The Role, Principles and Competencies The Role, Principles and Competencies of Family Medicine of Family Medicine

家庭医学的作用、原则和能力家庭医学的作用、原则和能力

Chris Jenkins, MD Chris Jenkins, MD 克里斯克里斯 .. 金肯医学博金肯医学博士士

Goals of TalkGoals of Talk 演讲的目的演讲的目的Why is general practice an important specialty in Why is general practice an important specialty in a medical system a medical system 为什么全科医学是医疗体为什么全科医学是医疗体系里的一个重要专科系里的一个重要专科Discuss why post graduate GP training is Discuss why post graduate GP training is important important

讨论为何毕业后的全科培训很重要讨论为何毕业后的全科培训很重要What are the benefits to the community and What are the benefits to the community and individual patientsindividual patients

对社区和病人个体有什么益处对社区和病人个体有什么益处What do GPs do What do GPs do 全科医生做什么全科医生做什么

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A Little US Medical HistoryA Little US Medical History

一点美国的医学史一点美国的医学史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 rotating internship

完成一年的实习医生轮转完成一年的实习医生轮转– Began practicingBegan practicing 开始行医开始行医Up to early 1900’s most American doctors were GPsUp to early 1900’s 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 1930’s 80% were GPs and only 20% Up to the 1930’s 80% were GPs and only 20%

specialistsspecialists 到到 1919 世纪世纪 3030 年代，医生中年代，医生中 80%80% 是全科医是全科医

生，生， 20%20% 是专科医生是专科医生

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A Little US Medical HistoryA Little US Medical History

一点美国的医学史一点美国的医学史1940’s: an explosion of medical knowledge and an 1940’s: an explosion of medical knowledge and an increase in specializationincrease in specialization

1919 世纪世纪 4040 年代：医学知识爆炸，专业化程度提高年代：医学知识爆炸，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 residencies There was an increase of specialty residencies

and certification boardsand 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

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Hard Times for GPsHard Times for GPs

全科医生的困难时期全科医生的困难时期1940 to 1952 specialty residencies grew from 5,200 to 1940 to 1952 specialty residencies grew from 5,200 to 22,00022,000

19401940 到到 19521952 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 增增加到加到 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 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

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Hard Times for GPsHard Times for GPs

全科医生的困难时期全科医生的困难时期General practice was getting left behindGeneral practice was getting left behind– 全科医疗被忽视全科医疗被忽视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 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 years CME requirement 150 hours every three years (first specialty to do this)(first specialty to do this)

要求每三年完成要求每三年完成 150150 小时的继续医学教育小时的继续医学教育（最先开始这样做的人群）（最先开始这样做的人群）

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77

GPs Struggle to SucceedGPs Struggle to Succeed全科医生奋斗成功全科医生奋斗成功

In mid 1940’s AAGP requested specialty training In mid 1940’s AAGP requested specialty training

19 19 世纪世纪 4040 年代中期，美国全科医学学会要求专科培年代中期，美国全科医学学会要求专科培训训– Better 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，但到别的地方进行”很好的想法，但到别的地方进行”

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GPs Struggle to SucceedGPs Struggle to Succeed全科医生奋斗成功全科医生奋斗成功

All through 1950’s and most of the 1960’s All through 1950’s and most of the 1960’s continued to work for improvementcontinued to 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 年代的年代的多数时间持续不断多数时间持续不断 地取得工作进步地取得工作进步

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American Medical System Suffered from Over SpecializationAmerican Medical System Suffered from Over Specialization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 1960’sUS medical system in the 1960’s

1919 世纪世纪 6060 年代的美国医疗体系年代的美国医疗体系– 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 suffering Patient care suffering 病人保健遭受到：病人保健遭受到：

Patient care suffering Patient care suffering 病人保健遭受到：病人保健遭受到：No one managing the overall care of the patientNo one managing the overall care of the patient

没有人管理病人的总体保健没有人管理病人的总体保健No one coordinating care among specialistsNo one coordinating care among specialists

