Từ năm 1946, Tổ chức Sức khỏe Thế giới (WHO) đã định nghĩa: Sức khỏe là một tình trạng hoàn toàn sảng khoái (well-being; bien-être) về thể chất, tâm thần và xã hội, chớ không phải chỉ là không có bệnh hay tật. Một định nghĩa như thế cho thấy đánh giá sức khỏe của một con người không thể chỉ dựa vào chuyện có hay không có bệnh tật; tương tự, không thể đánh giá sức khỏe của một cộng đồng mà chỉ dựa vào tỷ lệ bệnh tật, tỷ lệ tử vong, số giường bệnh, số bác sĩ... Cái khó ở đây là làm cách nào đánh giá được “tình trạng sảng khoái” về cả ba mặt: thể chất, tâm thần và xã hội - như định nghĩa đã nêu? Đánh giá sự sảng khoái, sự hài lòng cũng chính là đánh giá hạnh phúc. Mà đánh giá hạnh phúc là chuyện không đơn giản chút nào vì nó nặng tính chủ quan, dễ lệch lạc. Chính vì thế mà mãi nửa thế kỷ sau, WHO mới đưa ra được một bảng “Đánh giá chất lượng cuộc sống” (Quality of Life Assessement) liên quan đến sức khỏe và chăm sóc sức khỏe để cụ thể hóa định nghĩa đã nêu trên. Theo đó, người thầy thuốc chỉ quan tâm chữa trị bệnh tật là chưa đủ, mà phải quan tâm đến chất lượng cuộc sống của người bệnh. Nói khác đi, người bệnh sống không phải chỉ là sống sót, tồn tại, mà phải là sống có ý nghĩa, có hạnh phúc ở một mức độ tốt nhất có thể được.

WHO đề ra một bảng chỉ số gọi là WHOQOL-100 (WHO quality of life,100 đề mục) có thể triển khai thực hiện trên nhiều nước khác nhau, nhiều nền văn hóa khác nhau, bao gồm 6 lãnh vực: 1. Sức khỏe thể chất; 2. Tâm lý; 3. Mức độ độc lập; 4. Các mối quan hệ xã hội; 5. Môi trường và 6. Niềm tin, tôn giáo, vấn

đề tâm linh. Các chỉ số đo đạc này sẽ rất hữu ích cho việc cải thiện chất lượng phục vụ của ngành y trong việc chăm sóc sức khỏe người dân nói chung cũng như trong nghiên cứu khoa học, giám sát và cả trong hoạch định chính sách.

Theo WHO, Chất lượng cuộc sống là những cảm nhận của các cá nhân về cuộc sống của họ trong bối cảnh văn hóa và các hệ thống giá trị mà họ đang sống và liên quan đến các mục đích, nguyện vọng, tiêu chuẩn và các mối quan tâm của họ.

Điều dễ thấy ở đây là cách đo đạc Chất lượng cuộc sống đặt trọng tâm lên cảm nhận cá nhân của từng người, cho thấy có cái nhìn khác xưa đối với bệnh tật và sức khỏe lâu nay chủ yếu dựa vào “cảm nhận” của thầy thuốc! Do vậy, đánh giá bệnh tật sẽ không chỉ dựa trên kết quả các xét nghiệm máy móc mà còn trên những cảm nhận chủ quan, quan điểm riêng của từng cá nhân về bệnh tật của họ, về sự sảng khoái của họ trong cuộc sống thường ngày, trong bối cảnh văn hóa và môi trường thiên nhiên quen thuộc. Ở đây cho thấy vai trò của giáo dục sức khỏe, của truyền thông hiệu quả trong mối quan hệ giữa thầy thuốc và bệnh nhân. Mối quan hệ thầy thuốc - bệnh nhân không tốt thì người bệnh khó có thể duy trì chất lượng cuộc sống!

Suy nghĩ từ góc độ quan tâm đánh giá chất lượng cuộc sống của người bệnh như vậy sẽ làm thay đổi cái nhìn của người thầy thuốc về bệnh nhân trong quá trình điều trị. Cả người bệnh - khi hiểu rõ chất lượng cuộc sống là do mình quyết định – cũng sẽ không chỉ biết lệ thuộc vào thầy, vào thuốc, vào xét nghiệm mà còn biết tự tăng cường sức khỏe, nâng cao sức khỏe, nhờ vậy mà phấn

đấu, rèn luyện, hợp tác tốt với thầy thuốc. Dịch vụ y tế cũng phải thay đổi, xem có đáp ứng nhu cầu nâng cao chất lượng cuộc sống của người bệnh chưa, người bệnh có hài lòng về chất lượng phục vụ không và hệ thống tổ chức y tế có dễ tiếp cận, có luôn trong tình trạng sẵn sàng phục vụ bệnh nhân không?

“Hạnh phúc” hóa ra không còn là khái niệm chung chung nữa mà nay đã có thể đo đạc được!

(Từ Quang 34, tháng 10.2020)



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