On a recent trip to China, we learned that the barefoot-doctor concept is out of date; China has learned that there is a need for upgrading the primary healthcare provider. To what level should the primary healthcare provider be raised?
No doubt there are both differences and similarities between developing and developed countries. Certainly the move in China to upgrade the barefoot doctor, in terms of both education and experience, is to be noted.
In our own country, what we need is more effective utilization of the knowledge base that already exists among healthcare professionals. Nursing education in the US and in many other countries has improved the educational base. One result is that now most nurses find themselves functioning below their maximum capability, due to an inherent restraint within the healthcare system itself. Some adjustments need to take place in order to adequately "exploit" the knowledge base of the nurse.
What is the place of the physician? In Taiwan there is a greater output of physicians than nurses. I believe firmly that physicians are a national resource and need to be utilized properly and fully At present, the estimated ratio of one physician to six professional nurses exists in Taiwan. Why not consider a ratio of one physician to ten professional nurses with nurses functioning at their maximum level of competence?
One model that has been developed to fully maximize nurses' professional competence is the block-nurse system, a program developed to serve the elderly in my own community in 1981 and 1982. In this model, the professional nurse is the entry point into the system and maintains an involvement throughout the necessary referrals, including referrals to the physician. The nurse remains not only the care manager, but also the client's own nurse. It has been exciting to see the model being replicated in Portland, Oregon, and to know it is seriously being considered by the Japanese Nurses' Association.
After three year's experience with the block-nurse program in St Anthony Park, St Paul, Minnesota, I challenge nurses to organize their own local community to work collaborative Iy with visiting nurses, public health nurses, physicians, pharmacists, social workers, and the community organizations already in place. The professional nurse is the primary healthcare provider that I want for myself and my family At the same time, the expertise of the physician needs to be properly utilized. To expect the physician to take the time to explain in detail how to take medication, how to exercise properly and how to maintain the daily routine, when these areas should be the work of nurses, is wasteful of the physician's specialized training. The nurses' educational system has prepared nurses to be effective teachers and, I believe, effective primary healthcare providers, to be the new "gatekeepers."