Medical social work
综合性医院医务社会工作的志愿者服务模式
综合性医院医务社会工作的志愿者服务模式作者:朱建民,陆忆敏,许廉,葛春林【摘要】医务社会工作在医院的日常工作中起到越来越重要的作用,但是大量的医务社会工作需求,仅靠少量的专业社会工作人员来做不能满足医院的需求,建立起以专业社会工作者为指导、以医务志愿者为服务主体的医务社会工作模式,把社会工作的理念、方法和技巧融入医务志愿者服务之中,面向院内医务人员和社会人士广泛招募医务志愿者,经过统一的培训,开展有针对性的医务社会工作,建立医院志愿者服务体系,建立志愿者培训和支持机制,逐步拓展志愿者爱心服务项目,把医院建设成为志愿者服务基地,积极的探索出一条新的医务社会工作之路。
【关键词】医院;医务社会工作;志愿者Volunteer's pattern serve as medical social work in the general hospital Jianmin Zhu, Yimin Lu,Lian Xu, Chunlin GeAbstractThe medical social work plays more and more vital role in the hospital routine work, but the massive medical social work demand, only depends on the few specialized social worker to do cannot satisfy the hospital's demand. To establish the pattern that the specialized social workers as the instruction, the medical volunteer as the main body to do the medical affairs social work. It is necessary to integrates social work's idea, the method and the skill to the medical volunteer work and recruits the medical volunteer from the medical staff and the public widely. Undergoing unified training, the medical volunteer can do the target-oriented medical social work and then hospital establishes the hospital volunteer services structure, volunteer training and the support mechanism, develops the volunteer compassion service, constructs the volunteer's base of the hospital gradually. Andfinally the way of the positive exploration new medical affairs social work will be found.Key wordshospital; medical social work; volunteerShanghai Xuhui Center Hospital, Shanghai 200031,ChinaCorrespondenceto:YiminLu,Email:*********.cn医务社会工作是专业的社会工作之一,综合性医院的医务社会工作,是社会工作者运用社会工作的价值理念、专业知识、方法和技巧协助病人及其家属共同应对疾病,协调医患关系,发掘与利用病人所需要的社会资源,配合医护人员使医疗过程顺利进行,以提高医疗效果的专业服务活动。
医务社工限制英语六级的合理解释
医务社工限制英语六级的合理解释In recent years, there has been a growing trend towards imposing restrictions on medical social work practices. While some may view these restrictions as hindrances, they are often put in place for valid reasons to ensure the effectiveness, safety, and ethical standards of medical social work services.First and foremost, restrictions on medical social work help to maintain professional standards and protect the well-being of patients. By setting boundaries on the scope of practice and requiring proper qualifications and training, these restrictions help to ensure that only qualified and competent individuals provide medical social work services. This, in turn, safeguards the quality of care and minimizes the risk of harm to patients.Furthermore, restrictions on medical social work serve to uphold ethical principles and confidentiality standards. Medical social workers often deal with sensitive and confidential information about patients and their families. By imposing restrictions on the sharing and handling of this information, the privacy and dignity of patients are protected, and trust between the social worker and theclient is maintained.Additionally, restrictions on medical social work can help prevent conflicts of interest and maintain professional boundaries. By establishing guidelines for appropriate conduct and relationships with clients, these restrictions help to ensure that social workers maintain objectivity and prioritize the best interests of their clients without any personal biases or conflicts.In conclusion, the restrictions on medical social work are in place to uphold professional standards, protect patient well-being, maintain ethical principles, and prevent conflicts of interest. While these restrictions may seem limiting at times, they ultimately serve to ensure the effectiveness and integrity of medical social work services.中文翻译:近年来,对医务社工实践施加限制的趋势日益增长。
Medical Social Work (医疗社会工作,医务社会工作)
自2000年上海浦东新区东方医院、北京朝阳医院设立医务社 2006 年 7 月 20 日,人事部和民政部联合发布了《社会工作者职业水 会工作部以来,我国北京、上海、深圳等发达城市大型医院 平评价暂行规定》和《助理社会工作师、 社会工作师职业水平考试实 施办法》; 相继设立医务社会工作部,开展医务社会工作。
党的十六届六中全会 《决定》 明确提出了“建设宏大的社会工作人才 目前,全国有30多家医院设立了医务社会工作部门。 队伍” 的战略决策,并要求 “建立健全以培养、评价、使用、激励 主要内容的政策措施和制度保障”;
2009年在4月6日《中共中央、国务院关于深化医药卫生体制改革的意见》 提出了“构建健康和谐的医患关系”,提出了医务社会工作对建立和谐 医患关系的作用。这是政府推进医务社会工作的重要一步。
机构探访后的一些思考
Medical/Clinical/Surgical Social Work 医务社会工作
2000年,民政部开始向人事部提出了关于建立社会工作者职业资格制度 的意见, 并于2003 年初向各省市民政厅下发了《关于加强社会工作队 伍建设的通知》; 2004年5月16日,国家劳动和社会保障部发布了 《社会工作者国家职业 资格标准》;
•明确岗位设置,督促用人单位承担社会责 任。
•加强专业教育,为职业化打好基础。
问题初览:
1. 起步晚,发展基础薄弱,应市场需求而生; 2. 本土化学科体系尚不完善,与欧美医务社工相比缺 麻省总医院社会服务部 乏应有的理论与实践基础;
从网站内容角度来 霍普金斯医学院医务 3. 约翰斯· 医院市场化运行,独立承担雇佣义务社工的所有费 社会工作部 分析 用,导致除一些一线城市重点试点单位外,医务社
工难以进一步得到推广; 北大人民医院社会工作部 4. 相关培养方式无法适应用人单位需求,同时自身的 专业定位与职业定位不清„„„„ 服务 部门 首页 资源 首页 活动 项目 首页 资源
医务社会工作
“The Best Way to Explain it is to Do It”: Ida Cannon and the Professionalization of Medical Social Work During the Progressive Eraand the 1920sAnette Bickmeyer (Hannover)“What I was going to say,” said the Dodo in an offended tone, “was, that the best thing to get us dry would be a Caucus-race.”“What is a Caucus-race” said Alice; not that she much wanted to know, but the Dodo had paused as if it thought that somebody ought to speak, and no one else seemed inclined to say anything."“Why,” said the Dodo, “the best way to explain it is to do it.” (And, as you might like to try that thing yourself, some winter-day, I will tell you how the Dodo managed it.)(Dialogue between Alice and Dodo Bird; from Alice in Wonderland)This quote, “The best way to explain it is to do it,” was Ida Cannon’s motto for her work at the social service department at MGH, short for Massachusetts General Hospital. Ida Cannon’s contribution as pioneer of medical social work in American hospitals and her leading role in developing and professionalizing this medical social service is usually ignored in the historiography. Cannon, who put a life’s work into this project, promoted medical social work nationally as well as internationally. Already in the 1920s more than 400 social service departments had been introduced to hospitals all over the United States. Ida Cannon, born in 1877, was Chief of the social service department at MGH from 1914 until 1945. She died in 1960.Cannon and the professionalization of medical social work is the focus of my dissertation project. I look at Cannon as a case study of the second generation of social reformers in the years from 1900 to 1930. The larger part of the time frame that I concentrate on was later