一點感想

昨天看到一篇文章，說中國醫生其實絕大部分比美國醫生優秀，為什麽呢，因為人口眾多，經驗豐富阿，中國醫生看的病人，美國醫生一輩子都看不到。我記得自己在國內看門診，一個早上，40，50個，後麵還有護士不停地催，我頭也不抬起來，洗手間也沒時間上，這樣的“經驗”，我也不知道學到了多少東西，嗬嗬。

我以為，大牛到處都有，前兩天還看一個影片講非洲的政府醫生，我看著也覺得不錯呢。問題不是技術，是精神和觀念，我們不得不承認，現在中國年輕的醫生出來，能夠有前輩們那種精神的人很少了，現實的環境，價值觀的變化，都有關係。

醫者仁心，我覺得，醫學就和藝術一樣，到了最後，就不是技術論高下了，而是有沒有那顆心。

在美國複習考試，我印象很深刻的，就是醫學倫理學，我從頭自學一遍，怎麽和病人交流，怎麽維護病人的權利同時保護自己，怎麽避免糾紛，怎麽樣理解終末期病人和家屬的痛苦，甚至怎麽對待無理取鬧的病人，這些在我們的書裏找得到嗎？我們的醫學倫理學是選修課，從大學到住院，也從來沒有什麽課程或者講座，幫助年輕醫生們在醫患關係上得體處理。

這種教育，使得我們所有對病人，對醫學的態度，都是在自己的摸索中，靠著自己一點微弱的品格力量支撐著，社會上，法律上，甚至醫學界本身，都沒有足夠的支持，這對於病人，對於醫生本身，都是一種悲劇。

[stockfox]

Luohua v.s. Bolb, Round 1 精彩!

不知落花可否給封個"落花BLOG"特約評論員之類的TITLE,有了位置才有底氣作了中場總結及賽況分析與預測.

[bolb]

I agree patients shouldn't be foreced to choose between knowledge and attitude. But the reality is that they often have to choose either knowledge or attitude.

I didn't say "once we solve the resource shortage, our system will be rescued." My point was: from the whole society/system point of view, we have to correct the medical system before we can really restore/cultivate the professionism in the medical industry.

I didn't say we should "neglect the teaching because we think it will not help." I just feel we have to give the schools incentives to teach ethics and the students incentives to learn ethics. When ethics don't really matter in the current medical system, very few doctors and doctors-to-be would care about it.

[bolb]

落花，我剛寫了洋洋灑灑三大段，安然把我好好地訓了一頓。說我在這裏跟你胡攪蠻纏，拚命抬杠。要求我換寫風花雪月，吃喝玩樂。我這真是委屈啊。我哪敢跟你抬杠啊。你是專業人士，我一不給人看病也不找醫生給我看病，就是一個站著說話不腰疼的。本來也就是錦上添花地寫幾段給你解悶，哪敢企圖說服你啊。但安然威脅我說萬一以後有個我三長兩短說不定還要找你谘詢，你要是心狠一點我就得等到製度完善後才能醫得好病了。我嚇得趕緊就把那三段刪掉。

[女孩安然]

好來好來，大家不要寫論文來，我眼睛都花掉了，昏過去，你們怎麽這麽強拉，還列出1，2的，等下我要寫論文就到這裏來拉幾句。

[bolb]

Hi Luohua, I am not disputing all the observation you had. But my questions are why and how it happened? How should we fix it? The reason that doctors are trained without much professionism is that professionism is not required in the current medical system. Sure, medical students in China are hard to find a job 'cause all the hospitals don't have many open positions. But do we have enough hospitals? No, we don't. Do we have enough experienced doctors? No, we don't. The whole medical system is in malfunction. Why would a medical student need to care about professionism? The spots are limited, so you have to get them either by (your family's) networking or by good academic scores. Why would an experienced doctor need to care about professionism? There are only so few good hospitals and so few good doctors.

