Schroeder J L, Clarke J T, Webster J R
JAMA. 1985 Dec 6;254(21):3080-2.
The transition from a fee-for-service model to a prepaid health care system creates new challenges for both physicians and patients. Occasionally both can feel trapped in the new setting and must rely on new or different strategies to reach sometimes divergent objectives. This may alter the physician-patient relationship in ways that neither likes. Based on our experience in a large multispecialty academic group practice, we have developed management strategies to mitigate such stresses on both parties. These include review of marketing efforts; education of new patients to foster realistic expectations; a physician-generated, prospective internal policy for dealing with dissatisfied patients and physicians; a strong central administrative physician to serve as a "lightning rod" and counselor; and continuing physician orientation and education to improve judgment and attitudes. These strategies promote the physician's role as expert consultant-educator with the best interests of the patient as the first priority.
从按服务收费模式向预付医疗保健系统的转变给医生和患者都带来了新的挑战。有时，双方都会觉得被困在新环境中，必须依靠新的或不同的策略来实现有时相互矛盾的目标。这可能会以双方都不喜欢的方式改变医患关系。基于我们在一个大型多专科学术团体实践中的经验，我们制定了管理策略来减轻双方的此类压力。这些策略包括审查营销工作；对新患者进行教育以培养现实的期望；制定医生主导的、前瞻性的内部政策来处理不满意的患者和医生；设立一位强有力的中央行政医生作为“避雷针”和顾问；以及持续对医生进行培训和教育以提高判断力和态度。这些策略促进了医生作为专家顾问教育者的角色，将患者的最大利益作为首要任务。
