上海试点“家庭医生”一年的喜与忧 Shanghai pilot“Family doctor”A year of joy and sorrow

　　沈华年有点不相信自己的耳朵。

Shen hua year a little don't believe my ears。

　　“挂号费只要两块钱？第一个看专家，还不用重复做B超？”来上海同仁医院看胆囊结石的沈华年，觉得自己刚刚享受了贵宾待遇。而他，只是一个签约了家庭医生的上海“平头百姓”，他的通行证，就是其签约医生陈华开具的转诊单。

“The registration fee as long as two dollars？The first see experts，Also need not repeat doing B to exceed？”Come to Shanghai tongren hospital see gallbladder calculus of shen hua year，Think you just enjoy the VIP treatment。And he，Just a signed the Shanghai family doctor“Flat people”，His pass，Is the doctor Chen hua.very signing of the issue of the referral sheet。

　　在上海，像沈华年这样的患者至今已有75.98万户，209.9万人。自从2011年4月，上海作为一个医改重镇在10个区县试点家庭医生制度以来，“一家一医”正在全市范围内，逐渐从梦想变成现实。

In Shanghai，Like shen hua year such patients has been 759800 households，2.099 million people。Since April 2011，Shanghai as a medical center in 10 districts (counties) of pilot since family doctor system，“A medical”Is within the scope of the whole city，Gradually from dream into reality。

　　但中国青年报记者调查发现，少医生、待遇低、缺药品，却让它的脚步“难快起来”。

But China youth daily reporter survey found，Little doctor、Low salary、Lack of drugs，But let it steps“Difficult to hurry up and get”。

　　

首诊找家庭医生，告别当“无头苍蝇” The first diagnosis for family doctors，Farewell when“Absent-minded professor”

　　“喂，陈医生吗？我家有人血压又高了，呼吸有点不畅。您能不能过来看看？”自从签了家庭医生，颜媚娟一家但凡有个“头疼脑热”，再也不用为“看病难”犯愁。

“hello，Doctor chan?？My family some blood pressure and high，Breathing a little dull。Can you come and see？”Since signed the family doctor，Yan mei Juan a in every case a“Slight illness”，No longer have to“See a doctor difficult”worry。

　　不多会儿，她的家庭医生就到了。测血压、诊疗、开药……大医院能做的一项不落。如果情况严重，家庭医生会直接联系上级医院或者建议拨打120，在等救护车期间，她的医生也不闲着，随时在身边救治。

Not when，Her family doctors came to。Measuring blood pressure、Diagnosis and treatment、Prescribe...Big hospitals can do a don't fall。If serious，The family doctor would direct contact with superior hospital or suggest call 120，Waiting for an ambulance period，Her doctors are not idle，At any time in the side treatment。

　　一年前，家住上海市长宁区的颜媚娟，可不是这么看病的。

A year ago，Live in Shanghai's changning district of yan mei Juan，The doctor is not so。

　　用她的话形容，有点像无头苍蝇“没方向”。“以前，不管什么病都去中山医院。排长队挂号，见了医生，也没太多时间交流。大医院开的药还很贵。”

With her words describe，A bit like headless flies“No direction”。“before，No matter what disease go to zhongshan hospital。Platoon leader team registered，See the doctor，Also not too much time exchange。Big hospital open medicine is very expensive。”

　　她的看病经历，与很多人相同。在上海市卫生局基层卫生处处长刘红炜看来，以社区为依托的家庭医生制，就是一道“滤网”。困扰老百姓的常见病、多发病，经过这些全科医生一“筛”，能及时救治的不再费时费力，不能就近解决的，再有序地转向二级医院。

Her experience to see a doctor，And a lot of people the same。In the Shanghai health bureau grassroots health marshal LiuGongHui looks，To the community to rely on family doctor system，Is a“screen”。Trouble is a common people、Frequently encountered disease，After these general practitioners a“screen”，Timely treatment of time-consuming to no longer，Can't came near to solve，Then ordered to the secondary hospital。

　　糖尿病、高血压、慢性呼吸道疾病……据长宁区周家桥街道社区的家庭医生陈宇介绍，他们接触的患者，病症一般要比二级、三级医院的轻得多，但要广得多。

diabetes、hypertension、Chronic respiratory disease...According to ZhouGuQiao changning district street community family doctor researh material - 11 is introduced，They contact of the patients，Disease than secondary、Tertiary hospital is much lighter，But much more widely。

　　“比如，高血压在上海的发病率是23.6%～23.9%。如果说大医院的专科医生是修理机器的‘高精尖’，我们就是给大家的身体机器‘上润滑油’的多面手。”她开玩笑说。

“For example，The incidence of hypertension in Shanghai is 23.6% ~ 23.9%。If big hospital specialists to repair the machine‘high-grade’，We is to give everyone body machine‘On lubricating oil’versatile。”She joked that。

　　在上海，家庭医生95%以上是国家认证的全科医生。像很多西方国家一样，社区居民如果愿意，就“签下”某个医生，为全家服务。签约后，医生会给每个人建立健康档案卡，记录体检状况、家庭病史，并定期“上门追踪”。

In Shanghai，Family doctors more than 95% is national the authentication of general practitioners。Like many western countries，Community residents if willing to，it“sign”A doctor，For the whole service。After signing，The doctor will give everyone to set up health file card，Record medical condition、Family history，And regularly“Door-to-door tracking”。

