Merkel W T
J Fam Pract. 1983 Nov;17(5):857-62.
Although there have been many noteworthy attempts to integrate a family focus into family medicine, there is little evidence that this integration has occurred in either residency education or community practice. When the specialty was founded, a family emphasis may have been politically useful as a way to differentiate the new family physician from the old general practitioner. Now, however, it is unclear what specific family-related material should be taught or who should teach it since few family practice faculty are trained in understanding families. If a practicing family physician actually wants to see a family, practical problems concerning time, space, and money arise. Furthermore, the medicolegal system is structured to protect the confidential relationship between one patient and one physician. Other obstacles to the integration include the difficult epistemological shift required to apply systems theory, the current chaos in the family field, and family medicine's need to gain professional stature by being proficient in traditional medicine. It may be time for the family and family medicine to reconsider their well-intended but ill-advised relationship.
尽管已经有许多将家庭视角融入家庭医学的值得注意的尝试，但几乎没有证据表明这种融合在住院医师培训或社区实践中发生过。当这个专业创立时，强调家庭可能在政治上是有用的，作为一种将新的家庭医生与旧的全科医生区分开来的方式。然而现在，不清楚应该教授哪些与家庭相关的具体内容，也不清楚谁应该来教授，因为很少有家庭医学教员接受过理解家庭方面的培训。如果一名执业家庭医生真的想要诊治一个家庭，就会出现关于时间、空间和金钱的实际问题。此外，医疗法律体系的构建是为了保护单个患者与单个医生之间的保密关系。融合的其他障碍包括应用系统理论所需的艰难认识论转变、当前家庭领域的混乱状况，以及家庭医学需要通过精通传统医学来获得专业地位。也许是时候让家庭和家庭医学重新审视它们本意良好但却欠考虑的关系了。
