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General practice training in China:A multimodal experiential program provided by Australian educators

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Family Medicine and Community Health 2018年第1期6卷 14-19页

作者： Grant Blashki Hui Yang leon piterman Nossal Institute for Global Health and Melbourne Sustainable Society Institute The University of MelbourneParkvilleVictoriaAustralia Shenzhen International Primary Health Care Research Institute ShenzhenGuangdongChina Department of General Practice Monash UniversityMelbourneVictoriaAustralia China GP Program Monash Institute of Health and Clinical EducationMelbourneVictoriaAustralia

Our small group of expert GP academic trainers from Monash University and the University of Melbourne have been collaborating over the last decade to develop a GP model training program based in Luohu,Shenzhen,that deeply engages Chinese GPs and seeks to provide personal and professional development of the *** program is closely linked to continuing offshore GP education in Australia,with many trainees of the program having attended intensive training hosted by Monash University in Australia.

关键词： General practice primary care China training

Offshore teaching in chronic disease management:The Monash- Shenzhen experience

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Family Medicine and Community Health 2018年第1期6卷 10-13页

作者： leon piterman Hui Yang Grant Blashki Department of General Practice Monash UniversityMelbourneVictoriaAustralia China GP Program Monash Institute of Health and Clinical EducationMelbourneVictoriaAustralia Shenzhen International Primary Health Care Research Institute ShenzhenGuangdongChina Nossal Institute for Global Health and Melbourne Sustainable Society Institute The University of MelbourneParkvilleVictoriaAustralia

The important role of GPs and the high prevalence and burden of chronic disease in China have been discussed in other articles in this series,so there is no need to reiterate this background *** article deals with the pedagogy of chronic disease management as presented to cohorts of Chinese GPs from Shenzhen attending an offshore program at Monash University in *** program,which commenced in 2010,was 7 weeks in duration and has now expanded to 13 weeks,enabling greater coverage of important topics,more site visits,and instruction in teaching and research methods,along with development of research proposals often based on management of a chronic disease.

关键词： Chronic disease general practice education and training

Chronic non-communicable disease

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Family Medicine and Community Health 2018年第1期6卷 1-2页

作者： leon piterman Hui Yang Department of General Practice Monash UniversityMelbourneVictoriaAustralia China GP Programs Monash Institute of Health and Clinical EducationMelbourneVictoriaAustralia Shenzhen International Primary Health Care Research Institute ShenzhenGuangdongChina

Non-communicable disease(NCD),including chronic and at times complex disease has overtaken communicable or infectious disease as the number one cause of illness,disability and death *** this has been the case for decades in developed countries,NCD is also emerging as the major health problem in developing *** are a number of reasons for this change in disease *** include better control of infectious disease through sanitation,vaccination and judicious use of antibiotics(notwithstanding the emergence of antibiotic resistance).

关键词： death Chronic globally

澳大利亚全科医生案例分享——置若罔闻怎能建立信任?

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中国全科医学 2019年第7期22卷 761-763页

作者： leon piterman 梁艳嫦杨辉 Monash University 罗湖医院集团黄贝岭社区健康服务中心广东省深圳市518003

我第一次接触琼,大约在我开始做全科医生5年后。当时她是一位44岁的单身母亲,独自抚养照顾年龄分别为16、14、10岁的3个孩子,较年长的两个孩子是女孩。影响孩子们健康的各种问题或疾病都是比较常见的。大女儿身体健康,为了缓解痛经,她... 详细信息

我第一次接触琼,大约在我开始做全科医生5年后。当时她是一位44岁的单身母亲,独自抚养照顾年龄分别为16、14、10岁的3个孩子,较年长的两个孩子是女孩。影响孩子们健康的各种问题或疾病都是比较常见的。大女儿身体健康,为了缓解痛经,她正在服用避孕药。二女儿一直有偏头痛问题。10岁的儿子患有哮喘,偶尔会有运动损伤。

关键词：全科医生医生病人关系听力受损者

Difficult-to-Treat-Depression and GPs’ Role: Perceptions of Psychiatry Registrars

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Open Journal of Psychiatry 2014年第4期4卷 301-308页