called the Progressive Era. Women in those years of social change and reform were especially prominent in the role of reformers. Reformers of the first generation—for example Jane Addams or Francis Kellog—caught a lot of attention in historiography. Ida Cannon also belongs to this group of “exceptional women” of the Progressive Era.I consider medical social work an excellent example to show the realities under which a particular women’s work culture within the health-care industry developed. The seeds limiting the development of medical social work were planted already at its beginning. Altruistic ideals, reform spirit, gender concepts, and the promotion of professionalization eventually clashed and, ultimately, in the 1920s led to the fragmentation of medical social work.In this paper I want to focus on the gender concept on which Ida Cannon based her argument for the professionalization of social work: I claim that Cannon’s conception of social work as a profession was based on the nineteenth century gender concept of “separate spheres.” Elaborating on this thesis I also claim that Cannon expanded this gender concept for medical social workers in the early twentieth century by interpreting the “separate spheres” according to her needs, but she never went beyond this application. Before discussing gender concepts and women’s spheres, however, a brief introduction to medical social work is necessary.Medical Social Work or “A Mad Tea-Party”The first annual report of the social service department at MGH for the year 1905 began with a quote from Alice in Wonderland from the chapter “A Mad Tea-Party”:“Have some wine,” said the March Hare. “I don’t see any wine,” said Alice. “There isn’t any,” said the March Hare.This episode from Alice in Wonderland is a metaphor for the situation of out-patient departments in American hospitals. Many physicians, interested in a progressive medicine, considered the medical care for out-patients inadequate. Like the “Mad Tea-Party,” patients were often given advice that the patient was not able to follow: to say to an overworked, tuberculosis-ridden mother of four children, who lived in a rat-infested tenement house, that she needed a vacation in Florida, lots of milk and meat, was useless as she was not able to afford it.Often doctor and patient spoke to each other but not with each other; language barriers blocked the mutual understanding of immigrants and doctors, the latter often ignoring the social environment and personal concerns of the patient. Communication problems also arose when the doctor’s advice went simply beyond the comprehension of the patient. Especially questions of hygiene or rules of conduct were for many patients difficult to perceive. The individual life situation, social circumstances and the combination of mental and physical constitution of the patient were usually not taken into consideration by most doctors. As a consequence, symptoms and the diseases themselves would constantly reappear.Medical social workers in the early years were supposed to bridge all of these gaps between doctor and patient. They were to interpret the situation of individual patients through case studies. By analyzing their life-situations and by looking for possible causes of their illnesses in their social, mental or other circumstances, social workers developed a social analysis of each case. The medical social worker thus became the interpreter of the doctor’s advice, standards of hygiene and conduct towards the patient.The out-patient department was especially frequented by those people who could not afford a visit to an expensive private practice. Poor immigrants, workers and all those who for financial reasons had no other choice to receive medical treatment other than from the out-patient department came to the hospital. For these patients the physician Dr. Richard Cabot founded the social service department at MGH. He was inspired by the idea of supporting and developing a progressive medicine that took into account the whole person, the individual life situation, the intellectual, psychological and physical constitution. He wanted to overcome the traditional approach that looked at disease separately from the patient. Richard Cabot was the self-assured offspring of a very old distinguished Boston family that belonged to the group of so called “Boston Brahmins.” He faced resistance to his project but his family background certainly helped toovercome obstacles. The social service department started in 1905, and already in 1906 Ida Cannon worked as a volunteer in the department.“A Caucus-Race” or Ida Cannon’s Image of Medical Social Work, Problems and ResistanceNeither the hospital administrator nor the doctors, and certainly not most nurses, welcomed social work with arms wide open. It took nine long years until the social service department was officially accepted as part of the hospital. Under these conditions, Ida Cannon tried to establish and to legitimize medical social work at MGH against all odds. Those odds found expression not only in the organizational problems of the hospital but also in the personal policies of the hospital director, Dr. Washburn. This is best illustrated by his attitude toward the social workers: “You’ll have to watch these social workers, or there won't be any room for the people who belong here” (MGH papers). Medical social workers were outsiders and had to find their position in the hospital’s hierarchy.For my analysis I heuristically refer to Pierre Bourdieu’s term of the “field” in order to explain the problems of social workers (1997: 59-78). They had to position themselves in the “field” hospital and had to negotiate their position with other groups in that field. The leading force in the hospital was male. The doctors were at the top of the hierarchy; the nurses worked below them, following their orders. In 1904 nursing as a women’s occupation was officially granted through the “Nurse Practice Act” valid in not all states, and was still in its infancy. For these nurses medical social workers were a threat. Even more so when Cannon publicly defined the position of medical social workers in the hospital.In her book Social Work in Hospitals. A Contribution to Progressive