The&lancet——中国医生正面临威胁
世界著名医学杂志《柳叶刀》（The
lancet）发表名为“中国医生正面临威胁”的文章。在开始我想说，有些道理人家外国人都明白了，中国这么多当事人还晕着呢。当然，当事人不见得经历过，没经历过当然站着说话不腰疼。他们是谁，我想你懂的。
& “体制改革”是2010年8月在深圳举办的“世界肿瘤年会”的主题之一，在开幕致辞上，卫生部长陈竺介绍了中国的卫生体制改革，在大会上，来自世界各地的决策者们对体制改革的框架和做法进行了讨论，但却少有来自基层医生的声音。
System change, the theme of the
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.
& 中国医生更关注自身的安全，很多中国医生正在成为各种暴力的受害者。今年六月，山东的一名男子将一名医生和护士刺杀，这名男子的父亲13年前死于肝癌。福建的一名儿科医生从五楼跳下受伤，只是为了躲避一个已死新生儿父母的愤怒。这样，7月份沈阳27家医院聘请警察做副院长的行为就不足为奇了。随着医院向战场的转变，在中国做医生已是一个非常危险的工作。
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.
这个问题在很大程度上是一个认识问题。不少中国患者认为医生和医院通过让他们做更多额外的检查和治疗而牟利。除此，一些医生违规收取红包。很多患者将自己病情的恶化直接归咎于医生，声称医生缺乏同情心和技术。中国古代知识分子的理想是“不为良相，当为良医”，在现代，医生和护士也有“白衣天使”的称号，到底是什么在侵蚀着医生的良知？
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?
中国的媒体当然为医患关系的恶化火上浇油。在报纸、电视、网络上总是可以看见医生如何欺骗患者的新闻。就是在几个星期以前，《南方都市报》（广东最流行的报纸）错误地报道了一个医生在为一刚生完孩子的妇女处理痔疮时，故意将其肛门缝上。（翻译到这里我简直要怒了！TMD的鸡者们你们有点常识没有，这种事可不可能？！谁没事吃饱撑的缝人家屁眼！上过学没有！！你哪个垃圾小学毕业的？？！！——本人的话，与原文无关。）在2009年11月，中国最著名的“CCAV”报道北大一院违章让一学生参与手术过程，结果病人死了。（F*CK，医学生不操作培养个P医生啊？TM老医生死完了谁给你看病？——同样与原文无关）尽管有关部门规定医学生可以在上级医生的指导下进行临床操作，但医院的可信度大打折扣。（爱信不信——my
word）无论是媒体的无知还是为了吸引大众眼球，这种报道对医生和患者都是极大的伤害。（最终受害的肯定是患者—Ditto）
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.
&&& 中国的大多数医院，尤其是大型医院，比如协和医院、华山医院，都是政府开设的。1985年前，公立医院都是政府全额拨款，经济改革以后，医院从政府获得的拨款越来越少，结果是医院自负盈亏。诊断和治疗都是医院收入的主要手段，因此经济动机引发的过度诊治也就存在。为了使利益冲突减到最小，政府立法禁止医生从药代收取回扣。由于医生的基本工资太低，即使按中国标准，医生也要在收支平衡间痛苦挣扎。这种压力让许多医生被迫改行。（Kao！敢不敢把工资调高点你再禁回扣！这样更有效，有脑子没？！不让人活了是吧！反正ZF那些人腰包满满的，谁管你医生呢，就这样吧。）
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.
唉，后续还有报道，一样来自《柳叶刀》。
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