The Role, Principles and The Role, Principles and Competencies of Family Medicine Competencies 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, MDChris Jenkins, MD 克里斯克里斯 .. 金肯医学博金肯医学博

士士March 2010 2010March 2010 2010 年年 33 月月

Goals of TalkGoals of Talk 演讲的目的演讲的目的Why is general practice an important specialty in a Why is general practice an important specialty in a medical systemmedical system 为什么全科医学是医疗体系里的一为什么全科医学是医疗体系里的一个重要专科个重要专科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 doWhat 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 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 1940’s: an explosion of medical knowledge and an increase in specializationan increase 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

Effect of World War IIEffect of World War II 二战的影响二战的影响World War II made the situation for GPs worseWorld War II made the situation for GPs worse 二二战让全科医生的境遇变差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 rushed 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 training 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。

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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 1940 to 1952 specialty residencies grew from 5,200 to 22,000.to 22,000.

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 全科医全科医疗被忽视疗被忽视

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 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 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 1919 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，但到别很好的想法，但到别的地方进行”的地方进行”

All through 1950’s and most of the 1960’s continued All through 1950’s and most of the 1960’s 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 年代的多数时间年代的多数时间持续不断地取得工作进步持续不断地取得工作进步

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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US medical system in the 1960’s19US medical system in the 1960’s19 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 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 No one focused on preventive careNo one focused on preventive care 没有人关注预防保健没有人关注预防保健

No one who could treat most or all of common diseasesNo one who could treat most or all of common diseases 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 physical Patients had to see many specialists to get routine physical examsexams

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 missed diagnosisIncreasing number of medical mistakes and missed diagnosis

误诊和漏诊数目增加误诊和漏诊数目增加

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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 ReportThe Folsom Report

FolsomFolsom 报告报告

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

The Willard CommitteeThe Willard Committee WillardWillard 委员会委员会

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Acceptance at LastAcceptance at Last 终于接受终于接受Medical schools now began GP residenciesMedical 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 in breadth” specialty 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

– 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, etcetera) Membership in the AAFP: 96,614 (includes residents, 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 1313

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 Increased use of disease-focused preventive care (e.g., blood pressure screening, mammograms, (e.g., blood pressure screening, mammograms, pap smears, etc)pap smears, etc) 疾病为中心的预防保健增多（如疾病为中心的预防保健增多（如血压筛查，乳腺血压筛查，乳腺 XX片，宫颈防癌普查等）片，宫颈防癌普查等）Fewer patients admitted for preventable Fewer patients admitted for preventable complications of chronic diseasecomplications of chronic 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 CareCare 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 wellDoctor knows patient well 医生非常了解病人医生非常了解病人– Patients trust their doctorPatients trust their doctor 病人信任医生病人信任医生– Increased patient satisfactionIncreased patient satisfaction 病人满意度提高病人满意度提高– Greater ease of access to medical careGreater 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 costLower cost 更低的费用更低的费用– Fewer medical mistakesFewer medical mistakes 更少的医疗错误更少的医疗错误– Emphasis on preventionEmphasis 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！BritishBritish英国英国SwedishSwedish瑞典瑞典AustralianAustralian澳大利亚澳大利亚Hong KongHong Kong香港香港CanadaCanada 加拿大加拿大AmericaAmerica 美国美国

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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

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 – final model not yet decidedDeveloping – final model not yet decided

发展中－最终模式尚未确定发展中－最终模式尚未确定Principles of FM has similarities with some aspects of Principles of FM has similarities with some aspects of traditional Chinese medicinetraditional Chinese 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

Major medical centers recognize need for Major medical centers recognize need for the specialtythe specialty

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Major medical centers waiting for Beijing Major medical centers waiting for Beijing to decide what model and what training to decide what model and what training programprogram

大型医学中心在等待北京决定用何种模式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及何种培训项目

What is Family Medicine in the USA?What is Family Medicine in the USA?美国的家庭医学是什么？美国的家庭医学是什么？

Medical specialtyMedical specialty 医 学 专 业 医 学 专 业

Recognized as specialty in the US since Recognized as specialty in the US since 19691969自 从 自 从 1969 1969 年 起 在 美 国 被 认 定 年 起 在 美 国 被 认 定 为 一 种 医 学 专 业 为 一 种 医 学 专 业

Over 80,000 family physicians in the USOver 80,000 family physicians in the US在 美 国 有 超过在 美 国 有 超过 80,000 80,000 多名 全 科 医 生 多名 全 科 医 生

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What is Family Medicine in the USA?What is Family Medicine in the USA?美国的家庭医学是什么？美国的家庭医学是什么？

Over 4Over 46060 training programs(residencies) with training programs(residencies) with over 9over 9,000 residents,000 residents

超过超过 464600 个 住院医师培训项目 个 住院医师培训项目 , , 超过超过 99,000,000名住 院 医 生名住 院 医 生

Can treat 85-90% of medical problemsCan treat 85-90% of medical problems

能 够 治 疗 能 够 治 疗 85-90%85-90% 的医学问题的医学问题2222

What is Family Practice in the United States?What is Family Practice in the United States?

