潇湘渌水 @ 2010-05-09 10:20
最近因为一直在做primary care的调查，所以对这个自从1978年就在报告 A Manpower Policy for Primary Health Care 由Institute of Medicine 描述为 “accessible, comprehensive, coordinated, continual…[and] delivered by an accountable provider of health services”的服务框架很感兴趣。其实国内也就照搬这个框架，然后还取个名叫“六位一体”，但是整个搬过来的时候就发生了很多问题，这也是一直困扰政府卫生部门分管基层医疗卫生保健处室的大难题。在这次和上百名患者的面对面访谈中以及和8位从基层health manager到厅health policy maker的定性访谈中，很多人都谈到认识程度的问题（翻译为awareness可以吗？）。因为在早期经济体制时移植过来的只有西方现代的医院系统，这养成了国民今天让人头痛的就医习惯和医院庞大的门诊系统，要改变这些殊为不易，而且更离谱的是并不是所有发达国家都对这个PC体系很感冒，甚至有卫生经济学家就算出来这未必节省总费用。
还有搬过来的时候又不学习台湾同行的先进经验，一些单词翻译得错误百出。比起台湾中文里的“基层医疗照护”和“家庭医学”来讲，大陆的什么“初级卫生保健”、“全科医学”在民众中传播时既让人费解，又常常诱生歧义，前者“初级卫生保健”一点都不准确贴合英文，还把基本医疗这个重要的概念从字面剔除出去，搞得许多人还以为这是CDC干的活。后者就更是离题千里了，就算翻译成“普通医学”也比全科好得多，至少不会造成今天很多患者把全科和专科对立起来的思维惯性，其实GP哪里是什么全科罗？GP就是医学专科系统中的一个“专科分支”吗，不但患者搞不清，就访谈的许多health manager都糊涂得很。当年的那些土鳖翻译真害死人。
那在相对成熟一点的现代国家的卫生体系里PC都涵盖一些什么病患呢？或者由哪些医师分别在PC及其上两个层级中提供服务呢？
还有搬过来的时候又不学习台湾同行的先进经验，一些单词翻译得错误百出。比起台湾中文里的“基层医疗照护”和“家庭医学”来讲，大陆的什么“初级卫生保健”、“全科医学”在民众中传播时既让人费解，又常常诱生歧义，前者“初级卫生保健”一点都不准确贴合英文，还把基本医疗这个重要的概念从字面剔除出去，搞得许多人还以为这是CDC干的活。后者就更是离题千里了，就算翻译成“普通医学”也比全科好得多，至少不会造成今天很多患者把全科和专科对立起来的思维惯性，其实GP哪里是什么全科罗？GP就是医学专科系统中的一个“专科分支”吗，不但患者搞不清，就访谈的许多health manager都糊涂得很。当年的那些土鳖翻译真害死人。
那在相对成熟一点的现代国家的卫生体系里PC都涵盖一些什么病患呢？或者由哪些医师分别在PC及其上两个层级中提供服务呢？
Primary care: Common chronic illnesses, usually treated in primary care, include: Hypertension, heart failure, and angina, Diabetes, Asthma and COPD, Depression and anxiety, Back pain, Arthritis, Thyroid dysfunction. 如果在UK肯定是GP执业。
Secondary care is the service provided by medical specialists who generally do not have first contact with patients, for example, cardiologists, urologists and dermatologists. Allied health professionals, such as occupational therapists, speech therapists, and dietitians, also generally only work in secondary care.
In some localities (such as the UK), primarily for reasons of convenience, the term "secondary care" is used synonymously with "hospital care". This is despite the fact that certain secondary care specialists do not generally work in hospitals (such as psychiatrists), and some primary care facilities (notably the emergency department) are located within hospitals.
Tertiary healthcare is specialized consultative care, usually on referral from primary or secondary medical care personnel, by specialists working in a center that has personnel and facilities for special investigation and treatment.
Specialist cancer care, neurosurgery (brain surgery), burns care and plastic surgery are examples of tertiary care services.
Tertiary health care, a specialized, highly technical level of health care that includes diagnosis and treatment of disease and disability. Specialized intensive care units, advanced diagnostic support services, and highly specialized personnel are usually characteristic of tertiary health care. It offers highly centralized care to the population of a large region and in some cases to the world. ---Mosby's Medical Dictionary, 8th edition.@ 2009, Elsevier.
