華陀再世
一個中國醫學生(CMG)在美國的生活。。。
正文
體製改變是8月18到21日深圳舉行的世界癌症大會的主題，也是中國衛生部長陳竺在描述目前的中國醫療改革時傳達的中心信息。在此次大會上主導關於討論體製改變架構和行動的是許多中國之外的國際衛生政策製定專家和醫生，而中國國內醫生則很少參與其中。
要了解為什麽眾多負擔臨床一線工作的中國醫生在體製改革會議中鮮有代表，你首先明白對大多中國醫生來說個人安全才是他們的重點關注的。
中國醫生常常深受惡性暴力襲擊。
今年6月，山東省一位醫生和護士被一名13年前肝癌死亡病人兒子刺成重傷，而在福建省一位兒科大夫為了躲避自己收治後病故的新生兒憤怒的家屬從5樓跳下受傷。那麽就不會奇怪為什麽7月份沈陽市27家醫院邀請派出所領導擔任副院長了。一旦醫院變成暴力戰場，在中國做醫生就變成了一份危險的工作。
問題很大程度源於一種看法，大許多中國病人相信醫生和醫院總是陰謀通過不必要的檢查治療來增加收費賺錢。此外一些中國醫生違反規定收受紅包（為了得到關照而付的禮金）。許多病人把衛生係統的***歸咎於醫生，譴責他們沒有醫德和技術。
中國古代知識分子的理想是“不為良相則為良醫”，而在中國當代醫生護士曾經被譽為“白衣天使”，怎麽中國醫生形象如此江河日下呢？中國媒體當然在挑動緊急的醫患關係中起了重要作用。在報紙，電視和互聯網上都是一邊倒的關於醫務人員如何欺騙患者的報道。就在幾周之前南方都市報（廣東最受歡迎的報紙）還錯誤譴責一位為產後出現痔瘡的產婦治療的助產士，說她蓄意將病人的肛門縫合。而在2009年11月中國最大的官方媒體，CCAV報導著名的北京大學第一醫院允許醫學生參與診療非法行醫導致一名患者死亡。
盡管院方和衛生部申明相關的醫學生在有資質的執業醫生指導下參與臨床操作包括手術是合法的，民眾對醫院和醫生的信任卻受到巨大傷害。很難判斷南方都市報和CCAV的不實報道是因為缺乏醫學知識還是為了要製造煽情的故事。但是公眾對醫療職業的誤解肯定最終會受到傷害的是醫生和患者雙方。
大多中國醫院特別是像北京協和醫院和複旦華山醫院這樣的大規模醫院都是政府開設的。1985年之前中國的公立醫院是享受完全政府撥款的，在改革開放之後現在政府對醫院的經濟支持非常有限，導致醫院必須創收來應付支出。由於醫院收入主要來源於診療措施，就存在過度檢查和治療的利益驅使。為了減少不當的利益衝突，中國政府通過法令來阻止醫院收受藥商回扣。因為中國醫生的正式薪水即使按照中國收入標準也是不多的，許多醫生在經濟繁榮的中國不得不糾結於如何兼顧醫德和養家糊口的兩難。這樣的壓力加上感覺被政府和社會低估勞動價值，使得許多醫生離職下海。
中國的衛生改革如果不改善醫生的社會經濟地位就不會成功，而中國醫生應呼籲關注自身處境和建言獻策來更多改進醫療政策。
System change, the theme of the World Cancer Congress in Shenzhen, China, Aug 18—21, was a central message in the opening address by the Chinese Minister of Health, Chen Zhu, as he described current health-care system reforms in China. At the Congress many international health policy makers and physicians led discussions on frameworks and actions for system change, but there was little participation from local Chinese doctors.
