history-and-concept-of-general-practice.ppt

Part one,The history and concept of GP,2,The emergence and development of general practice,1.Ancient“Lang Zhong and the West healer,Application of simple natural philosophy in ancient medical theory,+experiences,+According to the books,3,2.Modern General Practitioners,Early 19th century,British magazine named the persons who have a variety of skills such doctors called a general practitioner,GP.,Therefore,general practitioners are born in America of the 18th century,and named after the 19th century in Europe.,Allocation of resources and the need to contradict,需专科,诊治人群,健康人群,亚健康人群,常见健康问题人群,疑难,病人群,三级医疗机构,二级医疗机构,基层医疗,保健机构,医疗供给呈“倒三角,”,人群医疗保健需要呈“正三角”,Appropriate Technology,+High Touch,适宜技术,+,高情感,经济有效,/,高覆盖,/,高满意度,副作用,:,低效率 低覆盖 低满意度,改 革,High Technology,（现代生物医学的成果）,高技术,+,高投入,+,大医院,High Touch,（历史上医生服务的体现）,里程碑,：,1969,年家庭医学被批准为,美国第,20,个医学专业,1971,年美国家庭医师学会定名,全科,/,家庭医学成为一个临床专业学科,全科,/,家庭医生形成专业实体,American Academy of Family,Physicians,（,AAFP,）,general practice/family medicine,general practitioner/family physician,family doctor,全科,/,家庭医生,3.Common trends States health care services,The patients age tend to aging,A variety of lifestyle diseases such as,AIDS,disease prevalence increases,Venue more from ward toward community clinics and family,采用,managed care,模式的国家增多卫生保健的经济合理性得到强调,美国的管理化保健,Managed Care,-Provide services in a defined network of health care providers,suppliers have,Medicare,Medicaid,成效显著,覆盖面迅速扩大,问题颇多,不断解决,英国的国家卫生服务系统,（,NATIONAL HEALTH SERVICE,，,NHS),Use of,NHS,funds,：,60,hospital service,20,GP service,20,Public health,preventive services,Each general practitioner about 2000 registered patients,1.Disease-related target,-A variety of medical knowledge and skills,2.Patient-related goals,-Consider the patient situation,compliance,cost-effectiveness,etc.,3.The related objectives of service system,-Take advantage of the service system,medical/community management,teamwork,etc.,4.Professional values and nature-related goals,-Attitudes,values,responsibility,etc.,5.Business development related goals,-Self-study,evaluation/quality assurance,teaching/research,information and evaluation,Teaching Goal of GP,Development and Prospects in China,Introduced to mainland China in the 1980s,Long-term,after graduating with general practitioners standardized training as the core,Currently,in-service training of health workers in transition(job training)as the focus,第二节 全科医学,(General)/,家庭医学,(Family Medicine),基 本 概 念,GP-produced in the 1960s,It is a new clinic secondary subject,individual,family and community-oriented,integrate clinical medicine,preventive medicine,rehabilitation medicine and medical psychology,humanities and social sciences relevant content in one of the new medical specialty.,全 科 医 学,专科医学,-,范围宽广,-,内容丰富,-,具有地域,/,民族,特点,服务模式与内容,以人为本 以健康为中心,一体化服务,(,Integrated Care,):,*,体制,:,家庭,-,社区,-,医院,“,一条龙,”,服务,-,服务,:,预防,-,医疗,-,康复各类专业合作,-,信息,:,生命,/,疾病全程,;,各家共享,-,财务管理,:,第三方,;,基层医生把关,全科医学在世界的发展,世界家庭医生学会,世界家庭医生组织,/,学会,（,WONCA,）,1972,年于墨尔本成立,发展趋势：,-,约有,50,个国家拥有国家级全科医生学术组织和全科医师培训项目,-WONCA,现有正式成员组织约,60,个,代表着世界上,15,万多名,GPs,全科医生：专科医生,1,：,1,World Organization,of Family Doctors,General practice,General Practice is the general medicine/family medicine theory applied to the patient,family and community care professional services,grassroots/community health services in major medical form,特点：强调以人为中心，将患者置于其家庭背景和社区环境中，强调运用家庭力量、人际关系、咨询以及心理治疗等方面的知识技能处理其医疗问题,长期负责式照顾,专科医疗与全科医疗在哲学上的区别,专科医疗 全科医疗,模 式,“,科学,”,模式,“,照顾,”,模式,价 值 科学性 科学性,+,艺术性,+,公益性,证 据 科研结果 科研结果,+,顾客体验,方 法 还原分析 整体综合,(,还原基础上,),Family Doctor:,To cure a few,To treat sometime,To comfort always,The difference between GP and specialist medical care,特 性,全科医疗 专科医疗,服务人口,较少而稳定,(1:2500),大而流动性强,(1:5,万,50,万,),照顾范围,宽,(,生物心理社会,),窄,(,系统,/,器官,/,细胞,),疾患类型,常见问题 疑难或罕见问题,(,未分化者多见,)(,多为已分化,),技 术,基本技术,不昂贵 高新技术,昂贵,方 法,综 合 分 科,责 任,持续性,生前,死后 间断性,服务内容,防治保康教一体化 医疗为主,态 度,健康为中心全面管理 疾病为中心救死扶伤,人为中心,医生为中心,病人主动参与 病人被动服从,全科医疗与专科医疗在具体特性上的区别,The role of general practitioners,?,?,?,?,?,1.Clinicians,2.Educators,municators,4.gatekeepers,5.Managers,6.The organization coordinator,Characteristic,of general practitioners,-Strong human emotions,-Professional skills,-Excellent management skills,-The scientific spirit,Training of GP,Systems thinking,physical diagnostic skills,Cost-benefit considerations,individual-group combined,Interpersonal/communication skills,Other supports,康,复,师,social worker,Vaccine injection,Nutritionist,Rehabilitation,25,Questions,1.,全科医生产生的必然性,?,2.,全科医生的基本技能有哪些,?,