George Lynn Cross Emeritus Professor of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
Professor Emeritus of Internal Medicine & Medical Informatics, OU-TU School of Community Medicine, Tulsa, Oklahoma.
Ann Fam Med. 2022 Jul-Aug;20(4):353-356. doi: 10.1370/afm.2827.
The development of patient-centered medical homes in the United States was, among other things, an attempt to improve patients' experiences of care. This and other improvement strategies, however, have failed to confront a major barrier, our disease-oriented medical model. Focusing on diseases has contributed to subspecialization and reductionism, which, for patients, has increased medical complexity and made it more difficult to engage in collaborative decision making. The progressive uncoupling of disease prevention and management from other outcomes that may matter more to patients has contributed to the dehumanization of care. An alternative approach, person-centered care, focuses clinical care directly on the aspirations of those seeking assistance, rather than assuming that these aspirations will be achieved if the person's medical problems can be resolved. We recommend the adoption of 2 complementary person-centered approaches, narrative medicine and goal-oriented care, both of which view health problems as obstacles, challenges, and often opportunities for a longer, more fulfilling life. The transformation of primary care practices into patient-centered medical homes has been an important step forward. The next step will require those patient-centered medical homes to become person centered.
美国以患者为中心的医疗之家的发展，除其他外，是为了改善患者的护理体验。然而，这些和其他的改进策略都未能解决一个主要障碍，即我们以疾病为导向的医疗模式。专注于疾病导致了专科化和还原论，这使得医疗变得更加复杂，也使患者更难以参与协作决策。疾病预防和管理与其他可能对患者更重要的结果的逐步脱钩，导致了护理的非人化。一种替代方法，即以人为本的护理，将临床护理直接针对寻求帮助的人的愿望，而不是假设如果能解决这个人的医疗问题，这些愿望就会实现。我们建议采用 2 种互补的以人为本的方法，叙事医学和以目标为导向的护理，这两种方法都将健康问题视为障碍、挑战，而且通常是过上更长、更充实的生活的机会。将初级保健实践转变为以患者为中心的医疗之家是向前迈出的重要一步。下一步将需要这些以患者为中心的医疗之家变得以人为本。
