Abstract
BackgroundStrong relations between medicine and public health have long been advocated. Today, professional medical practice assumes joint clinical/public health objectives:GPs are expected to practice community medicine;Hospital specialists can be involved in disease control and health service organisation;Doctors can teach, coach, evaluate, and coordinate care;Clinicians should interpret protocols with reference to clinical epidemiology.Public health physicians should tailor preventive medicine to individual health risks.This paper is targeted at those practitioners and academics responsible for their teams’ professionalism and the accessibility of care, where the authors argue in favour of the epistemological integration of clinical medicine and public health.Main textBased on empirical evidence the authors revisit the epistemological border of clinical and public health knowledge to support joint practice. From action-research and cognitive psychology, we derive clinical/public health knowledge categories that require different transmission and discovery techniques.The knowledge needed to support the universal human right to access professional care bridges both clinical and public health concepts, and summons professional ethics to validate medical decisions. To provide a rational framework for teaching and research, we propose the following categories:‘Know-how/practice techniques’, corresponding a.o. to behavioural, communication, and manual skills;‘Procedural knowledge’ to choose and apply procedures that meet explicit quality criteria;‘Practical knowledge’ to design new procedures and inform the design of established procedures in new contexts; andTheoretical knowledge teaches the reasoning and theory of knowledge and the laws of existence and functioning of reality to validate clinical and public health procedures.Even though medical interventions benefit from science, they are, in essence, professional: science cannot standardise eco-biopsychosocial decisions; doctor-patient negotiations; emotional intelligence; manual and behavioural skills; and resolution of ethical conflicts.ConclusionBecause the quality of care utilises the professionals’ skill-base but is also affected by their intangible motivations, health systems should individually tailor continuing medical education and treat collective knowledge management as a priority. Teamwork and coaching by those with more experience provide such opportunities. In the future, physicians and health professionals could jointly develop clinical/public health integrated knowledge. To this end, governments should make provision to finance non-clinical activities.
Highlights
Based on the professional experience, totalling 150 years, of three public health physicians and that of a general practitioner each of whom have combined practical and academic background, we justify the epistemological integration of clinical and public health medicine while discussing the necessity for social / professional ethics and the need for hybrid, clinical / public health decisions and action in medical practice
This paper is targeted at those practitioners and academics responsible for their teams’ professionalism and the accessibility of care, where the authors argue in favour of the epistemological integration of clinical medicine and public health
Writing for the practitioners and academics who feel themselves responsible for teamwork and professionalism in their services and for accessibility of care in the community, we argue for the effective epistemological integration of these two disciplines
Summary
Closer ties between clinical medicine and public health have been advocated more recently [1, 2] as well as in the past. Implementation research continued to focus on disease control programmes and biomedical interventions, unwittingly strengthening the rise of ‘inequality by disease’ This legacy would not hamper the advancement of health care if the division between collective and individual health sciences were found to be desirable. Clinicians concerns shouldn’t merely be quality of care and care accessibility; medical ethics; prevention and health promotion; and the management of population risks, diseases and health services. This is what all good clinicians do, bucking the trend for growing specialisation in the health sector. It is one illustration: Chinese acupuncturists or businessminded physicians will certainly have other views on individual/collective health practices and the relevant knowledge required
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