一点感想

昨天看到一篇文章，说中国医生其实绝大部分比美国医生优秀，为什么呢，因为人口众多，经验丰富阿，中国医生看的病人，美国医生一辈子都看不到。我记得自己在国内看门诊，一个早上，40，50个，后面还有护士不停地催，我头也不抬起来，洗手间也没时间上，这样的“经验”，我也不知道学到了多少东西，呵呵。

我以为，大牛到处都有，前两天还看一个影片讲非洲的政府医生，我看着也觉得不错呢。问题不是技术，是精神和观念，我们不得不承认，现在中国年轻的医生出来，能够有前辈们那种精神的人很少了，现实的环境，价值观的变化，都有关系。

医者仁心，我觉得，医学就和艺术一样，到了最后，就不是技术论高下了，而是有没有那颗心。

在美国复习考试，我印象很深刻的，就是医学伦理学，我从头自学一遍，怎么和病人交流，怎么维护病人的权利同时保护自己，怎么避免纠纷，怎么样理解终末期病人和家属的痛苦，甚至怎么对待无理取闹的病人，这些在我们的书里找得到吗？我们的医学伦理学是选修课，从大学到住院，也从来没有什么课程或者讲座，帮助年轻医生们在医患关系上得体处理。

这种教育，使得我们所有对病人，对医学的态度，都是在自己的摸索中，靠着自己一点微弱的品格力量支撑着，社会上，法律上，甚至医学界本身，都没有足够的支持，这对于病人，对于医生本身，都是一种悲剧。

[stockfox]

Luohua v.s. Bolb, Round 1 精彩!

不知落花可否给封个"落花BLOG"特约评论员之类的TITLE,有了位置才有底气作了中场总结及赛况分析与预测.

[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，我刚写了洋洋洒洒三大段，安然把我好好地训了一顿。说我在这里跟你胡搅蛮缠，拼命抬杠。要求我换写风花雪月，吃喝玩乐。我这真是委屈啊。我哪敢跟你抬杠啊。你是专业人士，我一不给人看病也不找医生给我看病，就是一个站着说话不腰疼的。本来也就是锦上添花地写几段给你解闷，哪敢企图说服你啊。但安然威胁我说万一以后有个我三长两短说不定还要找你咨询，你要是心狠一点我就得等到制度完善后才能医得好病了。我吓得赶紧就把那三段删掉。

[女孩安然]

好来好来，大家不要写论文来，我眼睛都花掉了，昏过去，你们怎么这么强拉，还列出1，2的，等下我要写论文就到这里来拉几句。

[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.

[落花飘零]

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 时 候 ， 小 医 生 们 都 不 大 愿 意 治 疗 了 。 老 医 生 们 认 为 如 果 积 极 治 疗 ， 还 可 以 拖 半 年 。
我 至 今 都 忘 不 了 ， 他 临 终 的 时 候 ， 呼 吸 困 难 ， 是 我 在 床 前 替 他 拿 着 的 氧 气 面 罩， 可 是 他 确 越 来 越呼 吸 困 难 。 我 不 是 谴 责 医 生 怎 么 没 有 道 德 ， 只 是 想 ， 多 活 一 天 对 於 活 着 的 人 就 多 了 一 份 想 念 啊 。
阿 拉 以 后 发 大 财了 ， 要 在 阿 拉 大 学 里 用 我 爸 的 名 字 盖 个 大 楼 ， 让 他 慈 祥 的 注 视 着 他 没 有 见 到 过 的 他 女 儿 学 习 战 斗 过 的 地 方 。

[落花飘零]

吹风姐姐！！好久不见，好吗？

[WindBlows]

说的好，支持。