Hull F M
Free University, Amsterdam, The Netherlands.
Soc Sci Med. 1987;25(6):679-87. doi: 10.1016/0277-9536(87)90095-5.
This paper attempts to analyse some of the complex problems that face primary health care practice in the developed world today. These are shown to be a degree of depersonalisation, that has come with greater efficiency, and a reduction in the quality of the doctor-patient relationship, which has accompanied increased medical effectiveness. These changes are in turn related to changes in diagnostic methods in primary care, to changes in the organisation of primary care and to change in the stress laid on interventive, preventive and rehabilitative care. All these inter-related problems have to be viewed against a background of shortage of resource which demand a far more stringent system of accountability than has been common until now. A possible solution lies in redefining the traditional medical role and the philosophical basis which underlies that role at a time when primary health care is confronted by the special problems of the AIDS pandemic. This would require major alterations in medical attitudes and in established medical education which may be impossible for the doctors to achieve by themselves. It is suggested that a most important role of socio-behavioural scientists lies in helping the medical profession to remove the attitudinal and educational barriers which prevent the realisation of the concept of a new sort of doctor who may cope with the demands of primary health care as we approach 2000.
本文试图分析当今发达国家基层医疗实践所面临的一些复杂问题。这些问题表现为，随着效率提高出现了一定程度的非人性化，以及随着医疗效果提升医患关系质量有所下降。这些变化反过来又与基层医疗诊断方法的改变、基层医疗组织形式的变化以及对干预、预防和康复护理重视程度的变化相关。所有这些相互关联的问题都必须在资源短缺的背景下看待，这就要求建立一个比以往更为严格的问责制度。在基层医疗面临艾滋病大流行这一特殊问题之际，一个可能的解决办法是重新界定传统医疗角色及其背后的哲学基础。这将需要在医学态度和既定医学教育方面进行重大改变，而医生自身可能无法实现这些改变。有人认为，社会行为科学家的一个最重要作用在于帮助医学专业消除态度和教育方面的障碍，这些障碍阻碍了新型医生概念的实现，而这种新型医生或许能够应对我们迈向2000年时基层医疗的需求。
