Shore J H
Department of Psychiatry, University of Colorado Health Sciences Center, Denver 80262, USA.
Am J Psychiatry. 1996 Nov;153(11):1398-403. doi: 10.1176/ajp.153.11.1398.
The shortage of primary care physicians is seen as an urgent health systems priority and is supported by a national consensus. Psychiatry is at a crossroad and must reevaluate the profession's role in primary care. This article supports the position that psychiatrists need to be able to medically evaluate and to provide basic primary medical care for seriously mentally ill patients who do not have adequate access to general health care. Many of the seriously mentally ill are difficult to treat when they contact a medical care provider. Because of their psychiatric symptoms, they often are unlikely to receive adequate medical care. Psychiatrists frequently are the only physicians with whom they have consistent contact.
This article contains a proposal for a new initiative to broaden the role of public psychiatrists to include a primary care role. In addition, new opportunities for dual or triple board certification are reviewed.
A new curricular model for primary care training in general psychiatry programs is outlined. The new curriculum would include training for diagnostic and primary care skills to prepare psychiatrists to provide basic primary medical services for the chronically mentally ill.
The new curricular proposal would create an elective psychiatry primary care track. This is possible within current accreditation requirements. Psychiatric residents could receive primary care training throughout their residency.
基层医疗医生短缺被视为卫生系统的一项紧迫优先事项，并得到了全国共识的支持。精神病学正处于十字路口，必须重新评估该专业在基层医疗中的作用。本文支持这样一种观点，即精神科医生需要能够对那些无法获得充分普通医疗服务的重症精神病患者进行医学评估并提供基本的基层医疗服务。许多重症精神病患者在与医疗服务提供者接触时很难得到治疗。由于他们的精神症状，他们往往不太可能获得充分的医疗服务。精神科医生常常是他们唯一能够持续接触的医生。
本文提出了一项新倡议的建议，以扩大公共精神科医生的作用，使其包括基层医疗角色。此外，还审视了双重或三重委员会认证的新机会。
概述了普通精神病学项目中基层医疗培训的新课程模式。新课程将包括诊断和基层医疗技能培训，以使精神科医生能够为慢性精神病患者提供基本的基层医疗服务。
新的课程建议将创建一个选修的精神病学基层医疗方向。在当前的认证要求范围内这是可行的。精神科住院医生在整个住院期间都可以接受基层医疗培训。
