Lieberman J A
Department of Family and Community Medicine, Medical Center of Delaware, Wilmington 19899, USA.
J Clin Psychiatry. 1996;57 Suppl 7:76-82; discussion 83-5.
Primary care medical practice is a broadly based medical discipline, emphasizing continuity of care in both sickness and health and effective doctor/patient communication and involving the patient as a partner in the provision of health care services. Against this background, there is troubling evidence that psychosocial (mental health) problems are not being adequately diagnosed and treated by physicians in general, and primary care practitioners in particular. This deficiency is the first step down the road to poor compliance. This author assumes that a goodly portion of the blame can be laid on the doorstep of the medical education establishment with its emphasis on the biomedical, reductionism, and high-tech tertiary care. Physicians exit the educational system with a predisposition to deal with problems from a biomedical perspective. They are unaware that, by the very nature of the doctor/patient relationship, they possess considerable ability to effectively intervene in the psychosocial area. Suggestions are given as to how primary care practitioners can improve on this dimension of their medical practice and deal with psychosocial issues. Available evidence would indicate that effectively dealing with these issues will improve patient compliance and outcomes.
初级保健医疗实践是一门基础广泛的医学学科，强调在疾病和健康状态下的连续护理以及有效的医患沟通，并让患者作为提供医疗服务的合作伙伴参与其中。在此背景下，有令人不安的证据表明，一般医生，尤其是初级保健从业者，并未对心理社会（心理健康）问题进行充分的诊断和治疗。这种不足是导致依从性差的第一步。本文作者认为，很大一部分责任应归咎于医学教育机构，其侧重于生物医学、还原论和高科技三级护理。医生从教育体系毕业时倾向于从生物医学角度处理问题。他们没有意识到，就医患关系的本质而言，他们具备在心理社会领域有效干预的相当能力。文中给出了关于初级保健从业者如何在其医疗实践的这一方面加以改进并处理心理社会问题的建议。现有证据表明，有效处理这些问题将改善患者的依从性和治疗效果。
