件45GeneralPracticehasaUniqueRuralorUrban:農(nóng)村或城市

DoFPbelongonlyinruralareas?

家庭醫(yī)生只屬于農(nóng)村地區(qū)嗎？NeededinRuralareas:villages,towns,smallcities在村、鎮(zhèn)、小城市等農(nóng)村地區(qū)需要：Notenoughspecialiststosupplyallsmalltowns沒(méi)有足夠的專家可以為所有小鎮(zhèn)提供醫(yī)療服務(wù)Notenoughdemandtosupportalltheotherspecialties沒(méi)有那樣多的對(duì)所有專科的醫(yī)療需求FP/GPneedstobewelltrainedtohandlemanycomplexproblemsandprocedures家庭/全科醫(yī)生需要得到很好的培訓(xùn)以應(yīng)付很多復(fù)雜的問(wèn)題和操作NeededinUrban/cityareas在城市也需要SpecializationisoneofthereasonsFMisneeded需要家庭醫(yī)生的一個(gè)理由是?？苹疢anagementofcareisevenmorecriticall更為關(guān)鍵的是健康照顧管理Costcontrol費(fèi)用控制整理課件46RuralorUrban:農(nóng)村或城市

DoFPbeALittleUSMedicalHistory

一點(diǎn)美國(guó)的醫(yī)學(xué)史Priorto1969aGP早在1969年，全科醫(yī)生：finishedmedicalschool

從醫(yī)學(xué)院畢業(yè)finishedaoneyearrotatinginternship

完成一年的實(shí)習(xí)醫(yī)生輪轉(zhuǎn)Beganpracticing開始行醫(yī)Uptoearly1900’smostAmericandoctorswereGPs在20世紀(jì)初之前大多數(shù)美國(guó)醫(yī)生是全科醫(yī)生Uptothe1930’s80%wereGPsandonly20%specialists到20世紀(jì)30年代，醫(yī)生中80%是全科醫(yī)生，20%是?？漆t(yī)生整理課件47ALittleUSMedicalHistory

一點(diǎn)ALittleUSMedicalHistory

一點(diǎn)美國(guó)的醫(yī)學(xué)史1940’s:anexplosionofmedicalknowledgeandanincreaseinspecialization20世紀(jì)40年代：醫(yī)學(xué)知識(shí)爆炸，專業(yè)化程度提高M(jìn)edicalstudentswantedsecurity:knowallaboutoneareaofmedicine醫(yī)學(xué)生想要安全感：掌握某個(gè)醫(yī)學(xué)領(lǐng)域的全部

知識(shí)Therewasanincreaseofspecialtyresidenciesandcertificationboards?？漆t(yī)師培訓(xùn)項(xiàng)目和資格認(rèn)證委員會(huì)增多Boardcertificationwasnotseenasnecessaryforgeneralpractice?？瀑Y格認(rèn)證并非全科醫(yī)療所必需的整理課件48ALittleUSMedicalHistory

一點(diǎn)EffectofWorldWarII二戰(zhàn)的影響WorldWarIImadethesituationforGPsworse二戰(zhàn)讓全科醫(yī)生的境遇變差Governmentdefermentsformedicalstudentsgoingintoresidencies.TherewasnoresidencyforGP政府讓醫(yī)學(xué)生延遲進(jìn)入住院醫(yī)生培訓(xùn)。當(dāng)時(shí)沒(méi)有全科住院醫(yī)生培訓(xùn)。Medicalschoolgraduatesrushedintospecialtyresidencies醫(yī)學(xué)院畢業(yè)生匆匆進(jìn)入?？谱≡横t(yī)生培訓(xùn)。AfterWWII:governmentpaidformedicalschoolandresidencytrainingbuttherewerestillnoGPresidencyprograms二戰(zhàn)以后：政府給醫(yī)學(xué)院和住院醫(yī)生培訓(xùn)付費(fèi)，但是仍然沒(méi)有全科住院醫(yī)生培訓(xùn)項(xiàng)目。整理課件49EffectofWorldWarII二戰(zhàn)的影響WoHardTimesforGPs

全科醫(yī)生的困難時(shí)期1940to1952specialtyresidenciesgrewfrom5,200to22,0001940到1952年，?？谱≡横t(yī)生培訓(xùn)項(xiàng)目從5200增加到22000Healthcarewasbecomingunavailabletomany許多人無(wú)法得到衛(wèi)生保健服務(wù)。specialistsstayedincitiesnearhospitals?？漆t(yī)生住在醫(yī)院附近城市GPsbecamefewerinnumber全科醫(yī)生數(shù)目越來(lái)越少整理課件50HardTimesforGPs

