美国家庭医学对中国全科(家庭)医学发展的展望和建议

Family Medicine in USA Today and Its Perspective in China

家庭医学发源于美国,是在早期全科医学实践的基础上对住院医生进一步规范化培训、延长培训时间、充实全科临床实践内容、严格毕业考察制度等而建立起来的一门综合性医学专科。由于其独特的以综合性基础医疗卫生服务为核心的学科特征,家庭医学在发达国家得到了积极的认可和充分发展,成为各国医药卫生服务的主体,在改善和提高各国居民健康水平、降低医药卫生服务成本等方面取得了广泛成功。由于多种原因,美国未能建立全民医保体系,专科医生服务占主导地位,家庭医学没有得到重视,导致美国医药卫生人均开支超过英国、法国、澳大利亚等其他发达国家1倍以上。我国新医改方案的推行和全科(家庭)医生制度的建立具有里程碑意义,必将造福于人民大众。但是在没有较好基础的条件下,迅速建立起庞大的全科(家庭)医生队伍,必然面临巨大的困难。如果我们用科学的发展观,把握重心,转变观念,合理布局,充分利用中央政府的宏观政策和国内外资源,可以在较短的时间内取得显著进展。本文通过总结美国家庭医学发展和住院医生培训的经验和教训,对我国全科(家庭)医学的发展提出展望和建议。

Family Medicine, a medical specialty devoted to comprehensive primary care for people of all ages, is orig- inated from USA and evolved from general practice with advanced, standardized residency training, and board certifica- tion. Family medicine has been recognized and developed as the foundation of modern healthcare system in advanced countries, and enjoys a great success in improvement of national health status and constraint of healthcare expenditure. In USA, national heahhcare system has failed, because of various reasons, to be established, family medicine has been neglected and the health- care system dominated by specialty care, leading to startling high costs （ double those in UK, France, Australia and other devel- oped countries） . The new heahhcare reform plan and development of family medicine system in China, hailed as a historic mile- stone, will certainly benefit all the people. But to field a colossal GP team on a poor basis, however, has proved to be a tremen- dous challenge. With strong momentum from central government and support of favorable finance and policy, a great achievement can be made when heahhcare model is truly switched from specialty care into primary care in medical education institutions and heahhcare industry. This article reviews experience and lesions in US family medicine development and her residency training pro- grams, to elucidate some perspectives and strategies on the development of family medicine in China.