Medicine, published in 1913, Cannon claimed that social workers’ place was not below the physician in the hospital hierarchy, following his orders, but next to the doctor (2). According to Cannon the position of the social worker was that of anexpert in social matters, who advised the expert in physical matters, the doctor. For women at that time this unusual professional status claim, was explained by Cannon in terms of gender. Her argument relied on the nineteenth century gender conception of the “separate spheres.” In championing the social worker’s position in the hospital she fit the Victorian gender concept to the changed social reality of early twentieth century America, expanded it to the professional field as far as possible, but did not transcend it.Cannon wrote in her book that the training of social workers and that of nurses was fundamentally focused on very different positions in the hospital. She criticized the nurses’ training in that they were not challenged to be independent thinkers nor were their leadership skills developed–and Cannon wanted “leaders” in social work (190). The social worker should draw her conclusions about her patients or clients, as she called them, separately from the doctor’s. The results from her social analysis together with the diagnosis of the doctor would help them to mutually decide on how best to help a patient.Cannon’s self-assured claim that social workers belonged on the same hierarchical stratum with the doctors, and her definition of medical social work as a profession caused resistance from the nurses. Cannon was certain about her own professional position next to the doctor. In Social Work in Hospitals she writes: “As the problems of many hospital patients are social as well as medical, two expert professions, not one alone, are needed.” Medical social work was, according to her definition, an “expert profession,” as much as that of the doctor. She points to the social worker’s power of judgment and writes about her quality: “Rather it is one of self-reliant judgment and planning in her own sphere” (2). This sphere was coded feminine, which Cannon not only emphasized but used for her own strategic intention.The historian Eileen Janes Yeo analyzed the Victorian gender concept of the “separate spheres” and confirms that women’s activities in the social realm were explained according to this gender concept. Those activities were seen aslinked to “feminine” qualities like morality, compassion and friendship as well as to the women’s role as mothers. They were not seen as being close to intellectualism, the natural sciences, politics and the economic world–those realms were part of the male domain and did not belong to the moral world of women (64-65).The special qualities and interests were allocated as “natural” to the sexes and were expressed in their distinctive gender spheres. According to nineteenth century zeitgeist these spheres were separate but equal. On the basis of mutual respect men and women–according to the construct of the “sexual communion of labor–would work together for the common good, each in his or her allocated sphere. Cannon argued in exactly the same vein when promoting social work in the hospital: there should be a balance between medical and social know-how, represented by doctors and social workers, who would work together closely and co-operate for the welfare of patient and society.The hospital though was not simply a field that was occupied by two groups, social workers and doctors, who only needed to negotiate a “sexual communion of labor.” Rather the field hospital was also fragmented by groups of women who based their position in the field on their interpretation of “separate spheres.”“If you Like to Try that Thing Yourself Some Winter Day” or Interpretations of the Women’s SphereAt MGH there were three groups of women next to each other, representing three steps of women’s emancipation in the social realm. At the same time they represented three different interpretations of the women’s sphere. First there was the Ladies Visiting Committee that had been active in philanthropy at MGH since 1869. These upper-class Ladies had found their role model in the persona of the “Lady Bountiful,” the charitable keeper of morals and order. They were well-meaning ladies and wives of the well-to-do. Their social status was also closely connected to their role as charitable philanthropists and supporters of the hospital, which earned them social prestige. Of course, they did not receive money but donated it. Ida Cannon was a clever negotiator and knew how to mobilize this group of women for the advantage of the social service department. Social workers and the Ladies were not in a competitive relationship. Rather they supported each other and together worked to lift the other’s status. I view the position these visiting Ladies occupy in the hospital as representing the first step towards an expanded interpretation of the women’s sphere according to the Victorian gender concept.The nurses, by comparison, had to earn their daily income through their work and were therefore financially and socially dependent on their occupation. They had accepted their role as help-maid to the doctor, working in the background assisting him, and not questioning their subordinate position in the field—at least not until social workers, who belonged to the same gender group, put themselves above them in the hospital’s hierarchy. The Visiting Ladies also were above the nurses because they belonged to another social group and were therefore no threat to nurses. But medical social workers–sometimes former nurses themselves, like Ida Cannon—threatened their occupational status. Nurses had interpreted the “communion of labor concept” as a help maid concept, assisting the physician, earning their livelihood and expanding the gender construct of “separate spheres” only within the limits of these self-restrictions.1Physicians did not have any problem or conflict with these first two groups of women at the hospital—philanthropic ladies and nurses—since there was no need to negotiate positions in the field and doctors were therefore comfortable in dealing with them. This was different in the case of social workers who were1 I borrowed the image of “limits” and “restrains” or restrictions from Steven Greenblatt’s veryinspiring essay “Culture.” See Critical Terms for Literary Study, eds. Frank Lentricchia and Thomas McLaughlin, Chicago and London: U of Chicago P, 1995. 