Bespoke practice.
Bespoke practice.
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定制练习。
DOI：
10.1016/s0140-6736(16)32603-4
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
Kneebone RL
中科院分区：
文献类型：
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作者：
Kneebone RL
约书亚的客户愿意接受不确定性是基于他们相信他有必要的知识和技能，他是值得信赖的。从某种意义上说，诉讼本身是职业关系的附带产物，而职业关系远不止是商业交易。每件衣服都是裁缝和顾客之间的人际关系的表达，也是一个合作和创造性的过程，而不是强加或规定的。不仅仅是西装通过渐进式的合身来进化。作为一名医生，我觉得这很有意义。临床实践从来不是茶壶工厂，但总是包含不确定性。我开始认为，照顾病人有很强的定制元素，特别是对于那些患有长期慢性疾病的人，如哮喘或糖尿病，治疗时间长达多年。例如，作为一名全科医生，我会从一个详细的病史开始，试图建立一个病人和他们生活的图景。我会和他们一起工作，把他们的症状和病情的影响与我对治疗和疾病的规范知识结合起来。我们一起制定一个计划。我们通过多次咨询逐步完善治疗，类似于一系列定制配件。和约书亚一样，我们的基础是建立在信任和诚信基础上的专业护理关系，随着每个病人的成长和年龄的增长，这种关系需要不断调整。对于约书亚来说，这些包括对风格和设计的深入了解，他的工艺美学;管理人类互动的专业知识;杰出的工艺;掌握布料的材料性和使用它的技术;以及平衡个人客户与其他客户需求的能力，并运行一个系统（他的业务），以确保他的生计。作为一名临床医生，我也认识到了这些因素。医学知识是理所当然的临床医生必须掌握大量的信息。管理人际互动的专业知识是临床医生在任何实践领域的标志。无论他们的专业是什么，倾听、观察和回应每个病人的能力是关键。精细运动技能也是必不可少的，特别是在外科或介入放射学等工艺专业。所有临床医生都在一个充满冲突需求的系统中执业，在这个系统中，个人的需求在医疗保健系统的限制范围内得到平衡，每个病人的期望和对系统的体验都必须得到考虑。
The willingness of Joshua’s customers to accept uncertainty is based on their confidence that he has the necessary knowledge and skill and that he is trustworthy. The suit itself is in a sense incidental to a professional relationship that is much more than a commercial transaction. Each garment is an expression of a human connection between tailor and customer and of a process that is collaborative and creative rather than imposed or prescribed. It is not just the suit that evolves through progressive fittings. The relationship evolves with it. To me as a doctor, this makes a lot of sense. Clinical practice is never a teapot factory but always contains uncertainty. I began to think that looking after patients has strong elements of bespoke, especially for those who have long-term chronic conditions such as asthma or diabetes with treatment extending over many years. As a general practitioner seeing a new patient, for example, I would start with a detailed history, trying to build a picture of my patient and their life. I would work with them to align their symptoms and the impact of their condition with my canonical knowledge of treatment and disease. Together we would develop a plan. Our progressive refinement of treatment through multiple consultations resembles a series of bespoke fittings. As with Joshua, the bedrock is a professional relationship of care based on trust and integrity, requiring continual adjustment as each patient develops and ages.This relationship contains many elements. For Joshua, these include a deep knowledge of style and design, of the aesthetics of his craft; expertise in managing human interaction; outstanding craftsmanship; mastery of the materiality of cloth and the techniques of working with it; and the ability to balance the needs of an individual customer with those of other customers and to run a system (his business) which assures his livelihood. As a clinician, I recognised these elements too. Knowledge in medicine is taken for granted—clinicians must master huge amounts of information. Expertise in managing human interaction is a hallmark of clinicians in any area of practice. Whatever their specialty, the ability to listen, observe, and respond to each patient as an individual is key. Fine motor skills are essential too, especially in the craft specialties such as surgery or interventional radiology. And all clinicians practise within a system shot through with conflicting demands, where the needs of the individual have be balanced within the constraints of a health-care system and where each patient’s expectations and experience of the system must be taken into account.