Engstrom J W, Hauser S L
Department of Neurology, University of California, San Francisco, School of Medicine 94143-0114.
West J Med. 1994 Sep;161(3):331-4.
Clinical neurologists in the health care system of the future should have a multifaceted role. Advances in the basic understanding of the nervous system and therapeutics of neurologic disease have created, for the first time in human history, an ethical imperative to correctly diagnose neurologic disease. In many situations, the neurologists may function as a consultant and principal physician for patients with primary nervous system disorders including Parkinson's disease, multiple sclerosis, Alzheimer's disease, epilepsy, migraine, cerebrovascular disease, movement disorders, and neuromuscular disease. Other important roles for neurologists include the training of future physicians, both neurologists and primary care physicians, the application of cost-effective approaches to care, and the support of health care delivery research and academic programs that link basic research efforts to the development of new therapy. To be successful, future residency training programs should include joint certification opportunities in both neurology and general medicine, and training programs for clinical investigators should be expanded. Despite its threats to specialists, managed care should also provide opportunities for new alliances among neurologists, other specialists, and primary care physicians that will both improve patient care and increase efficiency and cost-effectiveness.
未来医疗保健系统中的临床神经科医生应发挥多方面的作用。对神经系统的基本认识和神经疾病治疗方法的进展，在人类历史上首次产生了正确诊断神经疾病的道德责任。在许多情况下，神经科医生可以作为患有原发性神经系统疾病（包括帕金森病、多发性硬化症、阿尔茨海默病、癫痫、偏头痛、脑血管疾病、运动障碍和神经肌肉疾病）患者的顾问和主治医生。神经科医生的其他重要作用包括培训未来的医生，包括神经科医生和初级保健医生，应用具有成本效益的护理方法，以及支持将基础研究工作与新疗法开发联系起来的医疗保健服务研究和学术项目。为了取得成功，未来的住院医师培训项目应包括神经科和普通医学的联合认证机会，并且应扩大临床研究人员的培训项目。尽管管理式医疗对专科医生构成威胁，但它也应为神经科医生、其他专科医生和初级保健医生之间建立新的联盟提供机会，这将既能改善患者护理，又能提高效率和成本效益。
