从突发公共卫生事件的应对看全科医学科的职责和定位

全科医生是居民的健康守门人，在突发公共卫生事件和重大传染病防控中承担重要责任。自新型冠状病毒肺炎疫情蔓延以来，全国上下开展了一场史无前例的疫情阻击战，基层医疗卫生机构医务人员全部出动，在疫情防控中发挥了积极作用。但是，此次疫情也暴露了全科医学服务的部分缺陷，如全科医生数量不足；全科医生服务能力，尤其是公共卫生服务能力不足；分级诊疗不畅通，上下联通的长效协作机制尚不健全；部分人群的健康管理、社区健康照顾、社区健康宣教、社区心理干预开展不充分，全科医生的居民健康守门人的作用未充分发挥。基于上述情况，建议健全全科医学服务制度，加强具有岗位胜任力的全科医生培养，构建预防和治疗协同发展的全科医学团队服务，加强综合医院与基层医疗卫生机构的紧密医联体建设，实现基层首诊，畅通双向转诊，加强社区健康宣教、社区心理干预、社区健康管理，通过提供多样化的全科医学服务形式，不断提升基层医疗卫生机构的综合服务能力，深化全科医学服务内涵，促进全科医学事业规范化发展。合格的全科医师不仅是一名执业医师，同时也应是一名公共卫生医师，只有这样，才能真正实现基本医疗服务与基本公共卫生服务高效协同的运作。 

The responsibility and orientation of general practice from the response to public health emergencies

General practitioners (GPs) are the health gatekeepers of residents and play an important role in the prevention and control of public health emergencies and major infectious diseases. Since the spread of the COVID-19 epidemic, the whole country has launched an unprecedented epidemic prevention and control campaign top the epidemic. All medical staff of primary medical institutions had been mobilized and played an active role in the epidemic prevention and control. However, the epidemic has also exposed some shortcomings of general practice services, such as shortage of GPs; inadequate GPs' service capacity, especially the public health service capability; the blocked tiered medical services, and imperfect long-term cooperation mechanism between hospitals and primary medical institutions; insufficient community health management, community health care, community health education and community psychological intervention; GPs have not really played the role of residents' health gatekeeper. So the system of general medical service should be established and perfected. More GPs with competency should be trained. Prevention and treatment coordinated development should be built up. Health Alliance between general hospitals and primary medical institutions should be strengthened. First contact at grass-roots level and free two-way referral should be realized. Community health education, community psychological intervention and community health management should be improved. By providing diversified forms of general practice service, we can continuously improve the comprehensive service ability of primary medical institutions, deepen the connotation of general practice service, and promote the standardized development of general practice. Qualified GPs are not only medical practitioners, but also public health physicians, which can help to realize the efficient and coordinated operation between basic medical and basic public health services.