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日前我的一位病人預約好了在醫院手術,她提前兩小時到了,我按約定時間準時到達.走進術前準備室,麻醉師正在和病人談話,見到我,麻醉師馬上說:你的病人有一顆鬆動的牙齒,麻醉插管的時侯可能會碰掉它.邊上的病人趕緊插話:沒關係,我早就想拔掉這顆牙了,隻不過沒時間去看牙醫.,掉了正好.麻醉師說:那不行,如果你把牙吞到肚裏誰負責?如果你把它吸進肺裏那就是事故了!哎,沒辦法,我隻好叫來牙醫,牙醫倒還爽快,要病人到樓下牙科門診去幫她拔牙,我還來不及高興,一旁的護士說:病人現在是住院病人,不可以去看門診,得先辦出院,到門診去掛號拔牙,然後再辦入院做手術!天哪,這一進一出再加拔牙,至少兩三小時出去了,還是下次吧!我隻好把手術取消了,並在心裏告誡自己—下次安排手術之前,一定要先檢查病人的牙….
另一日我去醫院接生,剛進產房護士就告訴我,產婦的丈夫在陪伴產程中被什麽東西咬了,我一看,不過是幾個蚊蟲叮咬的疙瘩再加上撓抓和一點過敏反應,我正想給藥房打電話問他們能不能給一支抗過敏的藥膏,沒想護士長開口了:” 這事發生在醫院,得按規章製度行事!”我問什麽是規章製度?答:”他得到急診室去接受診治,我得寫事故報告.”我差點脫口而出:”Are you kidding me?” 但看她一臉嚴肅的樣子,話到嘴邊又吞下去了.我轉身對一臉茫然的father-to-be 說他得去急診室,他大笑:我老婆在生孩子,我卻為了蚊子咬去看急診,拉倒吧!我告訴護士長他不想去,護士長依然一本正經地說:我還是得寫事故報告,並讓他簽字說明他不願去急診室就診!我不禁在心裏大叫:Oh my God! Give me a break!
Take care my dear
我覺的從小題大作做起，才能使製度”使然“。一是一，二是二，局部低效率，整體高效率。要是中國人民也這麽“板眼”，就不會有那麽多亂哄哄的事兒，(全民全時間)拉關係走後門，官員/專家仗權/術受賄腐敗墮落了。
軍隊幹的是要命的勾當，所以才有那麽多無聊枯燥嗎用沒有的沒完沒了的操，練，洗，擦。我認為它的主要目的之一就是要通過這些誇張的，強化的，重複的訓練，使製度(不惜生命堅決服從命令)變成任何背景的士兵的本能之一。這樣真要用時才能“使然”。
行醫也是人命關天的勾當啊。
A while ago, I got a call for consult. A pt swallowed a filling material when the dentist was trying to fill his tooth. The AP CXR showed the material in the middle of chest. So the dentist called ENT, GI and Surgery for consult. When I reviewed CXR, I ordered a lateral CXR which showed the filling material in the esophagus, not in the bronchus, so I recommended GI evaluation, and asked remove ENT consult.When GI physician sew the pt, the material was in stomack. Finally GI did EGD to removed the material.
In fact, if they ordered a 2 view CXR,just need to call GI, no need to call ENT or surgery.
Also who cares about a small material in the stomach? It will pass through the GI and go to ground next morning.
Lots of health care personnel just do not want to be sued, they 小題大作, just want to protect themselves.