As a patient, if I have a choice, of course you would like to go to a knowledgeable, experienced and caring doctor. But what if I have to choose between a knowledgeable but less caring and a caring but less knowledgeable doctor? The resources are limited. All the good doctors are fully booked. I would go to a knowledgeable but less caring doctor. Two things can make things better. 1) produce more good doctors. but it often takes time. 2) make better use of resouces, such as improving the primary care system as you suggested.

So here is our difference. You think the root cause is the medical education system doesn't teach professionism. But I believe the root cause is even higher up. Even if medical schools teach professionism, it won't be very good and effective anyway. The whole medical system has problems. It's just like we all learned about Marx Lenning at school, but do we really give it a damn? We don't really need Marx Lenning to find a good job.

[落花飄零]

hehe, bolb,it is really hard to change somebody's opinion by several words, that's why i usually don't argue with people too much.

but as it comes to medical career in china, where i spent several years practiced, i would like to talk a little bit more. it is just about this topic, nothing personal, we are still friends.:)

i have worked in several wards which were not busy at all, but the attitude of doctors are exactly the same as those of working in busy wards. the point is, this is how we were educated, this is what medical students learned from residents, and residents learned from attendings, it is nothing to do with whether we are short of hand or not, it is how we develop the perspective of medical practice. with this education which largely neglects medical ethics, even if enough doctors are trained, most of them are just well knowledged but less caring people.

as a matter of fact, medical students in china nowadays are struggling to find a job, because the amount of medical students are rapidly increasing while most hospitals' spots are comparatively fixed.

the thing we urgently need to improve now in china, is not the quantity of physician, but the quality.

the other thing we should push, is the primary care system. when i was working in the university hospital, people came for common cold, medicine refill, this wastes lots of physician resource which can be easily solved by primary physician.

tanyway, hank you for discussing this topic with me.:)

[bolb]

But why don't doctors have good ethics and why aren't they more caring to the patients? Because they are in demand. It's still a market economy problem. We don't have enough good doctors, so they don't feel the need to provide good service.

[bolb]

落花, I was talking about damaof's comment.
Also, you can find really good doctors in Africa, in China, in India. But an average doctor that ordinary people can access in those places is still pretty bad. It's still a technology issue. When you don't have the technology, it really doesn't help much now matter how good-hearted you are. Sometimes too much heart can even cause more harm. The current problem in developing countries (and even in the US to some extent) is we don't have enough number of good doctors.

[bolb]

You have to look at from the doctor's perspective as well. What you need is good doctors. But good doctors usually have plenty of patients. If somebody has no chance to be cured, doctors tend to spend more time in other patients who would have more chances to recover. This is competition for limited resource. Doctors and hospitals are limited resources. It's so sad but true. If I am sick and have no chance to recover, I would rather commit suicide. But again, sometimes we also need determination to overcome disease. Hard to way.

[damaof]

我 爸 爸 病 重 的 時 候 ， 小 醫 生 們 都 不 大 願 意 治 療 了 。 老 醫 生 們 認 為 如 果 積 極 治 療 ， 還 可 以 拖 半 年 。
我 至 今 都 忘 不 了 ， 他 臨 終 的 時 候 ， 呼 吸 困 難 ， 是 我 在 床 前 替 他 拿 著 的 氧 氣 麵 罩， 可 是 他 確 越 來 越呼 吸 困 難 。 我 不 是 譴 責 醫 生 怎 麽 沒 有 道 德 ， 隻 是 想 ， 多 活 一 天 對 於 活 著 的 人 就 多 了 一 份 想 念 啊 。
阿 拉 以 後 發 大 財了 ， 要 在 阿 拉 大 學 裏 用 我 爸 的 名 字 蓋 個 大 樓 ， 讓 他 慈 祥 的 注 視 著 他 沒 有 見 到 過 的 他 女 兒 學 習 戰 鬥 過 的 地 方 。

[落花飄零]

吹風姐姐！！好久不見，好嗎？

[WindBlows]

說的好，支持。