　　“测血压，测血糖，做移动心电图、心肺听诊和拍照片采集信息。”说起上门服务的内容，陈宇医生如数家珍，但若发现哪个患者“病情突然爆发”，就迅速转诊。多数情况下，上午联系，下午就能住上院。

“Measuring blood pressure，Measuring blood sugar，Do mobile electrocardiogram、Cardiopulmonary auscultation and take pictures collection information。”Speaking of door-to-door service content，Researh material - 11 doctor, as he sees them，But if you find which patients“Condition suddenly broke out”，Quickly referral。In most cases，Morning contact，Afternoon can live senate。

　　沈华年已经尝到了转诊的“甜头”。

Shen hua year have a taste for the referral“sugarplum”。

　　需要做手术的他，走的是上级医院的“绿色通道”。“目前，上海试点的各个区县基本都打通了这个通道，上级医院会保留一点医疗资源，来‘接手’下面的转诊患者。”刘红炜说。此外，通过家庭医生，之前看病的“死档案”也变活了，上级医院不用从头看起。出院后，患者还能回到家庭医生那里继续治疗。既省了钱，又有连续性。而与西方国家不同的是，沈华年、颜媚娟们“签医生”是免费的，只用付药费，预约上门一次15元，对残疾人，这15元也免了。

He need to do surgery，Go is the superior hospital“Green channel”。“At present，Shanghai pilot of each area county basic all get through the channel，Superior hospital will maintain a little bit of medical resources，to‘Took over’The following referral patients。”LiuGongHui said。In addition，Through the family doctor，Doctor before“Dead files”Also become alive，Superior hospital need not from the look。After discharge，Patients can also return to the family doctor there continue to treatment。Both has saved money，And continuity。And with the western countries is different，Shen hua year、Yan mei Juan are“Sign the doctor”Is free，Only pay the expenses for medicine，Make an appointment the door a 15 yuan，To the disabled person，The 15 yuan also forgave。

　　

4000人才缺口的背后：待遇相差一半 4000 talents of the gap behind：Treatment are half

　　在欧美，家庭医生被称作居民的“健康守门人”。颜媚娟所在的社区，已有80%以上的居民签了家庭医生。

In Europe and the，The family doctor is called the residents“Health the gatekeeper”。Yan mei Juan community，More than 80% of the residents have signed a family doctor。

　　“你好陈医生，能再替我家老刘查查胆囊吗？”“你心脏要注意了，等一下帮你做个心电图。”上海的家庭医生以社区卫生服务中心为基地，同时留下24小时即时通信电话，以备签约家庭“叫诊”。推开服务中心大门，你能在消毒水味之外，嗅到人情味。

“Hello doctor chan，For my old liu can again see the gallbladder？”“You should pay attention to the heart，Wait a minute to help you become a electrocardiogram。”Shanghai family doctor to community health service center for base，At the same time 24 hours left instant communication telephone，For signing family“Called diagnosis”。Push service center gate，You can taste in disinfectants outside，Smell the milk of human kindness。

　　“这里的居民和签约医生彼此熟悉、信任，所以医患关系相比二级、三级医院，要好很多。”陈宇医生告诉记者。

“The residents and signing the doctor know each other、trust，So the doctor-patient relationship than secondary、Tertiary hospital，better。”Researh material - 11 doctors told reporters。

　　在颜媚娟眼里，家庭医生不是生了病才有用，“没病更有用”。“我家得心血管病的比较多，陈宇医生会给我们做预防，平时家里人也向她咨询一些健康问题。”她说，“小病随时看，得大病的几率不就降下来了？”

In yan mei Juan eyes，The family doctor is not only useful was ill，“Have no disease more useful”。“My home have to cardiovascular disease more，Researh material - 11 doctors will give us a prevention，At ordinary times to her family and consulting some health problems。”She said，“Ailment always look at the，To the risk of a serious illness not down？”

　　但问题也摆在眼前：并不是每个家庭，都能享受到这种个性化的医疗服务。

But the problem is in sight：Not every family，You can enjoy this personalized medical service。

　　“缺人。”刘红炜一针见血地指出背后的原因。

“Lack a man to。”LiuGongHui hit the nail on the head to point out the reason behind。

　　他给中国青年报记者算了一笔账。目前，上海在10个区县建立了75家社区卫生服务中心，有家庭医生2000多名。但是根据国际惯例的服务标准(一个家庭医生对应服务2500个居民，或者对应800～1000个家庭)，上海试点一年多，家庭医生的缺口仍有4000多人。

He gave the China youth daily reporter calculate a bill。At present，Shanghai in the 10 districts and counties established 75 community health service center，Have a family doctor more than 2000。But according to international practice service standards(A family doctor corresponding service 2500 residents，Or corresponding 800 ~ 1000 families)，Shanghai pilot more than a year，The family doctor's gap is still more than 4000 people。

　　不独上海市，在山西太原市、江西新余市等试点区，家庭医生制度改革也在启动。但业内共识是，一名合格的家庭医生，首先至少是有资质的全科医生。而据媒体公开报道，全国这样的医生目前只有7.8万人，远远不能满足需求。

Shanghai came，Taiyuan in shanxi、Jiangxi xinyu experimentsite area, etc，The family doctor system reform also at startup。But industry consensus is，A qualified family doctor，First of all is at least have aptitude of general practitioners。According to media reports and the public，So the doctor currently only 78000 people，Far cannot meet demand。