没有人综合协调专科医生的治疗没有人综合协调专科医生的治疗

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American 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– No one focused on preventive careNo one focused on preventive care 没有人关没有人关

注预防保健注预防保健– No one who could treat most or all of common No one who could treat most or all of common

diseasesdiseases 没有人能够治疗大部分或是所有的常见病没有人能够治疗大部分或是所有的常见病

Patients had to see many specialists to get routine Patients had to see many specialists to get routine physical examsphysical exams

病人不得不去看许多的专科医生以做常规体格检查病人不得不去看许多的专科医生以做常规体格检查– Central Asia worse: 10-12 doctors needed to do Central Asia worse: 10-12 doctors needed to do

preschool physicalpreschool physical 中亚情况更糟：做入学前体检需要看中亚情况更糟：做入学前体检需要看 1010 到到 1212 个医生个医生

– Increasing number of medical mistakes and Increasing number of medical mistakes and missed diagnosismissed diagnosis

误诊和漏诊数目增加误诊和漏诊数目增加1111

Medical Community Finally Recognized Medical Community Finally Recognized the Need for Well Trained Generaliststhe Need for Well Trained Generalists

医学界终于意识到对受过良好训练全科医生的需求医学界终于意识到对受过良好训练全科医生的需求

The Folsom Report Folsom The Folsom Report Folsom 报告报告

The Mills Commission Mills The Mills Commission Mills 委托代理委托代理

The Willard Committee Willard The Willard Committee Willard 委员会委员会

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Acceptance at Last Acceptance at Last 终于接受终于接受

Medical schools now began GP residencies Medical schools now began GP residencies

医学院校现在开始全科住院医生培训医学院校现在开始全科住院医生培训– February 8, 1969 the first residencies started: “February 8, 1969 the first residencies started: “specialty specialty in breadth” in breadth”

19691969 年年 22 月月 88日第一个住院医生培训项目开始：日第一个住院医生培训项目开始： ““范围宽的专业”范围宽的专业”– 1970 the ABFP (American Board of Family Practice) 1970 the ABFP (American Board of Family Practice) offered its first board exam offered its first board exam

19701970 年美国家庭医学认证机构进行了第一次资格认证考试年美国家庭医学认证机构进行了第一次资格认证考试

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Acceptance at Last Acceptance at Last 终于接受终于接受– 1971 the name changed from GP to FP to signify the 1971 the name changed from GP to FP to signify the change in trainingchange in training

19711971 年由年由 GPGP 更名为更名为 FPFP 以象征在培训方面的变化以象征在培训方面的变化– Rapid growthRapid growth 快速发展快速发展

1970 250 residencies with 3,820 residents1970 250 residencies with 3,820 residents

19701970 年年 250250 个住院医师培训项目，包括个住院医师培训项目，包括 3,8203,820 名住院医生名住院医生2007 463 residencies with 9,330 residents2007 463 residencies with 9,330 residents

20072007 年有年有 463463 个住院医师培训项目，包括个住院医师培训项目，包括 9,3309,330 名住院医生名住院医生Membership in the AAFP: 96,614 (includes residents, Membership in the AAFP: 96,614 (includes residents, etcetera) etcetera)

AAFPAAFP 的会员数目： 的会员数目： 96,614 96,614 （包括住院医生，等等）（包括住院医生，等等）

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The Importance of The Importance of Post Graduate TrainingPost Graduate Training 毕业后培训的重要性毕业后培训的重要性

Medical school alone is not enoughMedical school alone is not enough仅医学院是不够的仅医学院是不够的– Medical information is increasing rapidlyMedical information is increasing rapidly 医学信息飞速增加医学信息飞速增加– GPs need to know how to diagnose and treat common diseases, GPs need to know how to diagnose and treat common diseases,

not just book knowledgenot just book knowledge 全科医生需要知道如何诊断和治疗常见病，不仅是知道书本的知识全科医生需要知道如何诊断和治疗常见病，不仅是知道书本的知识

