Larson Eric B
Group Health Cooperative, Center for Health Studies, Seattle, Washington 98101-1448, USA.
Ann Intern Med. 2004 Apr 20;140(8):639-43. doi: 10.7326/0003-4819-140-8-200404200-00011.
The Society of General Internal Medicine asked a task force to redefine the domain of general internal medicine. The Society believes that the chaos and dysfunction that characterize today's medical care and the challenges facing general internal medicine should spur innovation. The task force proposed the following recommendations. 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 given by their teams, embrace changes in information systems, and aim to provide most of the care required by their patients. 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 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 in generalist fields. Research should 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. The task force believes that these changes will 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。该协会认为，当今医疗保健所具有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。特别工作组提出了以下建议。普通内科应始终忠于其核心价值观和能力，既要保持广度又要保持深度，涵盖从简单的初级保健到对患有多种复杂慢性病患者的持续护理。研究生教育和继续医学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筹资方式，尤其是按服务收费的方式，以认可传统面对面诊疗之外所提供服务的价值，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有选择地调整其最后1至2年的培训，以符合其执业目标，通常可获得通科领域的附加资格证书。研究应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。特别工作组认为，这些变革将使患者和公众受益，并使普通内科重新焕发生机。