在 美 国 家 庭 医 学 是 什 么 样 的在 美 国 家 庭 医 学 是 什 么 样 的 ?? 12% of all US doctors are family practice 12% of all US doctors are family practice doctors doctors

12% 12% 的 美 国 医 生 是 家 庭 医 生 的 美 国 医 生 是 家 庭 医 生

But 25% of all office visits in the US are to But 25% of all office visits in the US are to family doctors!family doctors!

但 是 美 国 但 是 美 国 25% 25% 的 就 诊 都 是 看 全 科 医 的 就 诊 都 是 看 全 科 医 生 ！ 生 ！

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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2525

Continuity of CareContinuity of Care照顾的持续性照顾的持续性

Seeing patients over an extended Seeing patients over an extended period of timeperiod of time

长时间内照顾病人长时间内照顾病人Developing the doctor-patient Developing the doctor-patient relationshiprelationship

发展医患关系发展医患关系Familiarity with patient health statusFamiliarity with patient health status

熟悉病患的健康状态熟悉病患的健康状态Developing trustDeveloping trust

发展信任关系发展信任关系2626

Management of CareManagement of Care保健管理保健管理

Evaluation of the PatientEvaluation of the Patient

病人病情的评估病人病情的评估Diagnostic testsDiagnostic tests

诊断检查诊断检查Involvement of specialistsInvolvement of specialists

专科医生参与专科医生参与Treatment plansTreatment plans

诊疗计划诊疗计划

2727

Patient Care in the Context of the FamilyPatient Care in the Context of the Family以家庭为背景的病人保健以家庭为背景的病人保健

Home environmentHome environment 家庭环境家庭环境

Family dynamicsFamily dynamics 家庭动力学家庭动力学

Family health beliefs and Family health beliefs and practicespractices

家庭的健康理念和实践家庭的健康理念和实践Social, work, and religious Social, work, and religious settingssettings

社会环境，工作环境和宗社会环境，工作环境和宗教环境教环境

2828

Preventive MedicinePreventive Medicine预防医学预防医学

Patient educationPatient education

病人教育病人教育Lifestyle modificationLifestyle modification

生活方式的调整生活方式的调整Age and gender specific Age and gender specific disease screeningdisease screening

根据年龄和性别而特异的疾病根据年龄和性别而特异的疾病筛查筛查Medical intervention Medical intervention 医疗干医疗干预预

2929

Team Approach to Health CareTeam Approach to Health Care健康照顾的团队合作健康照顾的团队合作

Involvement of other health care providers 其它医疗保健工作者的参与 Medical and surgical specialists

内外科专家 Behavioral medicine行为医学 Physical, occupational, home therapists物理治疗 ， 职业理疗师 ， 家庭治疗师Dietitians营养学家

3030

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3131

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

3232

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

3333

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 ))

3434

Pediatrics...Pediatrics...儿科学儿科学

3535

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3636

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

3737

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

3838

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！

3939

Not only Not only TTreatment of reatment of DDisease but isease but also Preventionalso Prevention

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

4040

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

4141

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 citiesNeeded in Rural areas: villages, towns, small cities 在在村、镇、小城市等农村地区需要：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 specialties Not enough demand to support all the other 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 complex FP/GP needs to be well trained to handle many complex

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

Needed in Urban/city areasNeeded 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 critica Management of care is even more critica

ll 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

4242

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

4343

The Need for a Good ModelThe Need for a Good Model一个好的全科医学模式的需求一个好的全科医学模式的需求

Meets patients primary health care needsMeets patients primary health care needs

满足病人初级卫生保健的需要满足病人初级卫生保健的需要Professionally satisfying Professionally satisfying 职业的满意度职业的满意度High quality training High quality training 高质量的培训高质量的培训Respect of Colleagues Respect of Colleagues 同行的尊敬同行的尊敬Trust of Patients Trust of Patients 病人的信任病人的信任Financially rewarding Financially rewarding 薪酬上的回报薪酬上的回报

4444

Major Lessons – Appropriate ModelMajor Lessons – Appropriate Model重要的教训重要的教训––合适的模式合适的模式

model must be appropriate to the regionmodel must be appropriate to the region 模式必模式必须和地区相适应须和地区相适应– Transplanting models without modification doesn’t Transplanting models without modification doesn’t

work well work well 不做调整而直接移植模式不能有效运行不做调整而直接移植模式不能有效运行One Specialty, Many modelsOne Specialty, Many models 一个专业，很多模式一个专业，很多模式