全科醫(yī)生的困難時(shí)期19HardTimesforGPs

全科醫(yī)生的困難時(shí)期Generalpracticewasgettingleftbehind全科醫(yī)療被忽視Begantofightback開始反擊EstablishedtheAmericanAcademyofGeneralPracticein1947

1947年建立美國(guó)全科醫(yī)學(xué)學(xué)會(huì)Grewquickly快速發(fā)展Highstandards高水準(zhǔn)CMErequirement150hourseverythreeyears(firstspecialtytodothis)

要求每三年完成150小時(shí)的繼續(xù)醫(yī)學(xué)教育

（最先開始這樣做的人群）Stillhadnoboardcertification仍然沒(méi)有專業(yè)資格認(rèn)證整理課件51HardTimesforGPs

全科醫(yī)生的困難時(shí)期GeGPsStruggletoSucceed

全科醫(yī)生奮斗成功Inmid1940’sAAGPrequestedspecialtytraining

20世紀(jì)40年代中期，美國(guó)全科醫(yī)學(xué)學(xué)會(huì)要求?？婆嘤?xùn)Bettertrainingindiagnosingandtreatingdisease

得到更好的診斷和治療方面的訓(xùn)練

Greaterawarenessofconditionsrequiringreferralorspecialtestsortreatment

更清楚地知道哪些情況下需要轉(zhuǎn)診或特殊檢查及治療

Approachedmajormedicalschools進(jìn)入重點(diǎn)醫(yī)學(xué)院“Goodideabutdoitsomewhereelse”

“很好的想法，但到別的地方進(jìn)行”整理課件52GPsStruggletoSucceed

全科醫(yī)生奮斗GPsStruggletoSucceed

全科醫(yī)生奮斗成功Allthrough1950’sandmostofthe1960’scontinuedtoworkforimprovement

整個(gè)20世紀(jì)50年代和20世紀(jì)60年代的多數(shù)時(shí)間持續(xù)不斷

地取得工作進(jìn)步整理課件53GPsStruggletoSucceed

全科醫(yī)生奮斗AmericanMedicalSystemSufferedfromOverSpecialization

美國(guó)醫(yī)療體系曾遭遇過(guò)度專業(yè)化USmedicalsysteminthe1960’s

20世紀(jì)60年代的美國(guó)醫(yī)療體系Increasinglyspecialized 越來(lái)越專業(yè)化Medicalcostsrising 醫(yī)療花費(fèi)上升Patientcaresuffering 病人保健遭受到：Patientcaresuffering 病人保健遭受到：Noonemanagingtheoverallcareofthepatient沒(méi)有人管理病人的總體保健Noonecoordinatingcareamongspecialists

沒(méi)有人綜合協(xié)調(diào)?？漆t(yī)生的治療整理課件54AmericanMedicalSystemSufferAmericanMedicalSystemSufferedfromOverSpecialization

美國(guó)醫(yī)療體系曾遭遇過(guò)度專業(yè)化Noonefocusedonpreventivecare沒(méi)有人關(guān)注預(yù)防保健Noonewhocouldtreatmostorallofcommondiseases沒(méi)有人能夠治療大部分或是所有的常見病Patientshadtoseemanyspecialiststogetroutinephysicalexams病人不得不去看許多的?？漆t(yī)生以做常規(guī)體格檢查CentralAsiaworse:10-12doctorsneededtodopreschoolphysical中亞情況更糟：做入學(xué)前體檢需要看10到12個(gè)醫(yī)生Increasingnumberofmedicalmistakesandmisseddiagnosis

誤診和漏診數(shù)目增加整理課件55AmericanMedicalSystemSufferAmericanMedicalSystemSufferedfromOverSpecialization

美國(guó)醫(yī)療體系曾遭遇過(guò)度專業(yè)化Healthcarewasbecomingunavailabletomany許多人無(wú)法得到衛(wèi)生保健服務(wù)。specialistsstayedincitiesnearhospitals?？漆t(yī)生住在醫(yī)院附近城市GPsbecamefewerinnumber全科醫(yī)生數(shù)目越來(lái)越少整理課件56AmericanMedicalSystemSufferMedicalCommunityFinallyRecognized

theNeedforWellTrainedGeneralists

醫(yī)學(xué)界終于意識(shí)到對(duì)受過(guò)良好訓(xùn)練全科醫(yī)生的需求TheFolsomReportFolsom報(bào)告TheMillsCommissionMills委托代理TheWillardCommitteeWillard委員會(huì)整理課件57MedicalCommunityFinallyRecoAcceptanceatLast終于接受MedicalschoolsnowbeganGPresidencies