Residency providesResidency provides 住院医生培训提供：住院医生培训提供：– Development of diagnostic and procedural skillsDevelopment of diagnostic and procedural skills 诊断和操作能力的发展诊断和操作能力的发展– Awareness of developments in other specialtiesAwareness of developments in other specialties 了解其它专业的发展了解其它专业的发展– Knowledge of how to use the entire medical system to benefit their Knowledge of how to use the entire medical system to benefit their

patientspatients 知道如何使用整个医疗体系以使病人受益知道如何使用整个医疗体系以使病人受益– Understanding of whole person care: bio-psycho-social-spiritual Understanding of whole person care: bio-psycho-social-spiritual

model of healthmodel of health 理解全人的照顾：健康的生物理解全人的照顾：健康的生物 --心理心理 -- 社会社会 --精神模精神模式式 1515

Primary Care Improves Primary Care Improves Community HealthCommunity Health

初级保健使社区健康得到改进初级保健使社区健康得到改进Better health outcomesBetter health outcomes健康结局更好健康结局更好Increased use of disease-focused preventive care (e.g., Increased use of disease-focused preventive care (e.g., blood pressure screening, mammograms, blood pressure screening, mammograms, pap smears, etc)pap smears, etc) 疾病为中心的预防保健增多（如血疾病为中心的预防保健增多（如血压筛查，乳腺压筛查，乳腺 XX片，宫颈防癌普查等）片，宫颈防癌普查等）Fewer patients admitted for preventable complications of Fewer patients admitted for preventable complications of chronic diseasechronic disease

更少的病人因可预防的慢性病并发症而收入院更少的病人因可预防的慢性病并发症而收入院

Lower all cause mortalityLower all cause mortality 全因死亡率降低全因死亡率降低

Fewer consultations with specialistsFewer consultations with specialists 专家会诊减少专家会诊减少

Less use of emergency servicesLess use of emergency services 减少使用急救服务减少使用急救服务

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Improved Community Health with Primary Improved Community Health with Primary Care Care 初级保健使社区保健得到改进初级保健使社区保健得到改进

Less re-hospitalizationLess re-hospitalization 减少再入院减少再入院Better detection of adverse effects of interventions Better detection of adverse effects of interventions 更好地发现干预措施的不良反应更好地发现干预措施的不良反应Better understanding of psychological aspects of a Better understanding of psychological aspects of a patient’s problempatient’s problem 更好地理解病人问题的心理方面更好地理解病人问题的心理方面Protection against overtreatmentProtection against overtreatment 避免过度治疗避免过度治疗More efficient use of resourcesMore efficient use of resources 资源更有效地利用资源更有效地利用Better compliance and lower hospitalization rate Better compliance and lower hospitalization rate 依从性更高，入院率更低依从性更高，入院率更低Other benefits as wellOther benefits as well 还有其它益处还有其它益处All well documented All well documented 都被很好地记录都被很好地记录

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General Practice has a Unique and Important General Practice has a Unique and Important Role in Health SystemsRole in Health Systems

全科医学在健康系统中有独一无二的重要作用全科医学在健康系统中有独一无二的重要作用Advocate for patients in medical systemAdvocate for patients in medical system

在医疗体系中支持病人在医疗体系中支持病人Management of patient careManagement of patient care 病人保健的管理病人保健的管理Preventive health care and patient educationPreventive health care and patient education

预防性的健康照顾和病人教育预防性的健康照顾和病人教育Provision of comprehensive health care in a single Provision of comprehensive health care in a single locationlocation 在一个处所提供综合性的健康照顾在一个处所提供综合性的健康照顾Care of entire families over timeCare of entire families over time 整个家庭的长期照顾整个家庭的长期照顾– Not limited to gender, age, organ systemNot limited to gender, age, organ system

不局限性别、年龄、器官系统不局限性别、年龄、器官系统

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General Practice has a Unique and Important General Practice has a Unique and Important Role in Health SystemsRole in Health Systems

