[1]史文宗,刘瑞吉,杨 柳,等.医改新形势下病案的人文需求[J].医学信息,2020,33(05):19-21.[doi:10.3969/j.issn.1006-1959.2020.05.006]
　SHI Wen-zong,LIU Rui-ji,YANG Liu,et al.Humanistic Needs of Medical Record in the New Situation of Medical Reform[J].Medical Information,2020,33(05):19-21.[doi:10.3969/j.issn.1006-1959.2020.05.006]
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医改新形势下病案的人文需求()
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医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
33卷
期数:
2020年05期
页码:
19-21
栏目:
出版日期:
2020-03-01

文章信息/Info

Title:
Humanistic Needs of Medical Record in the New Situation of Medical Reform
文章编号:
1006-1959（2020）05-0019-03
作者:
史文宗; 刘瑞吉; 杨 柳; 等
（秦皇岛市第一医院，河北 秦皇岛 066000）
Author(s):
SHI Wen-zong; LIU Rui-ji; YANG Liu; et al
(Qinhuangdao First Hospital,Qinhuangdao 066000,Hebei,China)
关键词:
病案; 人文需求; 健康管理; 平行病历
Keywords:
Medical record; Human needs; Health management; Parallel medical record
分类号:
R197.3
DOI:
10.3969/j.issn.1006-1959.2020.05.006
文献标志码:
B
摘要:
病案是医务人员记录患者疾病表现和诊疗情况的档案，是更为广义的健康记录，也是反映患者人文需求的重要介质。传统的病案只记录患者躯体症状的形式已经不能满足患者健康管理的需求，随着现代医学模式逐渐由生物医学模式转变为生物-心理-社会医学模式，循证医学、叙事医学、医学教育的发展及心身医学的兴起，对病案提出了更高的人文要求。本文从病案人文需求的作用、丰富病案人文需求的实施途径进行阐述，以期为医院的医疗、科研、管理提供更有价值的参考数据。
Abstract:
Medical record is medical personnel’s record of patients’ disease performance and diagnosis and treatment. They are a broader health record and an important medium to reflect the human needs of patients. Traditional medical record that only record the physical symptoms of patients have been unable to meet the needs of patient health management. With the modern medical model gradually changing from a biomedical model to a bio-psycho-social medical model, the development of evidence-based medicine, narrative medicine, and medical education and the rise of psychosomatic medicine has put forward higher humanistic requirements for medical record. This article elaborates on the role of the medical needs of the medical record and the implementation methods to enrich the human needs of the medical record, with a view to providing more valuable reference data for the medical, scientific research and management of the hospital.

参考文献/References:

[1]刘爱民.病案信息学[M].北京:人民卫生出版社,2017.[2]冯泽永.努力促进医学回归人文——评刘虹教授“人文医学引论”[J].医学与哲学,2019,40(7):14,20.[3]马斯洛.马斯洛人本哲学[M].北京:九州出版社,2017.[4]Gronblom Lundstrom L,Aasa U,Zhang Y,et al.Health care in light of different theories of health-A proposed framework for integrating a social humanistic perspective into health care[J].Journal of Integrative Medicine,2019,17(5):321-327.[5]李幼平,杨克虎.循证医学[M].第1版.北京:人民卫生出版社,2016.[6]喻佳洁,李琰,陈雯雯,等.循证医学的产生与发展:社会需求、学科发展和人文反思共同推动[J].中国循证医学杂志,2019,19(1):108-113.[7]朱声荣,李维,张晨,等.基于循证医学与真实病历库的CDSS实现与应用[J].中国数字医学,2019,14(5):36-38,42.[8]高晓喆.叙事医学在医疗纠纷处置中的应用[J].医院管理论坛,2019,36(4):15-17.[9]苏业璞,张颖,秦莉,等.创新思维推动传统病历适应叙事医学发展[J].医学与哲学(B),2016,37(10):82-84.[10]Song P,Tang W.Emphasizing humanities in medical education:Promoting the integration of medical scientific spirit and medical humanistic spirit[J].BioScience Trends,2017,11(2):128-133. [11]杨淑娟,张微雅.推动医学人文在医院实践中落地生根[J].中国医学人文,2019,5(3):55-56.[12]黄小东,葛金玲,王丽清.病历与病案的初步探讨[J].中国中医药现代远程教育,2016,14(18):31-33.[13]朱婷婷,邢烨.我国叙事医学应用研究进展及推广路径研究[J].医学与哲学,2019,40(10):49-52.[14]邓蕊,梁辰.医学伦理学视角下探讨叙事医学的平行病历[J].医学与哲学(B),2018,39(7):13-16.[15]高娟.综合医院内外科住院病人心理健康状况、心理护理需求及相关性分析[D].青岛大学,2013.

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更新日期/Last Update: 2020-03-01