Freed Gary L
Child Health Evaluation and Research Unit, University of Michigan, 300 North Ingalls, Ann Arbor, MI 48109 USA ; University of Melbourne, Parkville, 31 61 Victoria Australia.
Isr J Health Policy Res. 2015 Dec 10;4:57. doi: 10.1186/s13584-015-0051-6. eCollection 2015.
Two important considerations arise from this IJHPR article from Zimmerman and colleagues. First, is the question regarding what can be considered a "common" procedure in primary care and whether the designation can or should change over time. The second issue is whether it is enough for a doctor to feel comfortable doing a procedure for it to be within their scope of practice, or whether the practice specific outcome for the procedure in terms of safety and efficacy is a more relevant determination of whether the procedure should be performed in a given setting. In other words, just because a doctor "can" or "wants" to do a procedure, may not mean they "should" do a procedure. The role of procedures in a practice of primary care also differs markedly in the care of children vs. the care of adults. This phenomenon is partially the result of the more challenging aspects of the care of infants and small children with regard to the ability to maintain a sterile field for procedures, and the relative infrequency with which procedures are performed on children relative to adults. The scope of practice for pediatricians in the community has changed over time and is likely to continue to change. This paper helps to define the current state of practice for paediatricians with regard to the conduct of 10 specific procedures. It challenges us to think about the appropriateness of the venue of care and its implications for both the status quo and the future of community based primary care.
齐默尔曼及其同事发表在《国际健康促进与实践研究》上的这篇文章引发了两个重要思考。其一，关于在初级保健中什么可被视为“常见”程序，以及这种认定是否会随时间变化或应随时间变化。第二个问题是，对于医生而言，仅仅觉得做某项程序得心应手就意味着该程序在其执业范围内，还是说就该程序在安全性和有效性方面的特定实践结果才是决定在特定环境下是否应进行该程序的更相关因素。换句话说，仅仅因为医生“能”或“想”做某项程序，并不一定意味着他们“应该”做该程序。在初级保健实践中，针对儿童的护理和针对成人的护理，程序所起的作用也有显著差异。这种现象部分是由于在为婴幼儿进行程序时，要维持无菌操作区域更具挑战性，以及相对于成人，儿童接受程序治疗的频率相对较低。社区儿科医生的执业范围随时间发生了变化，而且可能会继续变化。本文有助于界定儿科医生在进行10项特定程序方面的当前实践状况。它促使我们思考护理场所的适宜性及其对基于社区初级保健的现状和未来的影响。