全科医学在保健体系中有独一无二的重要作用全科医学在保健体系中有独一无二的重要作用Benefits to communities and individuals Benefits to communities and individuals 对社区和个人的益处对社区和个人的益处– Doctor knows patient well Doctor knows patient well 医生非常了解病人医生非常了解病人– Patients trust their doctor Patients trust their doctor 病人信任医生病人信任医生– Increased patient satisfaction Increased patient satisfaction 病人满意度提高病人满意度提高– Greater ease of access to medical care Greater ease of access to medical care 医疗照顾更有可及性医疗照顾更有可及性– Lower cost Lower cost 更低的费用更低的费用– Fewer medical mistakes Fewer medical mistakes 更少的医疗错误更少的医疗错误– Emphasis on prevention Emphasis on prevention 强调预防强调预防– Satisfying professional careers for GP doctorsSatisfying professional careers for GP doctors

全科医生对职业感到满意全科医生对职业感到满意

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What is Family Medicine? It Depends on Who What is Family Medicine? It Depends on Who You Ask!You Ask!

家庭医学是什么？不同的国家有不同的回答！家庭医学是什么？不同的国家有不同的回答！British British 英国英国Swedish Swedish 瑞典瑞典Australia Australia 澳大利亚澳大利亚Hong Kong Hong Kong 香港香港Canada Canada 加拿大加拿大America America 美国美国

2020

Family Medicine in ChinaFamily Medicine in China中国的家庭医学中国的家庭医学

New in modern ChinaNew in modern China 是当代中国的新生物是当代中国的新生物Developing a new modelDeveloping a new model

发展中发展中Principles of FM has similarities with some aspects of traditional Principles of FM has similarities with some aspects of traditional Chinese medicineChinese medicine

家庭医学的原则与传统中医的某些方面有相似之处家庭医学的原则与传统中医的某些方面有相似之处– Care for the whole familyCare for the whole family 照顾整个家庭照顾整个家庭

Young and old Young and old 年轻者和年长者年轻者和年长者Male and female Male and female 男性和女性男性和女性

– All organ systemsAll organ systems 所有的器官系统所有的器官系统– Listen to patients Listen to patients 倾听患者倾听患者– Take time with the patientsTake time with the patients 花时间与病人在一起花时间与病人在一起

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Family Medicine in ChinaFamily Medicine in China中国的家庭医学中国的家庭医学

Some differences between GP and Some differences between GP and traditional Chinese medicine:traditional Chinese medicine:– Understanding of causes of diseaseUnderstanding of causes of disease– GPs emphasize family, social and GPs emphasize family, social and

environmental influencesenvironmental influences– GPs rely on science including evidence based GPs rely on science including evidence based

medicinemedicine– History and physical exam are done more History and physical exam are done more

thoroughly by GPsthoroughly by GPs

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Family Medicine in ChinaFamily Medicine in China中国的家庭医学中国的家庭医学

The government and entire medical system The government and entire medical system recognize need for general practicerecognize need for general practice

大型医学中心认识到对全科的需要大型医学中心认识到对全科的需要The Ministry of Health has now provided a The Ministry of Health has now provided a model for general practice and trainingmodel for general practice and training– It is being implemented across ChinaIt is being implemented across China

大型医学中心在等待北京决定用何种模式及大型医学中心在等待北京决定用何种模式及何种培训项目何种培训项目

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Where Do We Work?Where Do We Work?我们在哪里工作？我们在哪里工作？

ClinicClinic 门诊门诊

HospitalHospital 医院医院

Emergency DepartmentEmergency Department 急诊室急诊室

Nursing HomesNursing Homes 养老院养老院

OtherOther 其他其他

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Philosophical Focus of Family MedicinePhilosophical Focus of Family Medicine家庭医学的理念家庭医学的理念

