迎向21世紀的醫療保健與醫學教育

Health Care and Medical Education in the Twenty-First Century

謝博生(Bor-Shen Hsieh)

《Journal of Medical Education》 1卷1期 (1997/03) Pp. 5-10

https://doi.org/10.6145/jme.199703_1(1).0003

摘要

自從1980年以來，疾病的型態、醫療照護系統及醫學生的醫學教育都隨時代的變遷而有巨大的的改變。這種改變為全球所共同體認，而且有許多因應之調整及改革方案的執行，作者針對此種醫學潮流的改變及台大醫學院的因應改革之道提出整體報告。文中首先闡明醫學的任務，醫師的職責及醫療重心偏向於老年及慢性疾病的診治；此外，高度快速文明進展及社會變遷的結果對於疾病的發生及型態亦有顯著影響；生活壓力，人際競爭，不當飲食及作息結果造成文明病如高血壓、糖尿病、肥胖症、心身症等疾病的增加。因此，對社會文化因素的治療策略儼然成為今日醫學的重要課題。此外，新的醫療內涵並包括：新的健康問题如爱滋病患；快速的科技發展與應用；以及高漲的醫療開支和醫療保險所產生的新問題。應付這些巨大改變，宜加強生物心理社會模式的醫療照顧體系，病人的治療不再只限於免於生病，更應強調生理、心理及社會層面的健康。有鑒於對新世代醫師的教育必須以此方向做調整，台大醫學院自1992年開始推行醫學教育改革；新的敎育内容包括整合課程、小組敎學、小組討論、有關醫學人文、醫學倫理、社會心理、醫病關係的新課程及邏輯思考、問题解決、床邊敎學及終生學習態度的敎養等等。社會及醫學的變化將持續擴大，健康促進及疾病預防的重要性將持續提醒我們不應將眼光只限於狹義的疾病治療。具新觀念的新一代醫師將決定未來醫療的品質與成就。

關鍵字

醫療保健 ； 醫學教育 ； 生物心理社會模式

並列摘要

Editorial Note: There have been dramatic changes in disease patterns, medical care systems and medical education since the 1980s.These changes have been recognized worldwide and many adjustments and reforms have been undertaken. This article was originaly a speech given by invitation to the President of the Republic of China on February 17, 1997. It initially addressed the mission of medicine, the duty of physicians, and changing medical care patterns with the growing percentage of the chronic diseases. The rapid modernization of the past decades has created greater tension in daily life,more competition among people, and increasing number of modern diseases such as hypertension, ischemic heart disease, cerebral vascular disease, diabetes, obesity and psychosomatic disorders. The strategy to deal with this social and cultural impact on human health has become an important issue in today's medicine. There are also new medical problems such as caring for the AIDS patients; the rapid advancement of medical technology, such as new diagnostic procedures, new drugs and treatment methods, organ transplantation, gene therapy, and the application of molecular biology; and the high cost of medical care and changes in medical insurance policies. In dealing with these problems, the delivery of medical care using a bio-psycho-social model should be reemphasized. The goal of treatment is no longer just to be disease free but also emphasizes physical, psychological and social well-being. It is therefore very important to educate physicians of the new generation to be able to meet the challenges ahead. There are new concepts in medical education and new conclusions from many reform programs. The National Taiwan University College of Medicine has conducted medical education reform since 1992.The reform includes a new curriculum design using integrated courses, small group tutorials and new courses in medical humanities, medical ethics, society and the doctor-patient relationship, logical thinking, problem solving skills, bed side procedures, and active and life-long learning attitudes. The preliminary evaluation proves its feasibility, success and popularity. In conclusion, changes in society and medicine will continue to be enormous. The increasing importance of disease prevention and health promotion reminds us not to limit the goals of medical care to just treating diseases. Above all, physicians using these new concepts will play a major role in deciding medical care quality and its outcome in the future.(Full Text in Chinese)

並列關鍵字

health care ； medical education ； biopsychosocial model