Keidar Ilan
Med Law. 2014 Oct;33(3):87-106.
Modern medicine offers better health and longer life expectancy, yet consumes huge budgets. The Israeli Health Insurance Law (IHIL) regulates the delivery of health services to all Israel's residents through Health Maintenance Organizations (HMOS). These organizations confront constant struggles with their budgets and have to reduce expenses as much as possible (without harming the health level rendered). In the constant necessity to restrain expenses are embedded difficulties that might cause unrest to the Public Health System (PHS). At the edge of the public health spear are the Family Physicians (FPS) who have not only to supply the best possible medicine to their patients, and at the same time confront budgetary constraints that have the potential to hinder the level of rendered medicine, but also have, at times, to mediate between the conflicting interests of their patients' wish to receive the best available health measures, the FP own medical believes, the HMO's directives and, between the FPS wish, to keep up the number of their (content) patients. One of the World Health Organization's (WHO) concepts, like Israel's one, is that soul and body are inseparable and must be addressed simultaneously in the process of healing. Real life at the Family Physicians' clinics shows, at times, that despite the Israeli physicians' very high professional level, and the Israeli Health System (IHS)'s high efficiency, such a process, due to budgetary constraints, workload and various other reasons, does not always take place and, on the personal level, there are patients who feel that the "system" has treated them incorrectly and in an unsatisfactory manner. Unsatisfied and restless patients might cause undesirable consequences to the "system", like losing faith in one's FP and HMO, which might lead to the patients' reduced cooperation in the healing process, lawsuits amplification, patients leaving their FPS and their HMOs etc. Addressing the patient's soul and body as an inseparable unit would help harnessing the patients' will and mental resources to the healing process. A content and satisfied patient tends to less argue with his/her FP, to be more satisfied with the rendered health services, to be more grateful for the provided services, to be healthier (as some would argue), to be more motivated and committed to the healing process, thus, all parties would benefit, emotionally, physically and from the budgetary point of view. This article would like to offer a "simple" 'yet very effective way' to keep the HMO's members feel that they are not alone at their sensitive time of illness, that behind the FP's desk sits not only a professional figure, but also a "human being" who is there to support their "souls" as well, thus, harnessing the patients to the healing process, reducing the patients' possible discontent from the HMOS's ways of rendering services including, at times, in cases when the required or desired medical measures is not received. The correct use of Interpersonal Communication (IPC) by the FP encompasses tremendous opportunities to achieve the desired connection between soul and body during the healing process, and offers many personal, budgetary and other benefits to the patient, FP, HMO and the health system at large. Its use is almost costless, its contribution to the health system is huge and, last, but not least, it can easily be learned and adopted by FPS in their daily work with their patients and the system.
现代医学带来了更健康的身体和更长的预期寿命,但却耗费巨额预算。以色列《健康保险法》(IHIL)通过健康维护组织(HMOS)来规范向所有以色列居民提供的医疗服务。这些组织在预算方面面临持续的压力,必须尽可能削减开支(同时不损害所提供的医疗水平)。在持续需要控制开支的情况下存在一些困难,这些困难可能会给公共卫生系统(PHS)带来动荡。处于公共卫生前沿的是家庭医生(FPS),他们不仅要为患者提供尽可能好的医疗服务,同时还要面对可能阻碍所提供医疗水平的预算限制,而且有时还必须在患者希望获得最佳可用健康措施的利益冲突、家庭医生自身的医学信念、健康维护组织的指令以及家庭医生希望维持其(满意的)患者数量之间进行调解。世界卫生组织(WHO)的一个理念与以色列的理念一样,即身心不可分割,在治疗过程中必须同时加以关注。家庭医生诊所的实际情况有时表明,尽管以色列医生的专业水平很高,以色列医疗系统(IHS)效率也很高,但由于预算限制、工作量和其他各种原因,这样的过程并不总是能够实现,而且在个人层面上,有些患者觉得“系统”对他们的治疗不正确且不令人满意。不满意且烦躁不安的患者可能会给“系统”带来不良后果,比如对自己的家庭医生和健康维护组织失去信心,这可能导致患者在治疗过程中减少合作、诉讼增加、患者离开他们的家庭医生和健康维护组织等。将患者的身心作为一个不可分割的整体来对待,有助于调动患者的意愿和精神资源投入到治疗过程中。一个满意的患者往往与他/她的家庭医生争吵更少,对所提供的医疗服务更满意,对所提供的服务更感激,更健康(有些人会这么认为),更有动力并致力于治疗过程,因此,从情感、身体和预算角度来看,各方都会受益。本文希望提供一种“简单”但非常有效的方法,让健康维护组织的成员在生病这个敏感时期感到自己并不孤单,在家庭医生的办公桌后不仅坐着一个专业人士,而且还有一个“人”在那里支持他们的“灵魂”,从而使患者参与到治疗过程中,减少患者对健康维护组织提供服务方式(有时包括在未获得所需或期望的医疗措施的情况下)可能产生的不满。家庭医生正确使用人际沟通(IPC)在治疗过程中包含了实现身心所需联系的巨大机会,并为患者、家庭医生、健康维护组织和整个医疗系统带来许多个人、预算和其他方面的益处。其使用几乎没有成本,对医疗系统的贡献巨大,最后但同样重要的是,家庭医生在与患者及系统的日常工作中可以很容易地学习并采用。