醫(yī)學(xué)院?，F(xiàn)在開始全科住院醫(yī)生培訓(xùn)

February8,1969thefirstresidenciesstarted:“specialtyinbreadth”

1969年2月8日第一個(gè)住院醫(yī)生培訓(xùn)項(xiàng)目開始：

“范圍寬的專業(yè)”

1970theABFP(AmericanBoardofFamilyPractice)offereditsfirstboardexam

1970年美國(guó)家庭醫(yī)學(xué)認(rèn)證機(jī)構(gòu)進(jìn)行了第一次資格認(rèn)證考試整理課件58AcceptanceatLast終于接受整理課件58AcceptanceatLast終于接受1971thenamechangedfromGPtoFPtosignifythechangeintraining

1971年由GP更名為FP以象征在培訓(xùn)方面的變化

Rapidgrowth快速發(fā)展

1970250residencieswith3,820residents

1970年250個(gè)住院醫(yī)師培訓(xùn)項(xiàng)目，包括3,820名住院醫(yī)生

2007463residencieswith9,330residents

2007年有463個(gè)住院醫(yī)師培訓(xùn)項(xiàng)目，包括9,330名住院醫(yī)生

MembershipintheAAFP:96,614(includesresidents,

etcetera)

AAFP的會(huì)員數(shù)目：96,614（包括住院醫(yī)生，等等）整理課件59AcceptanceatLast終于接受整理課件59WhoisaFP/GP?

誰(shuí)是家庭醫(yī)生/全科醫(yī)生？Surgicalpersonality!外科性格！Internistpersonality!內(nèi)科性格！Familymedicinepersonality!全科性格！整理課件60WhoisaFP/GP?

誰(shuí)是家庭醫(yī)生/全科醫(yī)生？SuHowManyYearsofTrainingtobeaFPintheUSA?

在美國(guó)培訓(xùn)全科醫(yī)生需要多少年？PrimaryandSecondarySchool12years小學(xué)和中學(xué)12年 University4years大學(xué)4年

MedicalSchool4years醫(yī)學(xué)院4年P(guān)ostGraduateResidency3years住院醫(yī)生3年

Total總共

23years整理課件61HowManyYearsofTrainingtoWhataretherequirementstobeaFamilyMedicineDoctorintheUSA?

在美國(guó)成為全科醫(yī)生的要求是什么？Succesfullyfinishingmedicalschool

成功地完成醫(yī)學(xué)院校的學(xué)習(xí)PassingthethreestepUSMLE

通過(guò)三步美國(guó)行醫(yī)執(zhí)照考試Completingapprovedresidencyprogram

完成住院醫(yī)培訓(xùn)PassingonedayFamilyPracticeExam

通過(guò)一天的全科醫(yī)生資格考試Completing150hoursofcontinuingmedicaleducationevery3years(The

AmericanAcademyofFamilyPracticewasthefirsttorequirethis

每三年完成150小時(shí)的繼續(xù)醫(yī)學(xué)教育（美國(guó)家庭醫(yī)學(xué)會(huì)最先要求這項(xiàng)內(nèi)容）Recertificationrequiredevery7years

行醫(yī)執(zhí)照每7年重新認(rèn)證一次整理課件62WhataretherequirementstobOurClinicandHospital

我們的診所和醫(yī)院整理課件63OurClinicandHospital

我們的診所和Whatisatypicalweeklikeforafamilymedicinedoctor?

(Statisticsfrom2008)

一個(gè)家庭醫(yī)生典型的一周工作（2008年統(tǒng)計(jì)）84.9

patientsperweek!(howmanyinChina?)

每周84.9個(gè)病人(中國(guó)多少?)8.1hospitalpatientvisitsperweek每周看8.1個(gè)住院病人2.3nursinghomepatients每周2.3個(gè)養(yǎng)老院病人訪視0.6homevisits每周0.6個(gè)家庭訪視7.5PatientsSupervisedunderhomehealthcare7.5

個(gè)家庭照顧指導(dǎo)9.6Nursinghomepatientssupervised9.6

個(gè)護(hù)理院病人指導(dǎo)2.1Hospicepatientssupervised2.1個(gè)臨終關(guān)懷病人指導(dǎo)9.5patientswithfreeordiscountedcare9.5

個(gè)減免費(fèi)的病人51hoursaweek每周工作51個(gè)小時(shí)Approximately2500patientscaredfor(800families)

大約需要照顧2500個(gè)病人（800個(gè)家庭）整理課件64WhatisatypicalweeklikefoWhyisGPthespecialtyofthe21stCentury?