225-235.perceived as a threat to the physician’s competence and status.This sometimes difficult relationship between doctor and social worker is exemplified in the following situation. One early social worker remembered the hierarchical gap that existed between her and the “imminent doctor,” which she needed to overcome in order to do a good job. When an orthopedic surgeon had asked her to raise money for an expensive back brace for a woman who had been suffering chronic back pain, the social worker discovered during an interview with the patient that she had not had any teeth for many months. The woman had not been able to afford to buy artificial plates after having had her own teeth extracted. Apparently the “visiting surgeon had not noticed this while concentrating on her back condition.” The social worker’s “difficult duty” was, as she wrote, “to call his attention to the fact and suggest (how my knees shook) that we try a set of false teeth first and see if more food, better masticated, might possibly check the backache! It did, all was well. I did not get fired, either” (MGH papers, Burleigh).Physicians’ sometimes repulsive reactions to social work projects were based on a crisis in medical education in the U.S. during the first decade of this century. The development of medicine as a profession was just about to take root in accordance with scientific and European standards. Parallel to the publication of Cannon’s book Social Work in Hospitals the medical education and professional training of physicians in the U.S. had been at a watershed and with it physicians’ professional and social status. From the point of view of physicians, medical social workers were a hindrance to their high-flying professional goals. Doctors wanted to consolidate their professional image of the scientifically trained physician. If nurses were not interested in sharing their position with social workers in the hospital, doctors weren’t either. Still others thought that social work in hospitals was supporting a progressive medicine and therefore supported social work, like for example Richard Cabot who had thought of starting a social service department in the first place. He also argued according to the “separatespheres” gender construct when claiming that women should not become physicians but rather social workers. Therefore he supported Ida Cannon in her endeavors and when she proclaimed: “The best way to explain it is to do it.”Works Cited:Bourdieu, Pierre. “Zur Genese der Begriffe Habitus und Feld.” Der Tote packt den Lebenden.Schriften zur Politik & Kultur 2. Hamburg:VSA, 1997. 58-78.Cannon, Ida. Social Work in Hospitals: A Contribution to Progressive Medicine. New York: Survey Associates, 1913.Greenblatt, Steven. “Culture.” Critical Terms for Literary Study. Eds. Frank Lentriccia and Thomas McLaughlin. Chicago and London: U of Chicago P, 1995. 225-235.MGH papers (Ida Cannon’s papers at the social service department of Massachusetts General Hospital; they have been rearranged into a proper archive after summer 1996). IdaCannon. “Facilities,” 1939. 64-65.MGH papers. Edith Burleigh. “Scrappy Memoirs,” undated.Yeo, Eileen Janes. “Social Motherhood and the Sexual Communion of Labor in British Social Science, 1850-1950.” Women’s History Review 1.1 (1992): 62-87.。
医务社会工作
医务社会工作(Medical Social Work)学分数 2 周学时 2教学目的与要求:课程性质:社会工作专业选修课程。
本课程需要以社会工作方法(个案工作、小组工作、社区工作)为基础。
基本内容:医务社会工作是一门社会工作的专业课程,包括医务社会工作的概况、历史发展与现状;医务社会工作的内容、工作的取向和工作的环境;医务社会工作的理论基础与事务基础;以及医务社会工作的方法等方面。
基本要求:了解医务社会工作的概况、历史发展与现状;熟悉医务社会工作所涉及的内容、工作的取向和工作的环境;在基本掌握社会工作方法的基础上,能够初步地将社会工作的基础知识和理论与社会工作的方法综合地运用在医务领域之中。
教学方式:课程基本内容与相关理论的讲解;结合角色扮演、模拟操作练习和课堂专题讨论。
参考书目:1、莫藜藜著《医务社会工作》桂冠图书股份有限公司 2000年10月出版2、秦燕著《医务社会工作》巨流图书公司教学内容:(第1周)第一章绪论1、医务社会工作的定义2、医务社会工作的任务3、医务社会工作的意义(第2周)第二章医务社会工作的起源与发展1.医务社会工作在西方2.医务社会工作在中国(第3周)第三章医务社会工作的理论基础与事务基础1、生命周期理论2、压力与应对(第4周)3、危机调适理论4、医学心理学(第5周)第四章健康与疾病1、健康与疾病的定义2、病人角色与行为(第6周)第五章医务社会工作方法1、个案工作A)个案工作理论回顾B)个案工作实务(第7周)2、小组工作A)小组工作模式回顾B)小组工作实务(第8周)3、社区工作A)社区工作理论回顾B)社区工作实务(第9周)第六章医院医务社会工作1、医疗团队与社工角色2、急诊室的社会工作(第10周)3、各科疾病与社工取向A)内科社会工作B)外科社会工作C)妇产科社会工作D)小儿科社会工作E)临终关怀与悲伤辅导(第11周)第七章我国的医务社会工作环境与实务1、我国的医疗保障制度介绍A)我国医疗保障制度的演变B)我国医疗保障制度的现状(第12周)2、我国的医疗体系与医疗工作模式A)我国的三级医疗体系B)医疗诊断、治疗的模式(第13周)3、我国的医务社会工作实务与医务社会工作中的志愿者工作A)我国的医务社会工作实务B)医务社会工作中的志愿者工作(第14周)第八章医务社会工作管理、教学与研究1、医务社会工作行政2、医务社会工作督导3、医务社会工作教学4、医务社会工作研究(第15周)医务社会工作议题1、非住院及慢性疾病与社会工作2、其他相关议题(第16周)操作与观摩(第17周)操作与观摩(第18周)专题讨论。
医务社会工作的伦理困境及应对策略
Advances in Social Sciences 社会科学前沿, 2021, 10(2), 373-377Published Online February 2021 in Hans. /journal/asshttps:///10.12677/ass.2021.102054医务社会工作的伦理困境及应对策略王子健1,武舒燕21广西科技大学艺术与文化传播学院,广西柳州2山西医科大学护理学院,山西太原收稿日期:2021年1月28日;录用日期:2021年2月13日;发布日期:2021年2月24日摘要社会工作作为舶来品在中国本土化的过程中遇到许多伦理问题,当然医务社工也没有例外,也同样遭遇了许多伦理困境难题。
医务社工是社会工作的重要分支之一,但是它又区别于一般的社会工作,因为工作环境和服务对象的特殊性,医务社工更容易遭遇理论困境难题。
本文主要分析医务社工在实践过程中所遭遇的伦理困境问题及其应对策略,以此来推动医务社工更好的发展。
关键词社会工作,伦理困境,医务社工The Ethical Dilemma of Medical SocialWork and Its CountermeasuresZijian Wang1, Shuyan Wu21School of Art and Cultural Communication, Guangxi University of Science and Technology, Liuzhou Guangxi 2School of Nursing, Shanxi Medical University, Taiyuan ShanxiReceived: Jan. 28th, 2021; accepted: Feb. 13th, 2021; published: Feb. 24th, 2021AbstractAs an imported product, social work has encountered many ethical problems in the process of lo-calization in China. Of course, medical social workers are no exception, and they also encounter many ethical dilemmas. Medical social work is one of the important branches of social work, but it is different from general social work. Because of the particularity of the working environment and王子健,武舒燕the target, medical social work is more likely to encounter theoretical dilemmas. This article mainly analyzes the ethical dilemmas encountered by medical social workers in the process of practice and their coping strategies, so as to promote the better development of medical social workers.KeywordsSocial Work, Ethical Dilemma, Medical Social Work Array Copyright © 2021 by author(s) and Hans Publishers Inc.This work is licensed under the Creative Commons Attribution International License (CC BY 4.0)./licenses/by/4.0/1. 引言随着医疗改革的不断深入,医务社工已在北上广深等城市的大医院里开始崭露头角,但是由于重症患者的知情权与自决权的冲突、医疗资源不公平等现象的发生,都让医务社工陷入了理论的困境。
