Krishnan Anand
Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India.
Indian J Community Med. 2016 Jan-Mar;41(1):5-10. doi: 10.4103/0970-0218.170956.
Today, the Community Medicine professionals in India feel both "confused" and "threatened" by the mushrooming of schools of public health and departments of family medicine. The phenomenon of identity crisis and low-self esteem is not a recent one, nor is it restricted to India. The disciplines of community medicine and public health have evolved differently and despite some overlaps have differences especially in the need for clinical training. The core of the issue is that while the community medicine fraternity is keen to retain its clinical tag, what differentiates it from clinicians is the use of public health approach. I believe the strength of community medicine is that it bridges the gap between traditional fields of public health and clinical medicine and brings community perspective into health. The perceived threat from non-medical persons led public health is largely a result of us undervaluing our strength and our inability to foster partnership on equal footing with non-clinicians. While departments of community medicine have a fully functional rural or urban field practice area used for training at primary level care, these can serve as an excellent platform for training in secondary level care required for family medicine. National needs dictate that all three disciplines are required for improvement of population health, whether these are housed together or separately can be left to individual institutions to decide as long as they enable collaborations between them. We need to strengthen community medicine and market it appropriately to ministries of health.
如今，印度的社区医学专业人员对公共卫生学院和家庭医学系的迅速增加感到既“困惑”又“受到威胁”。身份危机和自卑的现象并非近期才出现，也不仅限于印度。社区医学和公共卫生学科的发展路径不同，尽管存在一些重叠，但也有差异，尤其是在临床培训需求方面。问题的核心在于，虽然社区医学同仁热衷于保留其临床标签，但它与临床医生的区别在于采用公共卫生方法。我认为社区医学的优势在于它弥合了传统公共卫生领域与临床医学之间的差距，并将社区视角引入健康领域。来自非医学人员主导的公共卫生的感知威胁，很大程度上是由于我们低估了自身的优势，以及我们无法与非临床医生在平等基础上建立伙伴关系。虽然社区医学系拥有功能齐全的农村或城市实地实践区域用于初级保健培训，但这些区域也可作为家庭医学所需二级保健培训的绝佳平台。国家需求表明，改善人群健康需要所有这三个学科，它们是集中设置还是分开设置可由各机构自行决定，只要能促进它们之间的合作即可。我们需要加强社区医学，并向卫生部进行适当的推广。
