王辰院士:专科医生可以有特长,但不可以偏废

2019-06-28 陈惠 《医师报》

一个医生在临床上的执业范围,到底是以什么为界? 哮喘、慢阻肺、呼吸衰竭和内科危重症等,实际上是指某个病种,或者某项技术,不是“亚专科”。 临床上经常有人问:“你是哪个亚专科的?”其实是在问“你擅长哪个领域”。 专科医生可以有特长,但不可以偏废。 内科医生的职业生涯怎么也应是80岁。 …… 3月23日,在中华医学会呼吸病学分会第五届全国呼吸危重症论坛上,中国医学科学院北京协和医学

一个医生在临床上的执业范围,到底是以什么为界?

哮喘、慢阻肺、呼吸衰竭和内科危重症等,实际上是指某个病种,或者某项技术,不是“亚专科”。

临床上经常有人问:“你是哪个亚专科的?”其实是在问“你擅长哪个领域”。

专科医生可以有特长,但不可以偏废。

内科医生的职业生涯怎么也应是80岁。

……

3月23日,在中华医学会呼吸病学分会第五届全国呼吸危重症论坛上,中国医学科学院北京协和医学院院校长、国家呼吸临床研究中心主任王辰院士作了题为《专科医师不可进一步将临床限于‘亚专科’》的报告。王辰院士指出,当前最令人担心的是,PCCM专科医师只专注于ICU,只关注呼吸衰竭,不关注其他,这将是从一个偏差到另一个偏差,从一个误区到另一个误区。

以下是《医师报》记者根据王辰院士讲话整理:

从希波克拉底时代开始,治病不分专科的状态持续了几百年上千年的时间。近代,医学进入新时期,从最开始生物医学模式转变为生物-心理-社会医学模式,经过100余年的时间进入了基于科学证据和科学基础的医学科学阶段。

医生的执业范围也随之变化,从希波克拉底时代不分专科,到出现了内科、外科的划分,知识和技能得到了拓展,如今,我们的专科是呼吸与危重症医学专科(PCCM)。

内外妇儿是专业,PCCM是专科。医学界的社会分工就是为了让医生群体能把患者照护好,让每个人都得其所、发挥其作用。PCCM专科医师执业范围就集中在呼吸与内科危重症上,执业范围太广则无暇顾及,太窄则独木难支。

现在有一种提法叫作“亚专科”,“亚专科”不是单独的临床体系,英文中并没有这个单词。而通常所说的“亚专科”如哮喘、慢阻肺和内科危重症等,实际上是指某个病种,或者某项技术、某个领域。临床上经常有人问:“你是哪个亚专科的?”其实是在问“你擅长哪个领域”。

专业和专科是怎么划分?专科较精深,专业较广博,但是知识体量不同,专业的知识体量是横向并有厚度,专科的知识体量是纵向并有高度。你可以选择成为专业医生,也可以成为专科医生,但是不能把执业范围限定得过窄,例如哮喘医生不看肺部感染,不看间质病肺病,不看胸膜病,不看肺栓塞等。

专科医生可以有特长,但不可以偏废,即只会做“所长”,而把专科其他领域的知识和技术废弃,如此会丧失鉴别诊断能力,与临床实践要求完全不符,与社会和医学界赋予医生的职责也不相符。

PCCM专科医师不可以仅做“呼吸”或仅做“危重症”,否则呼吸与危重症融合之妙尽失,这将酝酿专科分裂。PCCM专科医师必须轮转普通病房与ICU,必须参加全科大查房,必须出席呼吸门诊。这也是作为内科医生的职业生涯的规划。

你现在ICU里生龙活虎的,熬到凌晨2点钟下班,但是过了60岁或者65岁,还能干得动吗?按照现在的长寿年龄划分,内科医生的职业生涯怎么也应是80岁。满头白发的内科医生一定是最受尊重的。

人这一辈子是需要设计的,PCCM已经提供了一种精妙的设计,即将呼吸与危重症结合起来。从年轻医师开始,充分融合才能得其所,临床上才能既对其“症”又对其“因”,制定出合理的治疗方案。如若一定要分裂,这是“至蠢之事”。

未来会什么样?不排除进一步的细分,随着人类知识不断的爆炸,技能的不断拓展,未来将形成新的专科范围。当前最令人担心的是,PCCM专科医师只专注于ICU,只关注呼吸衰竭,不关注其他,这将是从一个偏差到另一个偏差,从一个误区到另一个误区。

总之,既要有专长又不能偏废,PCCM专科医师的临床工作和执业范围,是该专科的所有内容,而研究则可以精于某方面或某个领域。

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    2020-12-07 lifefamily
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    2019-06-28 junJUN

    院士是学术至高点,也是大家必争之地呀

    0

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