医学社会学英文
医学社会学英文Medical SociologyMedical sociology is a subfield of sociology that focuses on the social, cultural, and political factors that influence health, illness, and healthcare systems. It explores the ways in which social structures and relationships impact health outcomes, access to healthcare, and the experience of illness. Medical sociologists study a wide range of topics, including the social determinants of health, the social construction of illness and disease, the organization and delivery of healthcare, and the experiences of healthcare professionals and patients.One key focus of medical sociology is the social determinants of health. These are the social, economic, and environmental factors that influence individual and population health. For example, research has shown that individuals with lower socioeconomic status are more likely to experience poor health outcomes, due to factors such as limited access to healthcare, higher levels of stress, and exposure to environmental toxins. Medical sociologists also study the impact of race, ethnicity, gender, and othersocial identities on health, as well as the ways in which social inequalities contribute to health disparities.Another important area of study in medical sociology is the social construction of illness and disease. This perspective emphasizes that the experience and perception of illness are shaped by social and cultural factors. For example, the way in which a society defines and responds to mental illness, or the stigmatization of certain diseases, can have profound effects on individuals' experiences of illness and their access to care. Medical sociologists also examine how medical knowledge and practices are socially constructed, and how they reflect and reinforce existing power dynamics and social norms.The organization and delivery of healthcare is also a central focus of medical sociology. This includes the study of healthcare institutions, professional roles and relationships, and the ways in which healthcare is financed and regulated. Medical sociologists are interested in understanding how these factors shape the quality and accessibility of healthcare, as well as the experiences of healthcare workers and patients. They also examine howhealthcare policies and practices reflect broader socialand political values, and how they can reproduce or challenge social inequalities.Finally, medical sociology explores the experiences of healthcare professionals and patients. This includes the study of professional socialization, the dynamics ofmedical work, and the impact of healthcare settings on the well-being of professionals. Medical sociologists also examine the ways in which individuals navigate the healthcare system, the social support networks thatinfluence their experiences of illness, and the impact of illness on their social identities and relationships.Overall, medical sociology offers valuable insights into the complex interplay between social factors and health. By understanding these dynamics, we can work towards creating more equitable and effective healthcare systems, and promoting better health outcomes for all members of society.医学社会学医学社会学是社会学的一个子领域,专注于影响健康、疾病和医疗保健系统的社会、文化和政治因素。
社会工作专业词汇中英文对照
社会工作专业词汇中英对照A for marriage and family therapy 美国婚姻与家庭治疗协会A for the study of group work 美国小组工作研究会A hospital association 美国议员联合会A of Group worker 美国小组工作者协会A of marriage counselors 美国婚姻辅导委员会A of medical social worker 美国医务社会工作者协会A of psychiatric social work 美国精神病社会工作者协会A of schools of social work 美国社会工作院校联合会A of social workers美国社会工作者协会A psychiatric association 美国精神病学联合会A red cross 美国,自己翻译吧Administration andAdministration in social work (journal ) 《社会工作行政》(杂志)Administration 行政Adolescents and 青少年与吸毒Adolescents 青少年AdoptionAdoption 领养Advocacy and 倡导与未来的社会工作Advocacy 倡导AFDC 抚养儿童家庭补助计划Aftercare facilities and 出院后的照顾设施与精神健康服务Aftercare facilities 出院后的照顾设施Agency settings 机构场所Aging 老年AIDS epidemic 艾滋病流行Alcohol 醺酒Alcoholism 醺酒Almshouses 济贫院And social workApplicants for 申请领养人Applications of 小组工作的应用Assessment 评估Associated charities 联合慈善机构assumptions of 咨询的前提假设Bachelor of social work (BSW) degress 社会工作学士学位Balanced budget act (1997) 《平衡预算法案》1997Basic assumptions and principles of ~ 行政的基本假定与原则Battered women 受虐妇女Biopsychosocial 生理心理社会因素与个案工作Brief Introduction to Sociology社会学简论Caregivers 老年照顾者Caregivers 照顾者Case management andCase management 个案管理Case management 个案管理Case study method 个案研究方法Case work 个案工作Certification of social workers 社会工作者认证Changing nature of work 工作性质的改变Charity organization societies (COS) 慈善组织协会Cheating 欺诈child abuse and neglectChild abuse and neglect 虐待与忽视儿童Child guidance movement 儿童指导运动Child welfareChronically mentality ill and 慢性精神病与精神健康服务Chronically 慢性精神病ChurchCivil rights movement 民权运动Client案主Clinical Social Work临床社会工作Closed systems 封闭系统CocaineCode of ethics 伦理守则Collaboration in 行政工作的合并Collaboration 协办Commitment and 服务承诺与靖康精神服务Commitment 服务承诺Committee operation 委员会运作Commonwealth fund 英联邦基金Community chest 公益金Community mental health centers (CMHCS)and 社区精神健康中心与精神健康服务Community organization andCommunity organization and 社区组织与老年community organization 社区组织community resources 社区资源Community Services社区服务confidentiality 保密consolation 咨询Consultant role inConsultation in 行政咨询Continuing educationcontinuing education (CE) 继续教育contract with America 签约美国control groups 控制组coordination 协调corporate health care 矫治Corporate 公司型卫生保健Corrections andCorrections andcorrections and 矫正和社区组织Council on social work education (CSWE) 社会工作教育委员会Councils of Asocial Agencies 社会机构委员会Counseling 辅导Courts 法庭Crack 快克CrimeCultural Anthropology文化人类学Cultural dissonance 文化失调Cultural Sociology文化社会学Current Issues in Theories of Sociology社会学理论专题Curriculum Policy Statements and Educational Policy and Accreditation Standards (EPAS) curriculum statements 课程声明Day care centers 老年日间护理中心Day care centers 日间照料中心Day treatment 日间治疗De finedDefinedDefineddefineddefineddefinedDefinedDefinedDefined 行政的定义Deinstitutionalization 去机构照顾Diagnosis and 诊断与Diplomat exam 社会工作师资格考试disadvantaged groups弱势群体Disappoint in love失恋Discussion