Continuity of careContinuity of care 照顾的持续性照顾的持续性

Management of careManagement of care 健康照顾管理健康照顾管理

Treating patient in context of Treating patient in context of familyfamily

在家庭背景下治疗病人在家庭背景下治疗病人Preventive carePreventive care

预防保健预防保健Team approachTeam approach

团队探讨团队探讨EBMEBM

循证医学循证医学2828

Evidence Based MedicineEvidence Based Medicine循证医学循证医学

Knowing the questions to askKnowing the questions to ask 知道要问的问题知道要问的问题

Identifying the best evidence to Identifying the best evidence to answer the questionsanswer the questions

找出回答问题的最好依据找出回答问题的最好依据Assessing the evidence for validity and Assessing the evidence for validity and usefulnessusefulness

评估证据的有效性和有用性评估证据的有效性和有用性Applying the results to clinical/hospital Applying the results to clinical/hospital practicepractice

将结论应用于门诊或住院医疗将结论应用于门诊或住院医疗Evaluating the resultsEvaluating the results

评估结果评估结果3434

General Practice CompetenciesGeneral Practice Competencies全科医学的能力全科医学的能力

There is a wide range of possible skills for GPsThere is a wide range of possible skills for GPs 全科医生可掌握的临床技巧很广泛全科医生可掌握的临床技巧很广泛

Different countries choose different skills to meet their Different countries choose different skills to meet their own needsown needs

不同的国家根据本国的需要选择不同的临床技巧不同的国家根据本国的需要选择不同的临床技巧The basic role of GP remains the same in each countryThe basic role of GP remains the same in each country全科医生的基本任务在每个国家仍然是一致的全科医生的基本任务在每个国家仍然是一致的This next section will show you some of the skills we This next section will show you some of the skills we train GPs to do in the USAtrain GPs to do in the USA

下一部分将向您介绍美国全科医生被训练的部分技能下一部分将向您介绍美国全科医生被训练的部分技能

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Whom and what do we treat?Whom and what do we treat?我们给谁治疗，治疗什么？我们给谁治疗，治疗什么？

All ages and Both sexesAll ages and Both sexes所有的年龄和性别所有的年龄和性别

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ObstetricsObstetrics产科学产科学

(Will go into more detail on each area later if desired(Will go into more detail on each area later if desired如果愿意我们将在后面详细介绍每一方面的内容如果愿意我们将在后面详细介绍每一方面的内容 ))

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Ultra sound 超声 Dating 确定预产期 Fetal viability 胎儿变异度 Placenta position 胎位 Abnormalities 畸形Vacuum extraction 胎头吸引Episiotomies 侧切

External fetal heart 胎心监护 monitoringTocomonitor 宫缩监护Placement of scalp and IUPC 头皮电极放置及胎儿宫内检测Leopold Maneuver 臀位分娩助产术Reduction of shoulder dystocia 解除肩难产Labor induction 引产

Pediatrics...Pediatrics...儿科学儿科学

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Internal MedicineInternal Medicine内科学内科学

But All Other Specialties as WellBut All Other Specialties as Well 及所有其他专业及所有其他专业3939

Diagnostic Diagnostic MModalities and Laboratory odalities and Laboratory EEvaluationsvaluations

诊断模式和实验室结果评估诊断模式和实验室结果评估

4040

Laboratory studies 实验室检查 CBC 血常规 Chemistries 生化检查 LFTs 肝功 Cultures 培炎 Lipids 血脂 TSH 促甲状腺素 Many others 很多其他的Roentgen interpretationMicroscopy 显微镜检查 Wet prep 白带常规 Parasites 寄生虫 Other 其他 Rapid tests 快速检测 Strep 链球菌 Mono 单核细胞 Infulenza 流感 Hemoglobin and Hct 血红蛋白和血红蛋白压积 Blood sugar 血糖 H. Pylori 幽门螺旋杆菌 Others 其他

Procedures: Injections, Dermatological Procedures: Injections, Dermatological procedures, and Fine needle aspirationsprocedures, and Fine needle aspirations

