Lee T H
Partners Community Healthcare, Inc., Boston, MA 02199-8001, USA.
Schweiz Med Wochenschr. 1998 Nov 28;128(48):1889-92.
Practice guidelines are often perceived as a threat to physician autonomy. However, the true challenge to physician autonomy is the rising costs of health care, which in turn is the result of continued progress in medical research. Since, inevitably, choices must be made about how our limited resources are expended, an increasing number of physicians are concluding that health care providers should assume financial risk for providing care--so that providers can make the decisions about which interventions are used for which patients. In this context, groups of physicians are adopting practice guidelines as an important strategy for providing high quality and efficient care under capitation. At least in some areas, practice guidelines are emerging as a critical tool for physicians to assume financial risk, and thereby protect professional autonomy.
实践指南常常被视为对医生自主权的一种威胁。然而，对医生自主权真正的挑战是医疗保健成本的不断上升，而这又是医学研究持续进步的结果。由于不可避免地必须就如何使用我们有限的资源做出选择，越来越多的医生得出结论，医疗保健提供者应该为提供医疗服务承担财务风险——这样提供者就能决定针对哪些患者使用哪些干预措施。在这种背景下，医生群体正在采用实践指南作为在按人头付费情况下提供高质量和高效医疗服务的一项重要策略。至少在某些领域，实践指南正成为医生承担财务风险从而保护职业自主权的关键工具。