on Political & Economic Systems in Socialism社会主义各国政,经体制讨论division of child and family services 儿童与家庭服务科Doctoral programs in social work 社会工作博士培养方案Domestic violence家庭暴力Dropout rates 辍学率Drug abuseDrug abuse andDrug abuse andDrug abuse and 吸毒与青少年Drug abuse 吸毒Drug courts 吸毒法庭Drug therapy 吸毒治疗Eclecticism 折中主义Education for social work 社会工作教育Elizabethan Poor Laws 《伊丽莎白济贫法》Emergency care for 虚度紧急救护Employee assistance programs (EPAs) 雇员援助计划Encyclopedia of Social Work 《社会工作百科全书》English for Sociology专业英语Enrichment andEnrichment inEnrichment in living 充实生活Erotological Social Work老年社会工作Evaluation 评估Evaluation:估价, 评价, 赋值examples ofExamples ofExamples of 个案工作的案例Experimental group 试验组Extent and cost of 吸毒的范围与代价Faith-based social service 信心为本的社会服务FamilyFamilyFamily andFamily counseling 家庭辅导Family Preservation Services (FPS) 家庭维护服务Family Service Association of America (FSAA) 美国家庭服务协会Family Social Work家庭社会工作Family Support Act (1988) 《家庭支持法案》1988Family Welfare Association of America 美国家庭福利会Fieldwork 传说中的“实习”Fieldwork/n./野战工事, 野外工作, 实地调查, 现场工作。
“社会”办医
“社会”办医从哪里来,到哪里去?在英美,社会办医(social medical)指的是公共医疗,特指政府举办的医疗。
而我国的"社会资本办医"含义似乎恰恰相反,多指私人投资办医院。
这是否意味着:在英美人眼里,社会是属于公共的,而在国人眼里,社会是属于私人的呢?中国的社会办医究竟应该从哪里来,未来的发展又在哪里?什么催生了社会办医?我国看病难、看病贵的主要症结在于医疗服务资源(特别是优质资源)供给不足,从而导致出现配置扭曲、价格失衡等一系列怪现象。
缓解看病难、看病贵这个社会顽疾,不仅需要公立医院全力以赴,更需要民营医院等社会办医力量有所作为。
放开社会办医,不仅有利于扩大医疗服务供给,缓解供需缺口,满足国民多元化的医疗需求,同时也有利于增强服务竞争,降低医药费用。
因此,社会资本办医一直被视为深化医改的"活水"。
从历史经验来看,控制医药费用,主要有两个途径:一是依靠医疗保险方与医药供方的集体谈判,以克服患者单独议价的弱势和信息不对称;二是依靠充分的医疗服务供方竞争,通过同行约束来降低医药费用。
记得几年前,学界还流行着所谓"医疗服务业越竞争、费用越高"的奇谈怪论。
其实,与其他服务行业一样,竞争是保障服务意识和职业道德的不竭源泉。
消费者永远欢迎街上能多一家店铺,这样他们才能享受服务员的笑脸,有更多的选择和比较的自由,这一规律同样适用于医疗服务业。
早在1997年,国务院即明文提出,其他社会力量和个人可以兴办医疗机构,作为政府办医的重要补充。
自2012年以来,全国很多地方对社会办医开启"绿灯",倾力扶持。
多个省市相继推出了鼓励社会资本办医的措施,打破公立医院垄断,引入竞争,形成多元化办医格局,以提高医疗服务质量,降低医疗成本,解决老百姓"看病难、看病贵"问题。
一时间,社会办医成为社会各界关注的焦点,一些投资人更是摩拳擦掌。
关于social work的英文总结
mental health social work精神健康社会工作者属于医务社工,但更具专业性,独特性,主要任务是通过与患者患者家属及其他重要联系人之间的专业沟通,协助了解疾病,引导接受并运用现有治疗,此外,共同讨论影响正常社会功能和妨碍治疗的因素,积极利用患者潜能,促进寻求有效的改善途径,发展健康的人际关系,在此过程中,社工致力于协助患者脱离医疗机构的保护环境,适应社会及其自身的局限。
Mental health social workers are medical social workers, but they are more professional and unique. Their main task is to help understand the disease, guide the acceptance and use of existing treatment through professional communication with the patient's family members and other important contacts. In addition, they jointly discuss the factors affecting normal social function and hindering treatment, and actively make use of the patient's potential, Promote the search for effective ways to improve and develop healthy interpersonal relationships. In this process, social workers are committed to helping patients get rid of the protective environment of medical institutions and adapt to the society and its own limitations.。
三甲医院医务社会工作的实践与思考
2016年12月第20卷第12期 ·65·三甲医院医务社会工作的实践与思考■ 张红宇① 赵国光① 吴英锋① 张 洁①①首都医科大学宣武医院,100053 北京市西城区长椿街45号【关键词】三甲医院 医务社工 志愿者 外部环境 服务体系【摘 要】患者及家属的需求、临床医务人员的渴望、医学与社会的发展使医务社会工作大有前景。
三甲医院救治疑难、急危重症患者以及外埠患者较多,尤其必要开展医务社会工作。
当前环境下,三甲医院应将医务社会工作归口管理,创立职能统一的医务社会工作部,培养专职医务社工,大胆进行医务社会工作本土化探索,推动医务社会工作参与临床诊疗和医院管理,营造医务社会工作健康发展的外部环境。
Practice and thoughts on medical social work in the top tertiary hospitals / ZHANG Hongyu, ZHAO Guo-guang, WU Yingfeng, ZHANG Jie// Chinese Hospitals. -2016,20(12):65-66【Key words】top tertiary hospital, medical social work, volunteer, external environment, service system【Abstract】Patients and their family's demands, medical staff 's needs and the development of medicine and society makes medical social work has good prospect. The top tertiary hospitals have more difficult diseases, critically ill patients and other town patients which makes medical social work more necessary. Under current environment, it needs to establish a unifi ed function of the department of medical social work, cultivate professional medical social workers and promote the participation of medical social work in clinical work and hospital management. In addition, creating the external environment for the healthy development of medical social work is also the urgent problem to be solved.Author’s address:Xuanwu Hospital, Capital Medical University, No.45, Changchun Street, Xicheng District, Beijing,100053, PRC基于系统化的综合治疗模式使医疗活动从关注疾病转移到关注患者,从关注个体转移到关注患者家庭和社会关系,超越了临床医护人员的诊疗范畴。
基于优势视角分析取向下的癌症患者医务社会工作介入
Medical Social Work Intervention With Cancer Patients From the Strength Perspective 作者: 刘芳 宫阳阳 张东航
作者机构: 吉林大学第一医院,吉林长春130021
出版物刊名: 青少年研究与实践
页码: 67-71页
年卷期: 2015年 第4期
主题词: 优势视角 医务社会工作 抗逆力 癌症患者
摘要:以“个体都有自己解决问题的力量与资源,并具有在困难环境中生存下来的抗逆力”为基本假设,围绕癌症患者的抗逆力层次模型,从个体的外部支持因素、内在优势因素、效能因素及家庭的信念体系、组织模式、沟通过程等方面着手,帮助患者提升个体及家庭抗逆力,有效地应对疾病及相关问题的挑战,实现提高癌症患者的自我效能感、生活质量,构建和谐的医患关系的目的。
三级综合医院医务社会工作规范及流程江苏
英文回答:In accordance with the policy on health services in Jiangsu Province, the norms and procedures for the social work of the medical services at the level 3 general hospitals have been developed and implemented。
The purpose of the Code is to regulate the hospital ' s code of conduct for medical and social work, to ensure that medical and social workers practise their profession in accordance with the law, honour their faith and provide quality medical care to patients。
In the course of implementation, medical and social workers are required to adhere strictly to the rules of procedure, ensurepliance withthe rules and regulations, maintain a good image of hospitals and contribute positively to social harmony and stability。
根据江苏省医疗卫生服务的方针政策,三级综合医院医务社会工作规范及流程已经制定并实施。
该规范旨在规范医院医务社会工作的行为准则,确保医务社会工作人员依法行医、诚实守信,为患者提供优质的医疗服务。
医疗社会工作SocialWorkinHealthCare介绍
医务社会工作临床实务概况
家庭暴力个案(含儿虐)医务社会工作
➢ 社会心理评估:家庭结构、功能、支持、 支持程度、资源、人身 安全。
➢ 情绪支持与协助了解法令与程序(如验伤、就 医、备案与报案、诉讼等)
➢ 出院准备与转介后续服务评估:如法律咨询、 经济资源扶助、心理辅导与治疗、福利咨询等
➢ 通报:依责任通报制,通报各地家防中心 ➢ 结案与追踪辅导。
医务社会工作临床实务概况
医疗争议医务社会工作
➢ 倾听病家主诉及了解案情 ➢ 参与院内检讨会议,讨论案情与因应措施 ➢ 安排医疗说明会,促进医病沟通(沟通桥梁) ➢ 协调问题解决解决要求,促进达成共识 ➢ 适切引导寻求专业鉴定(保持中立) ➢ 协助和解程序之完成(全程纪录备查) ➢ 结案与持续追踪
医务社会工作临床实务概况
重大灾变事件医务社会工作
➢ 协助病患病症获得妥善处理为首要 ➢ 协助确认病患身份及联系相关亲友 ➢ 协调医护或警卫人员共同确认证件及拍照存证,
必要时通报警方协寻 ➢ 执行病患及家属情绪关怀与慰抚 ➢ 整合志工协助现场家属安抚、协寻任务及陪伴
病患进行医疗检查 ➢ 依据大批伤员发生时医院现场状况,协调休息
➢ 协助完成捐赠程序关心、协助丧葬处理事宜 ➢ 安排追思大会或捐赠者家属支持团体协助关怀家属
医务社会工作临床实务概况
安宁疗护医务社会工作 ➢ 落实安宁疗护理念,提供避患及家属四
全照顾之目标。 ➢ 提供社会心理、家庭、经济问题等评估
处遇及遗族悲伤辅导追踪 ➢ 建立团队情感支持网络、参与个案研讨
会及入院评估会谈 ➢ 推动安宁理念倡导与团体活动策划执行
人口及整体环境进行诊断、处遇、复
健、健康维护和预防的工作。
有一些是社会工作特别有兴趣提供服
