Larson Eric B, Fihn Stephan D, Kirk Lynne M, Levinson Wendy, Loge Ronald V, Reynolds Eileen, Sandy Lewis, Schroeder Steven, Wenger Neil, Williams Mark
Group Health Center for Health Studies, Seattle, Washington 98101-1448, USA.
J Gen Intern Med. 2004 Jan;19(1):69-77. doi: 10.1111/j.1525-1497.2004.31337.x.
The Society of General Internal Medicine asked a task force to redefine the domain of general internal medicine. The task force believes that the chaos and dysfunction that characterize today's medical care, and the challenges facing general internal medicine, should spur innovation. These are our recommendations: while remaining true to its core values and competencies, general internal medicine should stay both broad and deep-ranging from uncomplicated primary care to continuous care of patients with multiple, complex, chronic diseases. Postgraduate and continuing education should develop mastery. Wherever they practice, general internists should be able to lead teams and be responsible for the care their teams give, embrace changes in information systems, and aim to provide most of the care their patients require. Current financing of physician services, especially fee-for-service, must be changed to recognize the value of services performed outside the traditional face-to-face visit and give practitioners incentives to improve quality and efficiency, and provide comprehensive, ongoing care. General internal medicine residency training should be reformed to provide both broad and deep medical knowledge, as well as mastery of informatics, management, and team leadership. General internal medicine residents should have options to tailor their final 1 to 2 years to fit their practice goals, often earning a certificate of added qualification (CAQ) in special generalist fields. Research will expand to include practice and operations management, developing more effective shared decision making and transparent medical records, and promoting the close personal connection that both doctors and patients want. We believe these changes constitute a paradigm shift that can benefit patients and the public and reenergize general internal medicine.
普通内科协会要求一个特别工作组重新界定普通内科的领域。该特别工作组认为，当今医疗护理的混乱和功能失调以及普通内科所面临的挑战应能激发创新。以下是我们的建议：在坚守其核心价值观和能力的同时，普通内科应保持广泛且深入——涵盖从简单的初级护理到对患有多种复杂慢性病患者的持续护理。研究生教育和继续教育应培养精通能力。无论在何处执业，普通内科医生都应能够领导团队并对其团队提供的护理负责，适应信息系统的变化，并致力于提供患者所需的大部分护理。必须改变目前医生服务的融资方式，尤其是按服务收费的方式，以认可在传统面对面诊疗之外提供的服务的价值，并激励从业者提高质量和效率，提供全面、持续的护理。普通内科住院医师培训应进行改革，以提供广泛而深入的医学知识，以及对信息学、管理和团队领导能力的精通。普通内科住院医师应可以选择在最后1至2年根据自己的执业目标进行调整，通常可在专科通才领域获得附加资格证书（CAQ）。研究将扩大到包括实践和运营管理，开发更有效的共同决策和透明的医疗记录，并促进医生和患者都期望的密切个人联系。我们相信这些变革构成了一种范式转变，能够使患者和公众受益，并为普通内科注入新的活力。
