敘事醫(yī)學(xué)在基層醫(yī)療中的實(shí)踐：基于全科醫(yī)生視角

【摘要】 全科醫(yī)學(xué)提供的初級(jí)衛(wèi)生保健是實(shí)現(xiàn)全民健康的重要保障。隨著新醫(yī)改的不斷深入，我國基層醫(yī)療機(jī)構(gòu)的數(shù)量、全科醫(yī)生的數(shù)量及門診人次數(shù)均較十年前大幅提升。全科醫(yī)生作為全科醫(yī)學(xué)的實(shí)施主體，在以患者為中心、同時(shí)關(guān)注患者的心理和社會(huì)因素方面與敘事醫(yī)學(xué)理念不謀而合，敘事醫(yī)學(xué)是由具有敘事能力的臨床工作者所實(shí)踐的醫(yī)學(xué)，目前在我國存在理論強(qiáng)、實(shí)踐弱的情況。本文在全科醫(yī)生視角下，以平行病歷的形式展現(xiàn)敘事醫(yī)學(xué)在基層醫(yī)療中的實(shí)踐對(duì)全科醫(yī)生的積極影響。

【關(guān)鍵詞】 全科醫(yī)學(xué)；敘事醫(yī)學(xué)；平行病歷；基層醫(yī)療

【中圖分類號(hào)】 R 749.08 【文獻(xiàn)標(biāo)識(shí)碼】 A DOI：10.12114/j.issn.1007-9572.2023.0181

Discussion on the Practice of Narrative Medicine in Primary Care from the Perspective of General Practitioners

WANG Lin1，WANG Yixin2*，CHEN Tingyan3，LIN Shaohai4，ZHANG Yonghui5

1. Department of General Practice，Community Health Service Center of Shahe Higher Education Park，Changping District，Beijing 102206，China

2. Department of General Practice，Beijing Anzhen Hospital，Capital Medical University，Beijing 100029，China

3. Department of Gastroenterology，the First Affiliated Hospital of Fujian Medical University，F(xiàn)uzhou 350000，China

4. Beijing Health Human Resource Development Center，Beijing 100034，China

5. Department of General Practice，Huayuan Road Community Health Service Center，Haidian District，Beijing 100088，China

*Corresponding author：WANG Yixin，Chief physician；E-mail：wangyixin6417@sina.com

【Abstract】 Primary health care provided by general practitioners is an important safeguard for the achievement of universal health coverage. With the continues progress of new medical reform，the number of primary care settings，general practitioners and outpatient visits have increased significantly compared with one decade ago. General practitioners，as the main body of implementation of general practice，coincides with the concept of narrative medicine in terms of patient-centeredness and attention to both psychological and social factors of the patients. Narrative medicine is medicine practiced by clinical workers who have narrative ability，with strong theory and weak practice in our country at present. From the perspective of general practitioners，this paper presents the positive influence of narrative medicine practice in primary care on general practitioners in the form of parallel medical records.

【Key words】 General practice；Narrative medicine；Parallel medical records；Primary health care

實(shí)現(xiàn)全民健康應(yīng)立足兩個(gè)著力點(diǎn)，即全人群和全生命周期［1］。全科醫(yī)學(xué)面向社區(qū)和家庭，涵蓋了全人群和全生命周期的各類健康問題，將整體的健康促進(jìn)和健康維護(hù)作為目標(biāo)，將個(gè)體與群體健康融為一體，將醫(yī)學(xué)學(xué)科的橫向發(fā)展和相關(guān)的人文科學(xué)融為一體。我國當(dāng)前基層醫(yī)療以全科醫(yī)生為主體，發(fā)揮著保障居民健康的重要作用。敘事醫(yī)學(xué)強(qiáng)調(diào)醫(yī)生在接診患者時(shí)注重用心傾聽、與患者共情且關(guān)注醫(yī)患雙方負(fù)面情緒的處理，然后通過反思性寫作形成既體現(xiàn)醫(yī)學(xué)的客觀性又包括敘事主觀性的平行病歷，凸顯出更有溫度的醫(yī)療。全科醫(yī)生在診療過程中也在一定程度上體現(xiàn)著敘事醫(yī)學(xué)的人文性，但理論方面缺乏系統(tǒng)性地學(xué)習(xí)，影響了臨床實(shí)踐效果。本文以提供基層醫(yī)療的全科醫(yī)生為第一視角，通過分享平行病歷表現(xiàn)敘事醫(yī)學(xué)在全科診療過程中的應(yīng)用及其積極作用，希望可以引起更多同行對(duì)敘事醫(yī)學(xué)的關(guān)注，探索敘事醫(yī)學(xué)與全科醫(yī)學(xué)的融合發(fā)展。……