三级综合医院医务社会工作规范及流程
三级综合医院医务社会工作规范及流程1.医务社会工作人员应具备扎实的医学、心理学、社会学等专业知识。
Social workers in tertiary comprehensive hospitals should have solid professional knowledge in medicine, psychology, sociology, etc.2.医务社会工作人员应遵守相关的法律法规,严格遵守保密制度。
Medical social workers should comply with relevant laws and regulations and strictly abide by the confidentiality system.3.医务社会工作人员应当尊重患者的隐私权,不得泄露患者的个人信息。
Medical social workers should respect the privacy of patients and should not disclose their personal information.4.医务社会工作人员应建立起人性化、关怀体贴的工作风格,帮助患者建立信任感。
Medical social workers should establish a humane andcaring working style to help patients develop a sense oftrust.5.医务社会工作人员应协助患者解决医疗服务中出现的问题和困难。
Medical social workers should assist patients in solving problems and difficulties encountered in medical services.6.医务社会工作人员应主动关注患者的心理和社会需求,给予必要的支持和帮助。
我国医务社会工作发展现状、困境及建议
Advances in Social Sciences 社会科学前沿, 2023, 12(4), 1747-1751 Published Online April 2023 in Hans. https:///journal/ass https:///10.12677/ass.2023.124237我国医务社会工作发展现状、困境及建议黎玮玮,莫艳婷广西科技大学人文艺术与设计学院,广西 柳州收稿日期:2023年3月6日;录用日期:2023年4月10日;发布日期:2023年4月18日摘要 做好医务社会工作意义重大。
我国医务社会工作处于起步阶段,主要面临专业医务社工人才紧缺、社会认知度偏低、缺乏统一的行业标准与规范及保障体系不足的发展困境,建议加强医务社会工作人才队伍建设、开展立体式宣传提高社会认知度、出台实施统一的行业标准与规范、建立健全医务社会工作保障体系,不断推动我国医务社会工作高质量发展。
关键词医务社会工作,现状,困境,建议The Development Status, Dilemma and Suggestions of Medical Social Work in ChinaWeiwei Li, Yanting MoSchool of Humanities, Art and Design, Guangxi University of Science and Technology, Liuzhou Guangxi Received: Mar. 6th , 2023; accepted: Apr. 10th , 2023; published: Apr. 18th , 2023AbstractDoing a good job in medical social work is of great significance. China’s medical social work is in its infancy, mainly facing the shortage of professional medical social workers, low social recogni-tion, lack of unified industry standards and norms and insufficient security system development dilemma. It is recommended to strengthen the construction of medical social work talents, carry out three-dimensional publicity to improve social awareness, introduce and implement unified industry standards and norms, establish and improve the medical social work security system, and continuously promote the high-quality development of medical social work in China.黎玮玮,莫艳婷KeywordsMedical Social Work, Present Situation, Trouble, SuggestionCopyright © 2023 by author(s) and Hans Publishers Inc.This work is licensed under the Creative Commons Attribution International License (CC BY 4.0)./licenses/by/4.0/1. 引言医务社会工作是最能体现社会工作价值的一门新兴专业[1]。
【医院管理】_医务社会工作实践与探索——以上海为例
2009年新医改方案明确“发展医务社工”
2009民政局调研
2006年十六届六中全会精神“建设宏大社工队伍”
2006年原人事部、民政部联合出台《社会工作者职业水平评价暂行规定》和《助理社会 工作师、社会工作师职业水平考试实施办法》
2006 2018
2009
2010
2012
2014
2015
2017
不同层面全面响应
180
2017年超过11个国家级继续教育项目 160 2016年8个国家级继续教育项目
2015年所有社区卫生中心 140 2014年400人参加 120 2013年265人参加
2012年85人参加 100 2012年首次纳入医学生教育
2010年首次召开国际会议
80
2008年首个国家级继续教育项目 60 2004年首批MSW进入医院
医院
理念先进 内生动力 良性互动 回应需求
社工
专业热情 人文情怀 工作勤勉 注重点
注重内涵 适度超前 循序渐进
注重人才 服务浸润 加强融入
螺旋式上升
管理与体系建设
市政府
卫计委
民政局
党委书记 干部人事处
副局长
社工与志愿 服务处
卫计委定位
专业人才建设 学科体系建设 规范执业岗位
2014年 上海市社 会工作者 协会医务 社会工作 分会成立
2014年 上海医务 社会工作 发展成果 获得国家 “医改重 大举措之 一”
与国家宏观政策相呼应
标准化建设、人才培养计划 健康中国2030-健康上海2030
2014年上海市社会工作者协会医务社会工作分会成立
2018国家卫计委发布 《进一步i 改善医疗服 务行动计划》(2018 -2020)
地市级三级甲等综合医院引入医务社会工作的必要性思考
地市级三级甲等综合医院引入医务社会工作的必要性思考发表时间:2016-03-25T15:41:26.430Z 来源:《系统医学》2015年11期作者:简榕[导读] 四川省遂宁市中心医院 629000 医务社会工作在全国大型医院的医疗服务中的促进作用已被广泛认可,本文通过分析医务社会工作在医院发挥的作用,以及当前地市级三级甲等综合医院发展面临的挑战,阐述地市级三级甲等综合医院引入医务社会工作的必要性。
四川省遂宁市中心医院 629000【摘要】医务社会工作在全国大型医院的医疗服务中的促进作用已被广泛认可,本文通过分析医务社会工作在医院发挥的作用,以及当前地市级三级甲等综合医院发展面临的挑战,阐述地市级三级甲等综合医院引入医务社会工作的必要性。
【关键词】医务社会工作;地市级;三级甲等综合医院Thinking about Prefecture-level city of third-grade class-A hospital comprehensive hospital the necessity of introducing the medical social workJian RongSuining Central Hospital,SichuanAbstract:Medical social work in the promoting role of the national large-scale hospital medical services has been widely recognized,in this article,through analyzing the role of medical social work in the hospital,and the current prefecture-level city of third-grade class-A hospital comprehensive hospital development challenges,this paper described the prefecture-level city of third-class-A hospital comprehensive hospital the necessity of introducing the medical affair social workKey words:Medical social workprefecture-level city Third-grade class-A hospital【中图分类号】R192【文献标识码】A【文章编号】2096-0867(2015)-11-001-01 社会工作是一种助人自助活动。
《社会工作概论》PPT 第十六章 医务社会工作
三、医务社会工作的主要理论
(一)有关健康的理论
1.生理-心理-社会健康观和医学模式的转型
传统上健康状况主要从单纯生理学的角度界定, 没有考虑心理社会状况。实际上健康状况不仅是指 身体无病,而且是指心理健康和社会角色功能正常 发挥的状态。
2.健康危机干预和压力管理的理论
健康危机干预和压力管理理论的主要关注点是缩 小医生与病人之间的距离,在健康处境中提供心理 -社会型干预,以适应生理-心理-社会健康观和医学 模式的转变,提高医疗技术和健康照顾服务的质量 和效果。
第十六章 医务社会工作
第一节 医务社会工作的概念与发展 第二节 医务社会工作的价值与理论基础 第三节 医务社会工作的介入领域与实务方法 第四节 中国医务社会工作的发展
第一节 医务社会工作的概念与发展
一、医务社会工作及相关概念 (一)医务社会工作的概念
从社会工作专业和健康照顾服务体系之间关系的 角度将医务社会工作界定为医药卫生和健康照顾服 务领域中的社会工作专业服务。
基础知识 照顾者:为患者提供适当照顾,这种照顾涵盖心理、生理和社会
三个层面 支持者:为病人及其家属提供心理、情绪等方面的支持 资源整合者:寻求和整合社会资源,包括寻找病人需要的资源,
完成申请的程序与转介,请求资源机构提供资源等;(刘继同, 2005 刘继同,2006,刘斌志,2007 ) ……
广义上,我们认为医务社会工作指的是将社会工 作的知识、技术、态度与价值应用于健康照顾工作, 并侧重于疾病与人们社会功能间的关系,以及疾病 对人们社会关系的影响方面。
狭义的医务社会工作更多集中在医院和诊所这类 医疗机构,认为医务社会工作是社会工作者运用社 会工作知识与技术,从社会及心理层面来评估并处 理服务对象的问题。社会工作者作为医疗团队的一 份子共同协助患者及家属排除医疗过程中的障碍, 使患者早日痊愈,达到身心平衡,并使疾病而产生 的各种社会问题得以解决。(刘继同,2008)
医务社会工作PPT课件
瓦解绝望期:鼓励继续进行先前的活动,避免重大生活 变故,利用社区资源
① 重整期:适当参加新活动、交新朋友、培养新兴趣
公共卫生社会工作的主要方法
健康宣传和管理 社区保健 传染病的预防和控制
健康宣传方法
出院跟进工作
制订出院计划
明确哪些医院和诊所可以提供继续治疗 帮助家属了解如何照顾好患者,解决家庭护理问题
辅导家属照顾患者 协助家属与患者一起设计跟进服务方案
家庭医疗工作方法
对长期慢性病人的家庭医疗(见后) 连接家庭和社区卫生服务 寻求社会资源,减轻家属压力
慢性病人的家庭治疗
评估长期慢性病患者及其家庭的需求,明确 需要开展的服务活动
对社会进行死亡教育
患者家属 医护人员
陪伴临终患者
帮助患者回顾生命、完成心愿、缓解心理压力 安慰临终患者,使其安心度过最后的时光 运用放松技巧处理患者对健康问题的焦虑 建议医生使用合适的药物缓解患者的痛苦和恐惧
辅导临终患者家属
对家属的临终关怀辅导 对家属的悲伤辅导
麻木僵化期:保护悲伤者、提供实际帮助、允许并接受 情感的爆发,鼓励参与哀悼仪式
WHO的健康定义
健康不仅指一个人没有疾病或虚弱现象, 而是指一个人生理上、心理上和社会上的完 好状态。
健康的三个层次
躯体(生理)健康(躯体与环境之间的平衡) 心理健康(正确认识自我和环境) 社会适应能力
个人能力在社会系统中获得充分发挥 有效扮演与其身份相适应的社会角色 个人行为符合社会规范
拟定服务的具体计划,包括生理指标的维护、 家庭护理人员的培训和医务人员的定期查访
寻求社会资源,拓展有效的转介程序,减轻 医生和患者的负担
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6 April 1968