操作：注射，皮肤病方面的操作，和细针抽吸操作：注射，皮肤病方面的操作，和细针抽吸

4141

Biopsies: 活检 Punch 剔除法 Shave 刮除法 Excision 切除法Joint aspiration 关节液吸出和腔内注射 and injectionTendon injections 肌腱注射Cryotherepy 冷冻Hyfercation/cautery电切术

Cyst and lipoma removal囊肿和脂肪瘤切除Foreign body removal 去除异物 Eyes眼睛 Ears耳朵 Nose鼻子 Other其他Suturing/laceration repair缝合 /裂伤修补Casting simple fractures简单骨折的固定术Splinting 打夹板

4242

Colposcopy, Exercise stress testing, Flexible Colposcopy, Exercise stress testing, Flexible sigmoidoscopy,sigmoidoscopy, and many more!and many more!

阴道镜检查，运动负荷实验，纤维乙状结肠镜检查，阴道镜检查，运动负荷实验，纤维乙状结肠镜检查，还有更多！还有更多！

4343

ECG心电图Exercise Stress Test运动负荷试验Holter/event monitors动态心电监护Cardioversion with defibrillator 除颤仪除颤

Colposcopy 阴道镜Cryotherepy 冷冻Thoracentesis 胸穿Paracentesis 腹穿Lumbar puncture 胸穿Intubation 气管插管Cardio-pulmonary resuscitation心肺复苏

Endoscopy内镜Vascectomy输精管切除术Circumscision 包皮环切术

Not only Not only TTreatment of reatment of DDisease but also isease but also PreventionPrevention

不但治疗疾病而且预防疾病不但治疗疾病而且预防疾病CancerCancer screening screening

癌症筛查癌症筛查VaccinationsVaccinations

预防接种预防接种Lifestyle modificationLifestyle modification

生活方式的改变生活方式的改变

4444

Cooperation with other specialists Cooperation with other specialists -- health care health care professionalsprofessionals

与其他专科医生合作与其他专科医生合作

4545

Rural or Urban: Rural or Urban: 农村或城市农村或城市Do FP belong only in rural areas?Do FP belong only in rural areas?

家庭医生只属于农村地区吗？家庭医生只属于农村地区吗？Needed in Rural areas: villages, towns, small cities Needed in Rural areas: villages, towns, small cities 在村、镇、小城市等农村地区需要：在村、镇、小城市等农村地区需要：– Not enough specialists to supply all small towns Not enough specialists to supply all small towns

没有足够的专家可以为所有小镇提供医疗服务没有足够的专家可以为所有小镇提供医疗服务– Not enough demand to support all the other Not enough demand to support all the other

specialties specialties 没有那样多的对所有专科的医疗需求没有那样多的对所有专科的医疗需求– FP/GP needs to be well trained to handle many FP/GP needs to be well trained to handle many

complex problems and procedures complex problems and procedures 家庭家庭 // 全科医生需全科医生需要得到很好的培训以应付很多复杂的问题和操作要得到很好的培训以应付很多复杂的问题和操作

Needed in Urban/city areas Needed in Urban/city areas 在城市也需要在城市也需要– Specialization is one of the reasons FM is needed Specialization is one of the reasons FM is needed

需要家庭医生的一个理由是专科化需要家庭医生的一个理由是专科化– Management of care is even more critical Management of care is even more critical

l l 更为关键的是健康照顾管理更为关键的是健康照顾管理– Cost controlCost control 费用控制费用控制 4646

GP is New in Many CountriesGP is New in Many Countries

全科医学在许多国家是新生事物全科医学在许多国家是新生事物New SpecialtyNew Specialty 新的专科新的专科Challenge of deciding what it will be likeChallenge of deciding what it will be like

决定全科医学的模式是一个挑战决定全科医学的模式是一个挑战Integrating GP with existing medical systemIntegrating GP with existing medical system

将全科医学和现有的医疗系统一体化将全科医学和现有的医疗系统一体化Gaining acceptance with doctors and patientsGaining acceptance with doctors and patients

