Shippee N D, Allen S V, Leppin A L, May C R, Montori V M
ND Shippee, Division of Health Policy and Management, School of Public Health, University of Minnesota, D375 Mayo MMC 729, Minneapolis, MN 55455, USA. Email
J R Coll Physicians Edinb. 2015;45(2):118-22. doi: 10.4997/JRCPE.2015.206.
In this second of two papers on minimally disruptive medicine, we use the language of patient workload and patient capacity from the Cumulative Complexity Model to accomplish three tasks. First, we outline the current context in healthcare, comprised of contrasting problems: some people lack access to care and others receive too much care in an overmedicalised system, both of which reflect imbalances between patients' workloads and their capacity. Second, we identify and address five tensions and challenges between minimally disruptive medicine, the existing context, and other approaches to accessible and patient-centred care such as evidence-based medicine and greater patient engagement. Third, we outline a roadmap of three strategies toward implementing minimally disruptive medicine in practice, including large-scale paradigm shifts, mid-level add-ons to existing reform efforts, and a modular strategy using an existing 'toolkit' that is more limited in scope, but can fit into existing healthcare systems.
在关于微创医学的两篇论文中的第二篇里，我们运用累积复杂性模型中患者工作量和患者能力的语言来完成三项任务。首先，我们概述医疗保健的当前背景，它由相互矛盾的问题构成：一些人无法获得医疗服务，而在过度医疗化的体系中另一些人接受了过多的医疗服务，这两者都反映了患者工作量与其能力之间的失衡。其次，我们识别并解决微创医学、现有背景以及其他以患者为中心的可及医疗方法（如循证医学和更高的患者参与度）之间的五个矛盾和挑战。第三，我们勾勒出在实践中实施微创医学的三项策略路线图，包括大规模的范式转变、对现有改革努力的中级补充，以及使用现有“工具包”的模块化策略，该策略范围更有限，但能融入现有的医疗体系。
