目的 了解家庭医生的日常工作情况.方法 选取上海市6家社区卫生服务中心的12名家庭医生作为研究对象.采用现场观察的定性研究方法,观察家庭医生的门诊及上门服务(家访)情况.结果 共现场观察门诊服务的家庭医生7名,门诊患者90余人次,平均每人次门诊时间约5 min；家访的家庭医生5名,上门服务12户,平均每户家访时间约30 min.家庭医生所在社区的特点,街道、居委及其他社会组织的支持,不同家庭医生团队之间的合作,不同层次医疗服务的整合与协同以及相关政府部门配套政策的支撑,是家庭医生开展工作的社会支持网络.家庭医生的业务水平,居民与家庭医生的熟悉程度,家庭医生的沟通能力,患者的就医观念以及社区卫生服务机构的就诊环境,是居民对家庭医生信任度、满意度的影响因素.工作任务与待遇水平,社区卫生服务中心的管理情况、家庭医生对自身职业的认知以及服务对象的态度,是家庭医生工作态度与积极性的影响因素.结果 家庭医生制的实施应以社区为载体,整合社会多方面资源,从改善医患关系、培育社区社会资本、加快社区建设发展的角度来推进.%Objective To learn the conditions of family doctor in routine work. Methods Twelve family doctors form six community health service centers in Shanghai were chosen as the subjects. The qualitative research methods by using on - site observation was taken to investigate the conditions of family doctor in clinic and household services (home visits) . Results The outpatient services of seven family doctors were observed on the spot, including more than 90 patients, with an average time of service per capita being 5 min. The home services of five family doctors were observed, including 12 households, with an average time of service per capita being 30 min. The social support network for family doctors to carry out their work consisted of the characteristics of the community where family doctors work, supports from the communities, residents and other social organizations, cooperation between the different teams of family doctors, integration and synergy among different levels of health care services, and supporting policies support by the related government departments. The factors impacting the levels of the residents in trust and satisfaction were the family doctor's skills in medical services, familiarity of the residents with their family doctors, family doctor's ability to communicate, patients' concepts of medical care, and medical environments in community health center. The factors influencing family doctors' working attitude and activity were working tasks and income levels, management of community health center, and recognition on their own career and attitude to their service objects. Conclusion Family doctor system should take the community as its carrier, integrate social multifaceted resources, and advance in the lights of improving the doctor - patient relationship, nurturing community social capital and accelerating development of community building.
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