Identity crisis of public health physicians and its countermove in China: a brief discussion
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摘要: 国家治理现代化进程中实现“健康中国”有赖于健全的公共卫生体系,其关键在于一支技术过硬、数量充足、能适应时代需要的公共卫生医师队伍。然而我国各界对于公共卫生医师的认知很少,公共卫生医师队伍目前存在着严重的身份危机问题。公共卫生医师的身份危机主要表现在两个方面。一是公共卫生医师的“医师”身份缺失的危机,二是公共卫生医师的功能角色模糊,存在可替代性的危机。建议应首先明确我国公共卫生医师是否为预防医学医师,重新定位设计“公共卫生医师”的角色,将预防医学本科学历作为公共卫生医师准入的基本条件,适度拓宽临床医学专业医学生考取公共卫生医师的途径,改革预防医学与公共卫生教育培养体系。Abstract: “Healthy China Initiative” is an important part of national governance modernization and its realization relies on a sound public health system, which needs to be supported by a great number of qualified public health physicians. However, public health physicians were not generally acknowledged by the public and there was a serious identity crisis among the public health physicians in China. The absence of physicians′ role and the lack of well-defined professional function for public health physicians are two main manifestations of the identity crisis. To deal with public health physicians′ identify crisis, following countermeasures were suggested: clarifying whether public health physicians being exactly preventive medicine physicians in China, reconfirming professional role of public health physician, specifying bachelor degree in preventive medicine being a basic requirement for the appointment of a public health physician, appropriately broadening the way for clinical medicine students being recruited as public health physicians, and reforming education and training system for preventive medicine and public health.
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Key words:
- public health /
- preventive medicine /
- public health physician /
- medical education /
- identity crisis
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表 1 公共卫生医师与其他卫生专业人员在工作范围方面的异同
工作职责 公共卫生医师 全科医生 公共卫生护士 内科医师 传染病医师 健康管理师 疾病管理 一级预防 环境改善(生理、心理健康相关影响因素) 自然环境监测、干预(含生物、物理、化学因素) √ 社会环境监测、干预(含工作场所、医疗场所) √ 人群健康促进 健康问题诊断、干预(含健康宣传、教育) √ √ 个体健康促进 健康问题诊断、干预(含健康宣传、教育) √ √ √ √ √ √ 营养支持(含膳食指导) √ √ √ √ √ 计划免疫 √ √ √ √ √ 二级预防 早发现 普查(健康监测) √ √ 重点人群筛查 √ √ 个体健康监测 √ √ √ √ √ 早诊断 疾病诊断 √ √ √ √ 早治疗 个体临床治疗 √ √ √ √ 群体疾病(传染病、地方病、寄生虫病等)干预治疗 √ √ √ √ √ 传染病疫情管理(流行病学调查、处置) √ 三级预防 对症治疗 √ √ √ √ √ 康复治疗 √ √ √ √ 社区综合管理 信息管理等 √ √ 科学研究 新技术、新方法研发与效果评价 √ √ 标准和指南制定 √ √ √ √ √ 政策制定 政策设计 √ 政策实施 √ √ √ √ √ √ 政策评价 √ 推动其他领域健康相关政策制定 √ -
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