作者： Kay M. Jones leon piterman Office of the Pro Vice-Chancellor Peninsula Campus Monash University Frankston Australia

Introduction: For patients, GPs are the most accessible medical resource in the community and are the gatekeepers to other community resources including psychiatrists. Qualifying as a psychiatrist in Australia involves completing a five-year training program that includes rotations in hospitals and community settings. The aims of this research were to 1) explore psychiatry registrars’ perceptions of difficult-to-treat-depression (DTTD) and 2) what they thought about the GPs’ role in this regard. Methods: A semi-structured interview schedule comprising six questions was used;10 psychiatry registrars (6 females, 4 males) participated in a one-and-half-hour focus group. All were in their final year of training and undertaking a training post in a public hospital in Melbourne, Australia. Data were analysed using the Framework Method. Findings: Similar to GPs and GP trainees, psychiatry registrars’ perceptions and understanding of DTTD varied. While acknowledging limited experience in diagnosis and management, issues important to them included the utility of labels such as DTTD;patients distressed because of another diagnosis, substance abuse and/or life problems, the importance of accurate histories and notes, cost and limited availability of services particularly in the private sector, prescribing regimens, referring to allied health professionals, and suggesting/prescribing non pharmacological and/or complementary treatment. Also what was of concern was communication, both between health professionals and between health professionals and patients. Consensus was that treating depression in general practice is one of the hardest things for GPs to manage but there was value in using mental health plans. Discussion and Conclusion: While this cohort was small in number with limited experience, this study is the first to contribute to the literature that provides some insight into psychiatry registrars’ experiences and perceptions of DTTD. Outcomes may have implications for

关键词： Depression GP Psychiatry

《The Medical Republic》案例分享--在预测严重疾病时,“第六感”能发挥作用吗？

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中国全科医学 2017年第13期20卷 1531-1533页

作者： leon piterman 黄文静杨辉 3168 Monash University MelbourneAustralia 罗湖医院集团黄贝岭社区健康服务中心广东省深圳市518003

日常生活中,我们经常会使用＂第六感＂这个词,一般情况下其指的是感知。很多人（可能不是所有的人）有时会产生一些特殊的想法或额外的感知,认为将会发生一些不好的事。有些事情可能是让人不愉快的,而＂第六感＂使我们有能力去避免这些... 详细信息

日常生活中,我们经常会使用＂第六感＂这个词,一般情况下其指的是感知。很多人（可能不是所有的人）有时会产生一些特殊的想法或额外的感知,认为将会发生一些不好的事。有些事情可能是让人不愉快的,而＂第六感＂使我们有能力去避免这些事情的发生。人体拥有5种以上的感觉,如嗅觉、味觉、视觉、听觉及触觉,这使我们能够感觉到疼痛、位置、温度及平衡,

关键词：全科医生危重病感觉

澳大利亚全科医生案例分享——家庭悲剧:为什么是他们? 为什么是现在?

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中国全科医学 2019年第4期22卷 387-389页

作者： leon piterman 黄文静杨辉 Monash University 罗湖医院集团黄贝岭社区健康服务中心广东省深圳市518003

澳大利亚的全科医生具有行业自律性,体现在其自行制定行业标准、自主进行资质考核及自主执业等方面,也体现在The Medical Republic这一共享平台上。leon piterman是医学学士,医学博士,教育学硕士,英国医生学会会员,澳大利亚全科医生学... 详细信息

澳大利亚的全科医生具有行业自律性,体现在其自行制定行业标准、自主进行资质考核及自主执业等方面,也体现在The Medical Republic这一共享平台上。leon piterman是医学学士,医学博士,教育学硕士,英国医生学会会员,澳大利亚全科医生学会会员,Monash University副校长、全科医学教授,从事全科医学临床服务近40年,研究兴趣为慢性病管理、心理健康、医学教育。piterman教授建议我国的全科医生应培养“共和”思想,以为全科医学领域提供更多的平等交流机会。目前piterman教授定期为The Medical Republic撰写文章,本刊深受“医学共和”思想的启发,特邀本刊主编Monash University的杨辉教授对piterman教授的文章进行编译,并进行连载刊登!家庭是在社区中提供卫生服务的基本单位,因此,全科医生在社区中提供卫生服务,最好的策略就是以家庭为单位。家庭有时也会“生病”,也需要特别的治疗,即家庭治疗。只有维护了家庭的健康,才能维护个人的健康。家庭问题不是哪个成员的问题,而是所有成员的问题;家庭治疗不是治疗个别的家庭成员,而是治疗家庭关系,把家庭看成是一个整体、一个系统,进行系统分析和干预。为了引起全科医生对家庭治疗的重视,本期piterman教授为我们讲述了一则关于交通事故致人伤亡后其他家庭成员出现了各种健康问题的接诊故事,敬请关注(后附原文)。