painful. She was given tetracycline 250 mg. orally every six hours the day after these symptoms had begun, but as she now developed a fever and felt worse she w3as given phenoxymethylpenicillin 250 mg. orally every six hours. But as she did not improve after two days' treatment with the penicillin she was admitted to her local hospital. Her temperature was 1030 F. (39.5' C.). She was given a mixture of penicillin and streptomycin (Crystamvcin) intramuscularly. A blood count on admission showed that there was complete agranulocytosis, with only lymphocytes in tne peripheral blood smear, 1,000/cu. mm. She was transferred to the Radcliffe Infirmary. On admission she appeared ill, but was afebrile. There was a sloughing ulcer with a red base but little surrounding reaction on the right hand, and another near the anal margin. There was monilial infection in the mouth. There was no pharyngitis, and the spleen and lymph nodes were not enlarged. Investigations were as follows: Haemoglobin 12.1 g./100 ml., reticulocytes 0.4%, haematocrit 34%, blood sedimentation rate 102 mm./hr. (Westergren method), total white cell count 2,100 cu. mm., 1% myelocytes, 27% band forms, 7% segmented forms, 60% lymphocytes, 4% monocytes. Occasional plasma cells were seen in the blood film. Sternal marrow was hypocellular. Proportionate reduction in erythropoiesis, slight relative increase of myeloid cells, mainly at the myelocyte stage. Blood cultures were sterile. Cultures of the ulcers yielded Staphylococcus aureus, Pseudomonas pyocyanea, and Escherichia coli. No L.E. cells were found and antinuclear factor was not present. Coombs test was negative, serum proteins were normal, and serum immunoglobulin levels were normaL The prognosis was thought to be favourable, as there was evidence of polymorpho-
There is a staff of 3 to 5 doctors and a dozen or so English nursing sisters. Kampala has the larger part of the University of East Africa and there is a sizable European community. There is currently a need for a doctor to work in this hospital for some months or longer. Anyone free to go can be sure of a Radcliffe Infirmary, Oxford. rewarding and stimulating experience. I went REFERENCES with my wife and two teenage children. We Brit. mad. Y., 1959, 2, 417. pleasantly housed in the hospital 2 Meyler, L., of Drugs, 1963-1965, were Side-ejffects grounds, and my 13-year-old daughter Vol. 5, 1966. Amsterdam. Simpson, W. T., 1968, personal communication. attended a day school a mile away. Kampala is at 4,000 ft. (1,200 m.) and the climate is hot but comfortable. I will gladly give Medical Social Work further details to anyone wishing to know more. I may add that I went after 20 years SIR,-We noted with particular interest in general practice and with little knowledge the leading article " Medical Social Work in General Practice" (24 February, p. 464). of tropical medicine. The essentials are For nearly two years we have been taking easily acquired in practice.-I am, etc., part in a pilot study on the value of physioG. D. DENLOW. therapy in a general practice. A clinic is Derby. held weekly in our surgery for the reeducation of poor muscular performance in its early stages, this being particularly related Value of Post-mortem Examinations to respiratory conditions, posture and gait, and inadequate control of micturition. We SIR,-When the coroner's pathologist perconsider that early re-education is of the forms a necropsy the clinician who reported utmost importance if subsequent geriatric the case may not be able to see the examinadisability is to be prevented. tion carried out. These patients, who die While it is appreciated that State-registered from undiagnosed conditions or after operaphysiotherapists are in short supply, one or tions, are particularly interesting to clinicians. local two sessions a week in a general prac- A select few expert pathologists carry out tice are usually possible for a married woman most of examinations in London. The whose family commitments make work in a coroner's the does not usually know when hospital department out of the question.-We to expect officer the pathologist. Whenever I have are, etc., witnessed a post-mortem examination the courtesy and helpfulness of the pathologist MARGUERITE E. PENNEFATHER. have been matched only by his expertise. ELIZABETH R. TANNER. Always there has been willingness to listen London S.E.1. to the history and to look for suspected findings. This experience contrasts with the terse reports which may be purchased after Medical Factors and Road Accidents a delay, when the clinical details are halfSIR,-I have noticed that Mr. E. Grattan forgotten. The coroner who orders a necropsy, and and Mr. G. O. Jeffcoate refer, in their article entitled Medical Factors and Road Accidents the pathologist who performs it, fulfil their (13 January, p. 75), to a 1956 Worild Health legal duties. Any change must be at the Organization document " Guiding Principles demand of clinicians. Post-mortem examinain the Medical Examination of Applicants for tions carried out on behalf of coroners should Motor Vehicle Driving Permits." I wish not only fulfil a legal requirement but also to state that in January 1968 the World allow for clinical enlightenment. It would Health Organization convened, in Geneva, a require an increased number of pathologists meeting of a group of consultants in order to organized from a central control. The time revise, on behalf of the Economic Commis- and place of a necropsy could be passed on sion for Europe, the above-mentioned 1956 to the clinician. An extra fee could be paid W.H O. document to take into account recent by the Ministry of Health to the pathologist. medical developments and thoughts. It is A copy of the report would be sent to the expected that later in the year this revised clinician who reported the death to the document will be available upon request.-I coroner. In exceptional circumstances the am, etc., coroner would insist on excluding the ALAN BELL, clinician from the postmortem examination Secretary, Consultant Group to The present organization is adequate for Review " Guiding Principles It is doubtless in the Medical Examination of the legal requirements. Applicants for Motor Driving efficiently organized by the pathologists and Permits." coroners' officers. The clinicians, however, World Health Organization, Geneva. often miss the most instructive examination of all.-I am, etc., Willesden General Hospital, R. M. Kiax. London N.W. 10. Short Duty Tour in East Africa