Lesson Two
Intensify the Generalist Physician‘s Training
Main topic： What a GP is， and why GPs are badly needed in the USA.
2.1 Background information： Health service and general practitioners in Britain
The National Health Service in Britain was set up in 1948 shortly after the end of the Second World War. Its aim is to provide free medical treatment for all patients who wish to take advantage of the service. However， it is still possible to obtain private medical treatment and in this case the doctor charges a fee.
To say that the national Health Service is free is not entirely true. Every employed or self-employed person over sixteen years of age must put a stamp on an insurance card every week. This card is issued by a government department called the Department of Health and Social Security. The stamp costs money and the amount is constantly changing. Part of the cost of this stamp， in fact the greater part， is borne by the employer and it finances the National Health Service together with many other Social Security benefits such as retirement pensions， unemployment benefit， sickness benefit， maternity benefit and so on. At present except for children under sixteen and old-age pensioners there is a standard charge for prescriptions for medicine； an expensive drug costs the patient no more than a cheaper remedy. This， except for nominal charges for dental treatment and glasses， is all that one has to pay.
In order to participate in the Health Service， a patient must register with a General Practitioner， usually known as a G. P. Whenever he is ill or needs to consult a doctor for any reason he will in every case go to see his G. P. If the doctor feels that the case needs more expert help or the use of greater resources than are at his disposal， he will give his patient a letter to take to a hospital where more sophisticated treatment is available. Treatment and even food in hospital is， by the way， entirely free.
The following is an example of GP medical card in the UK：
（The front page）
This is your Your local Health Authority （HA） is
NHS medical card Camden and Islington HA
Please keep it in a safe place. It is proof 110 Hampstead Road， London
that you are entitled to NHS treatment. Your NHS number is
499 108 8607
Please tell us this number if you get in NW1 2LJ
touch with us. It will help us to find your
records more quickly.
MISS FAN ZHANG
PASSFILD HALL
1 ENDSLEIGH PLACE， LONDON
WC1H OPW
Your doctor is Your date birth
R RATNAVEL （23516） 13/11/1979
What to do if you want to change your doctor
| To the patient 1. Please read the notes about this on the other side of this card 2. Fill in this part of the car and give it to the new doctor to sign it Your signature: Date: If you are not the patient, please say what your relationship is to the patient. Name and address if either is different from the above: postcode |
To the new doctor Please fill in this part of the card Your name: Your code number Your signature to accept this patient Date: If you will be dispensing drugs, tick here □ If you claim a rural practice payment, number of miles between your main surgery and the patient’s home □ Office use HA cipher QAT Card issued on 22.06.01 |
Important information If you need to see a doctor
Take this card with you so that your doctor knows you are entitled to NHS treatment. You may have to pay if do not. If so，get a receipt from your doctor showing how to recover the fee. Your doctor and you.
All doctors will have the practice leaflet containing information to help you，such as surgery hours and the various services available to patients. Emergencie
Try to get your own doctor first，or a doctor who is covering for them. If they are not available，you can get treatment from any NHS family doctor，local primary care center，minor injuries unit or A & E. Failing that，dial 999. If you are away from home within the UK.
Do not send this card back to us. You can get NHS treatment from any family doctor. Just show this card to tell them your NHS number. Your number is on the front of this card. If you change you address
Tell your doctor new address as soon as you can. This is in case your doctor has to write to you or visit you at home. Also tell your HA （address overleaf）who may have to write to you about health screening programs.
If you have moved out of the area that your doctor covers，you may need to change your doctor.
If you go abroad （for more than 3 months）
Please send this card back to us. Our address is on the front. Your will need to register with a doctor again when you come home. If you want to change your doctor
You can do this at any time–you do not have to have a special reason. Just fill in the fron of this card and give it to your new doctor. If the doctor is willing to accept you，they will sign the card and send it to us. We will send you a new card with the details of your new doctor. You may go to your new doctor for treatment as soon as they have accepted you. How your local HA can help you
If you cannot find a doctor to accept you
Please let us know. We will find a doctor for you If you want more information
We can tell you
n Names and addresses of doctors，dentits，opticians and pharmacists in your area.
n About services that you can get in your area.
For example，about the doctors who speak other languages and about extra services like child health care， minor surgery and，for women，contraceptive and maternity medical services. Complaints
If you want to complain about the services of a GP，dentist，optician or pharmacist，you should contact the complaints manager at their practice or the practice staff member who handles complaints. Remember
We are here to help you. But if you write to us，please make sure you tell us your NHS number. We will be able to reply to you more quickly if you tell us your number. Your NHS number is on
the front of this card.
2.2 Main contents
Generalist career
↓
Primary care， characterized by：
1. First contact care， not differentiating health concerns；
2. Patient-centered， not organ or problem specific；
3. Continuous and longitudinal patient care， not temporary；
4. Coordination of medal， social and mental services through consultation and referral
U.S. Department of Health and Human Services （美国卫生和福利部） defines it as （P. 9）：
nHealth promotion and disease prevention；
nAssessment and diagnosis of common symptoms and signs；
nManagement of common acute and chronic medical conditions；
nIdentification of and appropriate referral for other needed health services
2.3 More words and expressions
1.人人享有卫生保健health for all / universal access （to health care）
2.卫生制度改革health system reform
3.卫生保健health care
4.医疗保健medical care
5.初级卫生保健primary health care
6.以病人为中心patient-centered
7.咨询机构advisory bodies
8.病人全程护理longitudinal patient care
9.会诊consultation
10.转诊referral
11.继续教育continuing education
12.毕业后教育after-graduation education
13.成本效益cost-effect
14. 风险效益risk-effect
15.医生队伍physician workforce
16.特定环境 settings
17.担当起…任务function as…
18.把…称为…define as / be defined as
19.把…看成…be seen as…
20.投身于…be committed to
21.有…权利have access to
22.树立目标set a goal
23.其特点是…be characterized by / be characteristic of
24.能胜任…be competent in doing / for
25.随着…深入（发展）as …take center stage
26.强调underscore
27.鉴于given…
2.4 More words and expressions for the exercise
1.预防性普查preventive screening
2.健康咨询health counseling
3.病史记录record taking / record keeping
4.医疗管理practice management
5.电话会诊telephone consultation
6.健康宣传health promotion
7.医学伦理学medical ethics
8.生物伦理学bioethics
9. 评估assessment / evaluation
10.常见病 common diseases
11.……是指… refer to / be referred to as
12.人人享有卫生保健health for all / universe acess