关键词：全科医生家庭治疗生物-心理-社会医学模式

Difficult-to-Treat-Depression and GPs’ Role: Perceptions of Psychologists

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Open Journal of Psychiatry 2015年第1期5卷 31-38页

作者： Kay M. Jones leon piterman Office of the Pro Vice-Chancellor Peninsula Campus Monash University Frankston Australia

Introduction: Since the Australian Government introduced the “Better Access to Mental Health Services” program in 2006, psychiatrists, psychologists and general practitioners (GPs) have become increasingly involved in service provision for people seeking help with mental health problems. The aim of this research was to a) explore psychologists’ perceptions of difficult to treat depression (DTTD) and b) explore what they thought about the GPs’ role in managing these patient given that most patients are referred to psychologist by GPs. Methods: A previously developed semi-structured interview schedule comprising six questions was used. Seven psychologists participated in a focus group held in Melbourne. Data were analysed using the framework method. Findings, including Discussion: While psychologists understood the term DTTD it was suggested that using different terms may limit understanding between health professionals. Rather than diagnosing, psychologists were more likely to conduct further assessment contextually to confirm GPs’ diagnosis. Communication with GPs was important, particularly when managing “long-term” and suicidal patients. Management included cognitive and behavioural interventions and referring to other mental health services, psychiatrists and/or other allied health professionals. Referral to psychiatrists could be difficult because of limited availability and for some patients, prohibitive costs. Although psychologists discussed non-pharmacological and/or complementary treatment options with patients, they were more likely to rely on GPs to discuss/prescribe these options. Conclusion: While generalisability may be limited, this study is the first to document some understanding of psychologists perceptions of DTTD and the importance of GPs and other health professionals’ role in managing this patient cohort.

关键词： GPs’ Role Difficult-to-Treat-Depression

Interprofessional Communication and Relationships in the Management of “Difficult to Treat” Depression: Perceptions of the Role of General Practitioners

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Open Journal of Psychiatry 2015年第3期5卷 260-266页

作者： Kay M. Jones leon piterman Office of the Pro Vice-Chancellor Peninsula Campus Monash University Frankston Australia

Background: Team based care is an essential ingredient of chronic disease management including chronic mental illness. Effective health care teams include members who have defined, yet intersecting roles, where mutual respect characterises professional interaction and the patient’s well-being is central. The aim was to explore the perception of psychologists, psychiatry registrars and psychiatrists with respect to GPs’ role in managing difficult-to-treat-depression (DTTD). Methods: A previously developed semi-structured interview schedule comprising six questions was used. Thirty-two health professionals participated. Data were analysed using the Framework method. Findings: Four main themes emerged: 1) The team approach was important, particularly to ensure information accuracy and/or when responding to patient needs and pressures;2) Referrals, usually generated by GPs can be a vehicle for other health professionals to provide advice to the GP;3) Availability and accessibility often depended on health professionals work location and knowing how to navigate the system;4) Limited availability of government funding impacts on patients’ accessibility to health professionals. Discussion: Interprofessional relationships were described as paramount. Appropriate and timely referrals are integral to patient management, regardless of challenges. Ongoing challenges include program funding, workforce numbers and costs to patients. Improvement to mental health care access was noted, even for patients among relatively disadvantaged groups and those receiving Medicare Benefits Schedule-subsidised services. Conclusion: Despite adequate GP/specialist communication, the delivery of optimal team based care to patients with difficult-to-treat depression is compromised by lack of access to specialised services and inadequate funding.

关键词： Depression Perceptions Psychiatry