Fiscella Kevin, Epstein Ronald M
Department of Family Medicine, University of Rochester School of Medicine & Dentistry, 1381 South Ave, Rochester, NY 14620, USA.
Arch Intern Med. 2008 Sep 22;168(17):1843-52. doi: 10.1001/archinte.168.17.1843.
There is so much to do in primary care, and so little time to do it. During 15-minute visits, physicians are expected to form partnerships with patients and their families, address complex acute and chronic biomedical and psychosocial problems, provide preventive care, coordinate care with specialists, and ensure informed decision making that respects patients' needs and preferences. This is a challenging task during straightforward visits, and it is nearly impossible when caring for socially disadvantaged patients with complex biomedical and psychosocial problems and multiple barriers to care. Consider the following scenario.
基层医疗中有诸多事务要处理,然而时间却少之又少。在15分钟的诊疗过程中,医生需要与患者及其家属建立合作关系,解决复杂的急性和慢性生物医学及心理社会问题,提供预防性护理,与专科医生协调护理工作,并确保做出尊重患者需求和偏好的明智决策。在常规诊疗过程中,这就是一项具有挑战性的任务,而当照顾那些存在复杂生物医学和心理社会问题且面临多重就医障碍的社会弱势群体时,这几乎是不可能完成的任务。请考虑以下情形。