為什么全科醫(yī)學(xué)會(huì)成為21世紀(jì)的?？?？Costeffective符合成本效益原則Satisfyingforthepatient患者滿意度高SatisfyingfortheGP!全科醫(yī)生滿意Emphasisonprevention強(qiáng)調(diào)預(yù)防Treatingthepatientinthecontextofthefamily在病人的家庭背景下治療Wholepersonmedicine

全人模式的醫(yī)學(xué)Systemsbasedapproach

以醫(yī)療體系為基礎(chǔ)的方法

整理課件65WhyisGPthespecialtyoftheThankYou!

謝謝！整理課件66ThankYou!

謝謝！整理課件66TheRole,PrinciplesandCompetenciesofFamilyMedicine

家庭醫(yī)學(xué)的作用、原則和能力ChrisJenkins,MD克里斯.金肯醫(yī)學(xué)博士April201120011年4月整理課件67TheRole,PrinciplesandCompe

我們是誰(shuí)？

Whoarewe?Cheung醫(yī)生Dannemiller醫(yī)生Heffron醫(yī)生

Jenkins醫(yī)生Leu醫(yī)生Rudd醫(yī)生Zhou周仲華醫(yī)生GuJian谷建醫(yī)生Joseph金世紅醫(yī)生

整理課件68我們是誰(shuí)？

Whoarewe?Cheun

我們是誰(shuí)？

Whoarewe?Baer醫(yī)生Chan醫(yī)生Heffron醫(yī)生

Jenkins醫(yī)生Leu醫(yī)生Schackow醫(yī)生Zhou周仲華醫(yī)生Gujian谷建醫(yī)生Longan醫(yī)生GuJian谷建醫(yī)生Joseph金世紅醫(yī)生

整理課件69我們是誰(shuí)？

Whoarewe?Baer醫(yī)

我們是誰(shuí)？

Whoarewe?Baer醫(yī)生Heffron醫(yī)生

Jenkins醫(yī)生PangYan醫(yī)生Burgos醫(yī)生GuJian谷建醫(yī)生Joseph金世紅醫(yī)生

整理課件70我們是誰(shuí)？

Whoarewe?Baer醫(yī)GoalsofTalk演講的目的Whygeneralpracticeisanimportantspecialtyinamedicalsystem為什么全科醫(yī)學(xué)是醫(yī)療體系里的一個(gè)重要?？芖hatdoGPsdo全科醫(yī)生做什么DiscusswhypostgraduateGPtrainingisimportant討論為何畢業(yè)后的全科培訓(xùn)很重要Whatarethebenefitstothecommunityandindividualpatients對(duì)社區(qū)和病人個(gè)體有什么益處整理課件71GoalsofTalk演講的目的WhygeneralWhatisFamilyMedicine?ItDependsonWhoYouAsk!

家庭醫(yī)學(xué)是什么？看你問(wèn)誰(shuí)！British英國(guó)Swedish瑞典Australia澳大利亞HongKong香港Canada加拿大America美國(guó)整理課件72WhatisFamilyMedicine?ItDeFamilyMedicineinChina

中國(guó)的家庭醫(yī)學(xué)NewinmodernChina是當(dāng)代中國(guó)的新生物Developinganewmodel發(fā)展一個(gè)新模式Thegovernmentandentiremedicalsystemrecognizeneedforgeneralpractice政府和整個(gè)醫(yī)學(xué)界認(rèn)識(shí)到對(duì)全科的需要TheMinistryofHealthhasnowprovidedamodelforgeneralpracticeandtrainingItisbeingimplementedacrossChina

衛(wèi)生部指出了全科醫(yī)療及其培訓(xùn)的模式

-全國(guó)都在實(shí)施整理課件73FamilyMedicineinChina

中國(guó)的家庭FamilyMedicineinChina

中國(guó)的家庭醫(yī)學(xué)PrinciplesofFMhassimilaritieswithsomeaspectsoftraditionalChinesemedicine家庭醫(yī)學(xué)的原則與傳統(tǒng)中醫(yī)的某些方面有相似之處Careforthewholefamily照顧整個(gè)家庭Youngandold年輕者和年長(zhǎng)者M(jìn)aleandfemale男性和女性Allorgansystems所有的器官系統(tǒng)Listentopatients傾聽患者Taketimewiththepatients花時(shí)間與病人在一起整理課件74FamilyMedicineinChina