– American ModelAmerican Model– 美国模式美国模式– British ModelBritish Model– 英国模式英国模式

– Knowledge base and technology/procedures Knowledge base and technology/procedures appropriate to the specialty and the region appropriate to the specialty and the region

知识基础、技术和操作要适合专业和地区知识基础、技术和操作要适合专业和地区

4545

Consequences of an Inadequate ModelConsequences of an Inadequate Model不适当模式的结果不适当模式的结果

No interest on the part of medical studentsNo interest on the part of medical students医学生没有兴趣医学生没有兴趣Inadequate training for the job assignmentInadequate training for the job assignment对于分配的工作没有得到充分的培训对于分配的工作没有得到充分的培训Feeling unprepared in those who do FP workFeeling unprepared in those who do FP work那些要做全科医疗工作的人感觉没有准备好那些要做全科医疗工作的人感觉没有准备好Lack of respect from colleaguesLack of respect from colleagues缺乏同事的尊重缺乏同事的尊重Lack of trust from patientsLack of trust from patients缺乏病人的信任缺乏病人的信任Low salaryLow salary低薪酬低薪酬High drop out rateHigh drop out rate 高的放弃率高的放弃率

4646

Who is a FP/GP?Who is a FP/GP?谁是家庭医生谁是家庭医生 // 全科医生？全科医生？

Surgical personality!Surgical personality! 外科特性！外科特性！

Internist personality!Internist personality! 内科特性！内科特性！

Family medicine personality!Family medicine personality! 全科特性！全科特性！

4747

Knowledge Base – Important to EmphasizeKnowledge Base – Important to Emphasize知识基础知识基础 -- 重中之重重中之重

Are three years of training enough?Are three years of training enough?三年的培训足够吗？三年的培训足够吗？Know what is needed to be known!Know what is needed to be known!知道所需要知道的知识知道所需要知道的知识– 25-30% of knowledge cove 85-90% of the diseases25-30% of knowledge cove 85-90% of the diseases

““Rapidly progressing glomerulonephritis” not high on the priority listRapidly progressing glomerulonephritis” not high on the priority list

25-30%25-30% 知识覆盖知识覆盖 85-90%85-90% 的疾病。的疾病。 急进性肾小球肾炎不是最优先需要学习的急进性肾小球肾炎不是最优先需要学习的

7/1,000,000 7/1,000,000 发病率发病率1/142,857 = 1/lifetime of FP…Maybe! 1/142,857 = 1/lifetime of FP…Maybe! 一个全科医生可能在一生中一个全科医生可能在一生中就看一个这样的病例就看一个这样的病例

– Debate over adding a 4Debate over adding a 4thth year year 是否需要增加第四年的培训仍有争议是否需要增加第四年的培训仍有争议

4848

Knowledge BaseKnowledge Base知识基础知识基础

FP’s know 20-30% of each of the other FP’s know 20-30% of each of the other specialties knowledge:specialties 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 FP’s know more than the specialist in other

areas 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

4949

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

5050

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

5151

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

5252

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

5353

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

5454

What is a typical week like for a family What is a typical week like for a family medicine doctormedicine doctor??

((Statistics fromStatistics from 200 20088))一个家庭医生典型的一周工作（一个家庭医生典型的一周工作（ 20020088 年统计）年统计）

8484.9.9 patients per week! (how many in China?) patients per week! (how many in China?) 每周每周 84.984.9 个个病人病人 (( 中国多少中国多少 ?)?)8.1 hospital patient visits per week 8.1 hospital patient visits per week 每周看每周看 8.18.1 个住院病人个住院病人2.3 nursing home patients 2.3 nursing home patients 每周每周 2.32.3 个养老院病人访视个养老院病人访视0.6 home visits 0.6 home visits 每周每周 0.60.6 个家庭访视个家庭访视7.5 Patients Supervised under home health care 7.57.5 Patients Supervised under home health care 7.5 个家庭个家庭照顾指导照顾指导9.6 Nursing home patients supervised 9.69.6 Nursing home patients supervised 9.6 个护理院病人指导个护理院病人指导2.1 Hospice patients supervised 2.12.1 Hospice patients supervised 2.1 个临终关怀病人指导个临终关怀病人指导9.5 patients with free or discounted care 9.59.5 patients with free or discounted care 9.5 个减免费的病人个减免费的病人51 hours a week 51 hours a week 每周工作每周工作 5151 个小时个小时Approximately 2500 patients cared for (800 families) Approximately 2500 patients cared for (800 families) 大约大约需要照顾需要照顾 25002500 个病人（个病人（ 800800 个家庭）个家庭）

5555

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

5656

Thank You!Thank You!谢谢！谢谢！

5757