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【medical-news】专家认为：医疗服务需要新的模式
By JANE E. BRODY
Published: December 29, 2008 纽约时报
“There’s been a drastic decline in the number of geriatricians — and just 300 new ones are being trained each year — yet the number of people over 65 will double in the next 20 years,” Dr. Atul Gawande, a surgeon at Brigham and Women’s Hospital in Boston and an associate professor at the Harvard School of Public Health, said in an interview. “Those who work in geriatric care are among the worst paid in the health care system. Is the time I spend as a surgeon excising a patient’s cancer worth 10 times more than the time the primary care doctor spent finding the cancer in the first place?”
Dr. Gawande, who examined the problems of medical care for the aged last year in The New Yorker, pointed out that as we grow older, “we don’t get one problem at a time.”
“People with multiple problems need time, and that is not cheap and is currently not paid for by medical insurance,” he said. “It’s not possible to address five different problems in a 20-minute visit.”
He and others see a pressing need for new approaches to keep aging patients as healthy as possible and living independently as long as possible. Dr. Chad Boult, a geriatrician at Johns Hopkins School of Public Health in Baltimore, says the goal should be care that is well coordinated, and patients and families who are involved in and educated about the care plan.
Dr. Boult is involved in testing a team approach, in which nurses trained in geriatrics are helping physicians in the Baltimore-Washington area provide coordinated care for 50 or 60 of their highest-risk older patients. The nurses go to patients’ homes, develop comprehensive care plans, help the patients in self-monitoring, help them overcome obstacles to self-care and connect patients and their families to community agencies.
According to geriatrics experts, social workers trained in the problems of the elderly can also participate by performing home assessments, for example, to prevent falls and costly, disabling fractures. They can help overcome barriers to good nutrition, and they can help make the community connections for assistance with the activities of daily living, like shopping.
Given the decline in geriatricians, “we have to rely on primary care doctors who need more training and education on how best to care for older adults,” Dr. Boult said in an interview. “We need to deploy the small cadre of geriatricians and make them real leaders and educators, from teaching first-year medical students to providing continuing education for practicing physicians.”
The Baltimore team project has already demonstrated an improvement in the quality of care that ailing elderly patients receive, Dr. Boult said. And by keeping patients out of the hospital, he expects it will save money for insurers like Medicare.
While current insurance systems pay many thousands of dollars for hospital-based care, they cover only a fraction of the far less expensive care delivered by doctors and nurses that can keep patients out of the hospital.
“We’re still working within an old model of care,” said Dr. Sean Morrison, a geriatrician at Mount Sinai Medical Center in New York. “In the past, a medical problem was either fixed or you died. That’s no longer the case. Now we treat you and you live with the condition for many years.
“The system needs to be restructured to meet the needs of people with chronic illness, and this can’t be done without addressing the social needs of older adults. If we fail to do this, we will be facing a bankrupt Medicare system.”
http://www.nytimes.com/2008/12/30/health/30bbox.html?em 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领。 New Model of Care Is Needed, Experts Say
专家认为：医疗服务需要新模式
By JANE E. BRODY
作者：JANE E. BRODY
Published: December 29, 2008 纽约时报
2008年12月29日 纽约时报
“There’s been a drastic decline in the number of geriatricians — and just 300 new ones are being trained each year — yet the number of people over 65 will double in the next 20 years,” Dr. Atul Gawande, a surgeon at Brigham and Women’s Hospital in Boston and an associate professor at the Harvard School of Public Health, said in an interview. “Those who work in geriatric care are among the worst paid in the health care system. Is the time I spend as a surgeon excising a patient’s cancer worth 10 times more than the time the primary care doctor spent finding the cancer in the first place?”
“从事老年医学的医生已经开始出现了严重短缺，每年仅有300名新进入系统培训的医生，而进入65岁以上老龄阶段的老年人在未来的20年中将增加1倍”，哈佛大学公共卫生学院副教授，布林格女子医院外科医生Atul Gawande博士在接受采访时说，“这些从事老年医学的医生是整个医疗服务体系中报酬最少的人群之一。一位初级保健医生初诊发现肿瘤所花费时间，会不及我们外科医生为病人切除肿瘤所花费时间的1/10吗？”
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作者:admin@医学,生命科学 2011-06-07 05:11
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