得到医生和患者的接受得到医生和患者的接受Becoming an attractive specialty to medical Becoming an attractive specialty to medical students students 成为对医学生有吸引力的专业成为对医学生有吸引力的专业

4747

Knowledge BaseKnowledge Base知识基础知识基础

FP’s know 20-30% of each of the other specialties FP’s know 20-30% of each of the other specialties knowledge:knowledge:全科医生应该知道每一个专科知识的全科医生应该知道每一个专科知识的 20-30%20-30%Specialists see FP from their perspectiveSpecialists see FP from their perspective

专科医生从他们的角度看待全科医生专科医生从他们的角度看待全科医生– FP’s know less than the specialist in his areaFP’s know less than the specialist in his area

在专科领域全科医生的知识不如专科医生在专科领域全科医生的知识不如专科医生– FP’s know more than the specialist in other areas FP’s know more than the specialist in other areas

在其他的领域全科医生的知识多于专科医生在其他的领域全科医生的知识多于专科医生

5353

Depth vs. Breadth of Knowledge BaseDepth vs. Breadth of Knowledge Base知识基础的深度与广度对比知识基础的深度与广度对比

0102030405060708090

100

Internist内科

Pediatrics儿科

Ob-Gyn妇产科

Surgery外科

5454

0102030405060708090

100

FP全科Internist内科Peds儿科Ob-gyn妇产科 .Surgery外科

Total Knowledge ContentTotal Knowledge Content总知识含量总知识含量

5555

How Many Years of Training to be a FP in How Many Years of Training to be a FP in the USA?the USA?

在美国培训全科医生需要多少年？在美国培训全科医生需要多少年？

Primary and Secondary School Primary and Secondary School 12 12 yearsyears 小学和中学 小学和中学 1212 年年

University University 4 4 yearsyears 大学 大学 44 年年

Medical School Medical School 4 4 yearsyears 医学院 医学院 44 年年

Post Graduate Residency Post Graduate Residency 33 years years 住院医生 住院医生 33 年年

Total Total 总共总共 23 23 yearsyears

5656

What are the requirements to be a Family What are the requirements to be a Family Medicine Doctor in the USA?Medicine Doctor in the USA?

在美国成为全科医生的要求是什么？在美国成为全科医生的要求是什么？Succesfully finishing medical schoolSuccesfully finishing medical school成功地完成医学院校的学习成功地完成医学院校的学习Passing the three step USMLEPassing the three step USMLE通过三步美国行医执照考试通过三步美国行医执照考试Completing approved residency programCompleting approved residency program完成住院医培训完成住院医培训Passing one day Family Practice ExamPassing one day Family Practice Exam通过一天的全科医生考试通过一天的全科医生考试Completing 150 hours of continuing medical education Completing 150 hours of continuing medical education every 3 years (Theevery 3 years (The American Academy of Family Practice American Academy of Family Practice was the first to require thiswas the first to require this每三年完成每三年完成 150150 小时的继续医学教育（美国家庭医学会最先小时的继续医学教育（美国家庭医学会最先要求这项内容）要求这项内容）Recertification required every 7 yearsRecertification required every 7 years行医执照每行医执照每 77 年重新认证一次年重新认证一次

5757

Our Clinic and HospitalOur Clinic and Hospital我们的诊所和医院我们的诊所和医院

5858

Why is GP the specialty of the 21Why is GP the specialty of the 21stst Century? Century?为什么全科医学会成为为什么全科医学会成为 2121世纪的专科？世纪的专科？

Cost effective Cost effective 符合成本效益原则符合成本效益原则Satisfying for the patient Satisfying for the patient 患者满意度高患者满意度高Satisfying for the GP!Satisfying for the GP!Emphasis on prevention Emphasis on prevention 强调预防强调预防Treating the patient in the context of the familyTreating the patient in the context of the family

在病人的家庭背景下治疗在病人的家庭背景下治疗Whole person medicineWhole person medicine全人模式的医学全人模式的医学Systems based approachSystems based approach

以医疗体系为基础的方法以医疗体系为基础的方法

6060