Need versus salvage: a healthcare professional's perspective.
Need versus salvage: a healthcare professional's perspective.
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需要与挽救：医疗保健专业人士的观点。
DOI：
10.1080/15265160802015081
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发表时间：
2008
期刊：
影响因子：
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通讯作者：
Rosen,AllysonC
中科院分区：
文献类型：
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作者：
Bien,GinaD;Kinoshita,LisaM;Rosen,AllysonC
Gross（2008）主张将关注需求的医疗保健与关注军事准备的医疗保健进行更清晰的区分，这带来了潜在的问题。限制士兵在战场上的医疗选择既不能保护基本上被俘虏的人口，也会破坏医务人员的士气和道德标准。对于那些不会重返战场的重伤者，这些士兵将过渡到退伍军人服务，其方式是提供适当的程序来评估他们是否适合履行职责，并人道地过渡到专门的医疗保健。在美国，退伍军人医疗保健系统为服务相关伤害提供专门护理，并利用与现役人员分开的资源。Gross（2008）声称，由于军事医学的目标是让士兵重返岗位，因此不能服役的严重受伤士兵不应该获得普通公民以外的特殊医疗服务。在武装冲突期间，其目标是通过“抢救”或提供医疗护理，以尽可能多的士兵在治疗后返回战斗，从而节省人力和支持军事准备。在军事医学的背景下照顾重伤病人转移了提供者的主要目标是抢救。他进一步声称，承认：这份手稿的写作得到了VA Special MIRECC学术联盟办公室的部分支持。（精神疾病研究，教育和临床中心）高级精神病学和心理学奖学金计划，退伍军人事务部，退伍军人事务部的优异评审补助金（批准号：YES 0048825）、VA Palo Alto Health Care System、Sierra-Pecific MIRECC和国家老龄化研究所（批准号：KO 1AG 025157）。本文中表达的观点是作者的观点，并不一定代表美国退伍军人事务部的观点。联系人：Gina D Bien，Sierra-Pacific MIRECC，VA Palo Alto Health Care System，3801米兰达大街（151 Y），帕洛阿尔托，CA 94304。电子邮件：gbien@斯坦福大学。edu还是gina。很好。政府对这些士兵的特殊照顾超过了对平民的照顾，这是一种不公平的特权，因为他们作为需要帮助的病人的地位是指导他们获得服务的因素。因此，格罗斯建议军医治疗严重受伤的士兵，提供最低限度的姑息治疗，并将他们作为病人转移到国家医疗保健系统中，与其他平民平等地竞争基本的医疗援助水平的护理，所有病人都根据需要接受治疗。然而，我们主张，军医不能只关注残值，既要保持军队士气，又要保持职业操守。此外，为重伤士兵提供单独的医疗保健并不是一种不公平的特权。对严重受伤的退伍军人的专门治疗提高了他们的护理质量，是许多其他医疗保健服务部门的一个特点。最后，在雇主提供医疗保健的社会中，有义务确保士兵也得到与其他专业工作人员同等的工伤和疾病治疗。这并不一定需要在国有化的医疗保健系统的主持下发生。要求医疗专业人员坚持严格的救助模式，降低他们提供基于需求的护理的能力，可能会危及他们的士气。毛额（2008年）表明
Gross (2008) advocates a sharper distinction between healthcare that focuses on needs versus military readiness, and this introduces potential problems. Restricting soldiers’ healthcare options on the battlefield both fails to protect an essentially captive population and undermines the morale and ethical standards of medical personnel. For the seriously wounded who will not return to battle, these soldiers are transitioned to veterans’ services in a manner that provides due process for assessing their fitness for duty and a humane transfer to specialized healthcare. In the United States, the veterans healthcare system provides specialized care for service-related injuries and draws on resources separate from those involved in active duty. Gross (2008) claims that because the goal of military medicine is returning soldiers to duty, seriously injured soldiers who cannot serve should not receive special access to healthcare beyond that of an ordinary citizen. During armed conflict, the objective is to conserve manpower and support military readiness by “salvaging” or providing medical care with the goal of returning as many soldiers as possible to combat after treatment. Caring for seriously wounded patients in the context of military medicine diverts providers from their primary goal of salvage. He further claims thatAcknowledgment: Writing of this manuscript was supported in part by the Office of Academic Affiliations, VA Special MIRECC (Mental Illness Research, Education, and Clinical Center) Fellowship Program in Advanced Psychiatry and Psychology, Department of Veteran Affairs, Merit Review Grant of Department of Veterans Affairs (Grant# YES0048825), VA Palo Alto Health Care System, Sierra-Pecific MIRECC, and National Institute on Aging (Grant# KO1AG025157). The views expressed in this article are those of the authors and do not necessarily represent the views of the US Department of Veterans Affairs. Address correspondence to Gina D. Bien, Sierra-Pacific MIRECC, VA Palo Alto Health Care System, 3801 Miranda Ave (151Y), Palo Alto, CA 94304. E-mail: gbien@ stanford. edu or gina. bien@ va. gov providing special care to these soldiers over civilians is an unfair privilege since their status as patients in need is what guides their access to services. Thus, Gross recommends that military physicians treat seriously wounded soldiers by providing minimal palliative care and transferring them as patients to compete equally with other civilians for basic Medicaid-level care in a national healthcare system in which all patients are treated based on need. However, we claim that military physicians cannot focus exclusively on salvage value and maintain both military morale and the integrity of their profession. Furthermore, providing separate health care to seriously wounded soldiers is not an unfair privilege. Specialized treatment for seriously injured veterans improves their quality of care and is a feature of many other branches of healthcare delivery. Finally, in societies where employers provide health care there is an obligation to ensure that soldiers also receive treatment for work-related injuries and illness commensurate with that of other working professionals. This does not necessarily need to occur under the auspices of a nationalized healthcare system. Asking medical professionals to adhere to a strict salvage model by reducing their ability to provide need-based care likely jeopardizes their morale. Gross (2008) indicates