要了解為什麽眾多負擔臨床一線工作的中國醫生在體製改革會議中鮮有代表，你首先明白對大多中國醫生來說個人安全才是他們的重點關注的。
中國醫生常常深受惡性暴力襲擊。
今年6月，山東省一位醫生和護士被一名13年前肝癌死亡病人兒子刺成重傷，而在福建省一位兒科大夫為了躲避自己收治後病故的新生兒憤怒的家屬從5樓跳下受傷。那麽就不會奇怪為什麽7月份沈陽市27家醫院邀請派出所領導擔任副院長了。一旦醫院變成暴力戰場，在中國做醫生就變成了一份危險的工作。
問題很大程度源於一種看法，大許多中國病人相信醫生和醫院總是陰謀通過不必要的檢查治療來增加收費賺錢。此外一些中國醫生違反規定收受紅包（為了得到關照而付的禮金）。許多病人把衛生係統的***歸咎於醫生，譴責他們沒有醫德和技術。
中國古代知識分子的理想是“不為良相則為良醫”，而在中國當代醫生護士曾經被譽為“白衣天使”，怎麽中國醫生形象如此江河日下呢？中國媒體當然在挑動緊急的醫患關係中起了重要作用。在報紙，電視和互聯網上都是一邊倒的關於醫務人員如何欺騙患者的報道。就在幾周之前南方都市報（廣東最受歡迎的報紙）還錯誤譴責一位為產後出現痔瘡的產婦治療的助產士，說她蓄意將病人的肛門縫合。而在2009年11月中國最大的官方媒體，CCAV報導著名的北京大學第一醫院允許醫學生參與診療非法行醫導致一名患者死亡。
盡管院方和衛生部申明相關的醫學生在有資質的執業醫生指導下參與臨床操作包括手術是合法的，民眾對醫院和醫生的信任卻受到巨大傷害。很難判斷南方都市報和CCAV的不實報道是因為缺乏醫學知識還是為了要製造煽情的故事。但是公眾對醫療職業的誤解肯定最終會受到傷害的是醫生和患者雙方。
大多中國醫院特別是像北京協和醫院和複旦華山醫院這樣的大規模醫院都是政府開設的。1985年之前中國的公立醫院是享受完全政府撥款的，在改革開放之後現在政府對醫院的經濟支持非常有限，導致醫院必須創收來應付支出。由於醫院收入主要來源於診療措施，就存在過度檢查和治療的利益驅使。為了減少不當的利益衝突，中國政府通過法令來阻止醫院收受藥商回扣。因為中國醫生的正式薪水即使按照中國收入標準也是不多的，許多醫生在經濟繁榮的中國不得不糾結於如何兼顧醫德和養家糊口的兩難。這樣的壓力加上感覺被政府和社會低估勞動價值，使得許多醫生離職下海。
中國的衛生改革如果不改善醫生的社會經濟地位就不會成功，而中國醫生應呼籲關注自身處境和建言獻策來更多改進醫療政策。
System change, the theme of the World Cancer Congress in Shenzhen, China, Aug 18—21, was a central message in the opening address by the Chinese Minister of Health, Chen Zhu, as he described current health-care system reforms in China. At the Congress many international health policy makers and physicians led discussions on frameworks and actions for system change, but there was little participation from local Chinese doctors.
To understand why there were so few Chinese delegates in the plenary sessions on system change compared with sessions on patients' care, one must first understand that for many Chinese doctors personal safety is of greater concern.
Chinese doctors are often victims of terrible violence.
In June this year, a doctor and a nurse were fatally stabbed in Shandong Province by the son of a patient who died of liver cancer 13 years ago, and a paediatrician in Fujian Province was injured after leaping out of a fifth-floor window to escape the angry relatives of a newborn baby who had died under his care. Thus, it is not surprising to see that in July police officers were invited to be the vice-presidents of 27 hospitals in Shenyang. With hospitals turned into battlegrounds, being a doctor has become a dangerous job in China.
The problem may be largely one of perception. Many Chinese patients believe that doctors and hospitals conspire to increase charges by providing unnecessary examinations, investigations, and treatments. Additionally, some doctors accept red envelopes (a monetary gift in exchange for favourable service) against the rules. Many patients blame the deterioration of their health directly on doctors, claiming that doctors lack devotion and skills.
The intellectual ideals of ancient China were “either to be a good prime minister or to be an excellent doctor”, while in modern China doctors and nurses used to be worshipped as “angels in white”. How has the perception of Chinese doctors become so eroded? The Chinese media certainly have an important role in provoking tension between doctors and patients. There is disproportionate coverage in newspapers, television, and on the internet of how health professionals have cheated patients. Just a few weeks ago the Southern Metropolis Daily (the most popular newspaper in Guangdong) falsely accused a midwife, who had treated haemorrhoids for a patient after childbirth, of stitching the patient's anus closed on purpose. In November, 2009, one of China's most authoritative media outlets, CCTV (China Central Television), reported that the renowned Peking University First Hospital was carrying out illegal medical practices by allowing medical students to do surgical procedures, and as a result a patient had died.
Even though the hospital and the Ministry of Health made it clear that involving medical students in clinical procedures including surgery under the supervision of licensed doctors is legal, trust in doctors and hospitals was seriously damaged.
It is hard to tell whether the misreport resulted from a lack of medical knowledge on the parts of the Southern Metropolis Daily and CCTV, or whether it was motivated by a desire for a sensational story. However, the public misunderstanding of the medical profession will surely hurt both doctors and patients in the end.
Most hospitals in China, especially the large ones such as Peking Union Medical College Hospital and Huashan Hospital of Fudan University, are run by the government. Public hospitals in China enjoyed full government funding before 1985. After economic reforms, the hospitals now receive very limited financial support from the government, with the result that hospitals must generate income to cover costs. As the main source of hospitals' income is from diagnostics and treatment, there is a financial incentive to over-investigate and over-treat. To minimise inappropriate conflicts of interest, the Chinese Government passed laws to prevent doctors receiving financial kickbacks from drug companies.
Because the standard salary of a doctor is modest, even by Chinese standards, many doctors struggle to balance professional ethics and making ends meet in an economically booming China. Such pressures, coupled with a sense of feeling seriously undervalued by the government and society as a whole, drive many doctors out of medicine into other jobs.
China's health-system reforms cannot be successful without reforming the social and economic status of doctors. Chinese doctors should be involved more in shaping health policy, by giving voice to their own experiences and constructive ideas about the health system.
The Lancet, Volume 376, Issue 9742, Page 657, 28 August 2010
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