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1、The Role,Principles and Competencies of Family Medicine 家庭医学的作用、原则和能力Chris Jenkins,MD克里斯.金肯医学博士March 2010 2010年3月Goals of Talk演讲的目的Why is general practice an important specialty in a medical system为什么全科医学是医疗体系里的一个重要专科Discuss why post graduate GP training is important 讨论为何毕业后的全科培训很重要What are the bene
2、fits to the community and individual patients 对社区和病人个体有什么益处What do GPs do全科医生做什么3 3A Little US Medical History一点美国的医学史Prior to 1969 a GP Prior to 1969 a GP 早在早在19691969年，全科医生：年，全科医生：finished medical schoolfinished medical school从医学院毕业从医学院毕业finished a one year rotating internshipfinished a one year r
3、otating internship完成一年的实完成一年的实习医生轮转习医生轮转Began practicingBegan practicing开始行医开始行医Up to early 1900s most American doctors were GPsUp to early 1900s most American doctors were GPs 在在1919世纪初之前大多数美国医生是全科医生世纪初之前大多数美国医生是全科医生Up to the 1930s 80%were GPs and only 20%Up to the 1930s 80%were GPs and only 20%spe
4、cialistsspecialists 到到1919世纪世纪3030年代，医生中年代，医生中80%80%是全科医生，是全科医生，20%20%是是专科医生专科医生4 4A Little US Medical History一点美国的医学史1940s:an explosion of medical knowledge and 1940s:an explosion of medical knowledge and an increase in specializationan increase in specialization 19 19世纪世纪4040年代：医学知识爆炸，专业化程度提高年代：医学
5、知识爆炸，专业化程度提高Medical students wanted security:know all Medical students wanted security:know all about one area of medicineabout one area of medicine 医学生想要安全感：掌握某个医学领域的全部医学生想要安全感：掌握某个医学领域的全部知识知识There was an increase of specialty There was an increase of specialty residencies and certification boardsr
6、esidencies and certification boards 专科医师培训项目和资格认证委员会增多专科医师培训项目和资格认证委员会增多Board certification was not seen as necessary Board certification was not seen as necessary for general practicefor general practice 专科资格认证并非全科医疗所必需的专科资格认证并非全科医疗所必需的Effect of World War II二战的影响World War II made the situation for
7、GPs worse二战让全科医生的境遇变差 Government deferments for medical students going into Government deferments for medical students going into residencies.There was no residency for GPresidencies.There was no residency for GP 政府让医学生延迟进入住院医生培训。当时没有全科住政府让医学生延迟进入住院医生培训。当时没有全科住院医生培训。院医生培训。Medical school graduates ru
8、shed into specialty Medical school graduates rushed into specialty residenciesresidencies 医学院毕业生匆匆进入专科住院医生培训。医学院毕业生匆匆进入专科住院医生培训。After WWII:government paid for medical school and After WWII:government paid for medical school and residency training but there were still no GP residency residency traini
9、ng but there were still no GP residency programsprograms 二战以后：政府给医学院和住院医生培训付费，但是仍二战以后：政府给医学院和住院医生培训付费，但是仍然没有全科住院医生培训项目。然没有全科住院医生培训项目。6 6Hard Times for GPs全科医生的困难时期1940 to 1952 specialty residencies grew from 5,200 1940 to 1952 specialty residencies grew from 5,200 to 22,000.to 22,000.1940 1940到到1952
10、1952年，专科住院医生培训项目从年，专科住院医生培训项目从52005200增加增加到到2200022000Health care was becoming unavailable to manyHealth care was becoming unavailable to many 许多人无法得到卫生保健服务。许多人无法得到卫生保健服务。specialists stayed in cities near hospitalsspecialists stayed in cities near hospitals专科医生住在专科医生住在医院附近城市医院附近城市GPs became fewer in
11、 numberGPs became fewer in number全科医生数目越来越少全科医生数目越来越少7 7Hard Times for GPs全科医生的困难时期General practice was getting left behindGeneral practice was getting left behind全科医疗全科医疗被忽视被忽视Began to fight backBegan to fight back开始反击开始反击 Established the American Academy of General Established the American Academy
12、 of General Practice in 1947Practice in 1947 19471947年建立美国全科医学学会年建立美国全科医学学会 Grew quicklyGrew quickly快速发展快速发展High standardsHigh standards高水准高水准CME requirement 150 hours every three CME requirement 150 hours every three years(first group to do this)years(first group to do this)要求每三年完成要求每三年完成150150小时的继
13、续医学教育（最先开始这样做小时的继续医学教育（最先开始这样做的人群）的人群）Still had no board certificationStill had no board certification仍然没有资格认证仍然没有资格认证GPs Struggle to Succeed全科医生奋斗成功In mid 1940s AAGP requested specialty training In mid 1940s AAGP requested specialty training 1919世纪世纪4040年代中期，美国全科医学学会要求专科培训年代中期，美国全科医学学会要求专科培训 Better
14、 training in diagnosing and treating diseaseBetter training in diagnosing and treating disease 得到更好的诊断和治疗方面的训练得到更好的诊断和治疗方面的训练 Greater awareness of conditions requiring referral or Greater awareness of conditions requiring referral or special tests or treatment special tests or treatment 更清楚地知道哪些情况下需
15、要转诊或特殊检查及治疗更清楚地知道哪些情况下需要转诊或特殊检查及治疗Approached major medical schoolsApproached major medical schools进入重点医学院进入重点医学院“Good idea but do it somewhere else”“Good idea but do it somewhere else”“很好的想法，但到别的很好的想法，但到别的地方进行地方进行”All through 1950s and most of the 1960s continued All through 1950s and most of the 19
16、60s continued to work for improvementto work for improvement 整个整个1919世纪世纪5050年代和年代和1919世纪世纪6060年代的多数时间持续年代的多数时间持续不断地取得工作进步不断地取得工作进步9 9American Medical System Suffered from Over American Medical System Suffered from Over SpecializationSpecialization美国医疗体系曾遭遇过度专业化美国医疗体系曾遭遇过度专业化US medical system in the 1960s19US medical system in the 1960s19世纪世纪6060年代的美国医疗体年代的美国医疗体系系 Increasingly specialized Increasingly specialized 越来越专业化越来越专业化 Medical costs rising Medical costs rising 医疗花费上升医疗花费上升 Patient care su
