Chen Kai, member of Chinese People's Political Consultative Conference and academician of China Academy of Sciences.
On February 26th, 20 16, the State Council issued the Outline of Strategic Planning for the Development of Traditional Chinese Medicine (20 16~2030), which clearly stated that "both Chinese and Western medicine should be paid equal attention to and equal status should be implemented". Then, how do the members of the two associations view and interpret "paying equal attention to Chinese and Western medicine"?
The core of "medical and health system with China characteristics" is that the government adheres to the basic principle of "paying equal attention to Chinese and western medicine" and runs the guiding ideology of "integrating Chinese and western medicine" through all medical and health work. Since the founding of New China, the state has adhered to the policy of "paying equal attention to both Chinese and Western medicine", and China's medical and health undertakings have given full play to the advantages of combining Chinese and Western medicine, showing great superiority in medical practice.
On 20 11July1day, the State Council issued the Guiding Opinions on Establishing the General Practitioner System, demanding "gradually establishing and improving the training, use and incentive system of general practitioners with characteristics in China, and comprehensively improving the level of primary health care services"; 20 15 years 10 months, 1 1 Guiding Opinions on Promoting the Contract Service of General Practitioners (Draft for Comment) further proposed that "treatment with Chinese medicine characteristics" should be included in the contract service, "giving full play to the important role of Chinese medicine in prevention and health care and encouraging the provision of Chinese medicine services welcomed by the masses".
Judging from the long-term medical and health practice at the grass-roots level in China, especially in some remote, mountainous and medicine-deficient areas, practice has proved that the implementation of "paying equal attention to" and "combining" Chinese and western medicine has obvious advantages. Therefore, general practitioners with China characteristics should have the knowledge structure of western medicine and traditional Chinese medicine (or ethnic medicine), and be able to provide the people with basic Chinese medicine appropriate technology and diagnosis and treatment services.
General practitioners are a bit of a misnomer
However, in the survey, we found that in the current general practitioner education, training and primary medical work, the principle of "paying equal attention to Chinese and Western medicine" has not really been implemented, mainly in:
1. The culture mode is not suitable. At present, all kinds of medical education (western medicine, Chinese medicine) regard general education as a part of medical education, but quite a few schools regard it as an elective course, and only some colleges regard it as a compulsory course. In medical education in western medical colleges, the content of education is basically the curriculum system of western medicine, and the five-year undergraduate medical education is only a Chinese medicine course with 60~80 hours, which obviously cannot meet the requirements of understanding and mastering basic knowledge and skills such as Chinese medicine, Chinese medicine, acupuncture and massage. Three years after graduation, only two weeks of Chinese medicine practice are arranged in the standardized training of residents, which can only be grasped.
The basic knowledge and skills of western medicine general practitioners trained by this model are weak, and it is difficult to provide medical and health services such as TCM syndrome differentiation, health care and appropriate technology. Being a general practitioner can't meet the needs of ordinary people, and can't undertake the basic task of the general practitioner contract service to be released in the State Council.
2. The internship position is not suitable. At present, the country has fully implemented the standardized training system for residents, in which general practitioners are divided into "general practitioners" and "general practitioners of Chinese medicine". As far as the impact is concerned, some areas have copied the Interim Provisions on the Scope of Practice in Practice Registration issued by the former Ministry of Health and state administration of traditional chinese medicine as early as 20 1 1, and classified the general practice posts into the 17 clinical category, which made the practice posts of general practitioners of traditional Chinese medicine limited to the Chinese medicine department of hospitals and could not enter the general practice departments.
Subsequently, general practitioners in China were also excluded from the statistics of 1 10,000 general practitioners. Even in primary medical institutions, such strange phenomena often occur: on the one hand, the number of general practitioners is not up to standard, and western general practitioners who enter general practice positions cannot meet the needs of grassroots people for Chinese medicine health care, disease prevention and chronic disease intervention; On the other hand, China general practitioners who can serve the people at the grass-roots level cannot enter the general practice post.
In fact, at present, the training content of general practitioners of traditional Chinese medicine includes not only the knowledge of various disciplines of traditional Chinese medicine, appropriate technology of traditional Chinese medicine, medical care and so on. , including all the relevant knowledge of western medicine. Taking the training of general practitioners of traditional Chinese medicine in Shanghai as an example, some subjects (such as infectious diseases, etc. ) fully integrated with western medicine, effectively ensuring that Chinese general practitioners can be fully qualified for the medical services of grassroots general practitioners. However, at the end of the training of general practitioners, it is still defined as "general practice of Chinese medicine", and its practice scope and career development are greatly limited, which is very unfavorable to the training of general practitioners and the development of general medical services.
Chinese medicine is indispensable to the implementation of general practice.
In view of the above situation, according to the spirit of documents such as "Establishing the Training System for General Practitioners" issued by the State Council and "Guiding Opinions on Signing General Practitioners", the author puts forward the following suggestions:
Strengthen the training of general practitioners. Medical colleges and universities should take the content of general practice as a compulsory course for the cultivation of medical students, significantly increase their class hours and teaching content, so that every medical student must master the basic knowledge of general practice.
Improve the content setting of general practice education. Strengthen the course construction of general practice, gradually realize the unified general practice education between western medicine colleges and Chinese medicine colleges, and establish a unified course body including the teaching contents of western medicine and Chinese medicine.
Improve the standardized training of general practitioners. The standardized training of general practitioners is no longer divided into traditional Chinese medicine and western medicine, and the general practitioners graduated from western medicine colleges and universities of traditional Chinese medicine are brought into a unified training system, including training contents, training programs and training requirements. The continuing education of general practitioners should be based on the requirements of the service content and scope of grass-roots general practitioners, comprehensively carry out clinical training of traditional Chinese and western medicine, and become a general practitioner with China characteristics.
Improve the practice environment of general practitioners. General practitioners who have completed the standardized training of general practitioners no longer distinguish between Chinese and western medicine, but are all registered in accordance with general practice; Medical institutions that set up general practitioner positions should also arrange all these personnel in general practitioner positions. When determining the proportion of general practitioners in primary medical institutions, all general practitioners (including Chinese medicine and western medicine) who have obtained the certificate of standardized training of general practitioners will be included in the statistical caliber.