中國(guó)的家庭FamilyMedicineinChina

中國(guó)的家庭醫(yī)學(xué)SomedifferencesbetweenGPandtraditionalChinesemedicine:全科醫(yī)學(xué)和傳統(tǒng)中醫(yī)的區(qū)別Understandingofcausesofdisease對(duì)病因的理解GPsemphasizefamily,socialandenvironmentalinfluences全科強(qiáng)調(diào)家庭、社會(huì)和環(huán)境的影響GPsrelyonscienceincludingevidencebasedmedicine全科醫(yī)學(xué)更依賴科學(xué)包括循證醫(yī)學(xué)HistoryandphysicalexamaredonemorethoroughlybyGPs全科醫(yī)生采集病史和體格檢查更全面徹底。整理課件75FamilyMedicineinChina

中國(guó)的家庭WhatisFamilyMedicineintheUSA?

美國(guó)的家庭醫(yī)學(xué)是什么？Medicalspecialty醫(yī)學(xué)專業(yè)RecognizedasspecialtyintheUSsince1969自從1969年起在美國(guó)被認(rèn)定為一種醫(yī)學(xué)專業(yè)Over80,000familyphysiciansintheUS在美國(guó)有超過(guò)80,000多名全科醫(yī)生整理課件76WhatisFamilyMedicineintheWhatisFamilyMedicineintheUSA?

美國(guó)的家庭醫(yī)學(xué)是什么？Over420trainingprograms(residencies)withover9,000residents

超過(guò)420個(gè)住院醫(yī)師培訓(xùn)項(xiàng)目,超過(guò)9,000名住院醫(yī)生Cantreat85-90%ofmedicalproblems

能夠治療85-90%的醫(yī)學(xué)問(wèn)題整理課件77WhatisFamilyMedicineinthe

WhatisFamilyPracticeintheUnitedStates?在美國(guó)家庭醫(yī)學(xué)是什么樣的?

12%ofallUSdoctorsarefamilypracticedoctors

12%的美國(guó)醫(yī)生是家庭醫(yī)生But25%ofallofficevisitsintheUSaretofamilydoctors!

但是美國(guó)25%的就診都是看全科醫(yī)生！

整理課件78

WhatisFamilyPracticeinthWhereDoWeWork?

我們?cè)谀睦锕ぷ?？Clinic門診Hospital醫(yī)院EmergencyDepartment急診室NursingHomes養(yǎng)老院Other其他整理課件79WhereDoWeWork?

我們?cè)谀睦锕ぷ鳎緾linPhilosophicalFocusofFamilyMedicine

家庭醫(yī)學(xué)的理念Continuityofcare照顧的持續(xù)性Managementofcare健康照顧管理Treatingpatientincontextoffamily在家庭背景下治療病人Preventivecare預(yù)防保健Teamapproach團(tuán)隊(duì)探討EBM循證醫(yī)學(xué)整理課件80PhilosophicalFocusofFamilyContinuityofCare

照顧的持續(xù)性

Seeingpatientsoveranextendedperiodoftime長(zhǎng)時(shí)間內(nèi)照顧病人Developingthedoctor-patientrelationship發(fā)展醫(yī)患關(guān)系Familiaritywithpatienthealthstatus熟悉病患的健康狀態(tài)Developingtrust發(fā)展信任關(guān)系整理課件81ContinuityofCare

照顧的持續(xù)性

SeeiManagementofCare

保健管理EvaluationofthePatient病人病情的評(píng)估Diagnostictests診斷檢查Involvementofspecialists?？漆t(yī)生參與Treatmentplans診療計(jì)劃整理課件82ManagementofCare

保健管理EvaluatPatientCareintheContextoftheFamily

以家庭為背景的病人保健Homeenvironment家庭環(huán)境Familydynamics家庭動(dòng)力學(xué)Familyhealthbeliefsandpractices家庭的健康理念和實(shí)踐Social,work,andreligioussettings社會(huì)環(huán)境，工作環(huán)境和宗教環(huán)境整理課件83PatientCareintheContextofPreventiveMedicine

預(yù)防醫(yī)學(xué)Patienteducation病人教育Lifestylemodification生活方式的調(diào)整Ageandgenderspecificdiseasescreening根據(jù)年齡和性別而特異的疾病篩查Medicalintervention醫(yī)療干預(yù)整理課件84PreventiveMedicine

預(yù)防醫(yī)學(xué)PatienTeamApproacht