中国医生何去何从

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在中国行医已经成为一项高危行业。劳动强度大收入低,医生的合法权益得到不到有效的保障,时不时受到患者及其家属恐吓。中国医生何去何从,著名的杂志Lancet发文讨论了中国医生状况。

在中国行医已经成为一项高危行业。医生的合法权益得不到充分的保障,很多人受到暴力恐吓,一些医疗人员因为他们的工作而遇害。

2012年11月29日,天津中医药大学附属医院的一位女医生在门诊被砍死,这仅仅是遇害医疗人员长长清单上的一个例子。虽然中国政府已经出台了一些政策来保护医生,但目前,我们还没看到有实际意义的措施来制止这种悲剧的发生。迄今为止,仅2013年就已有12例暴力伤害医疗人员的事情发生,而在2012年这个数字是14例。

如此紧张的医患关系根源在哪里? Therese Hesketh 教授和他的同事认为医疗行的商业化是这种情况恶化的主要原因。虽然中国政府在努力改善医保,但是即使有医保患者通常也要支付大量治疗费用,报销的金额非常有限。而且,有些医院的资金是自筹或半自筹,因此这些医院的目的就是为了创收。所以现在可能没有短期解决中国医疗行业经济难题的方案。

除此之外,很多患者及其家属误解了医疗人员。他们认为不管什么疾病只要到医院治疗,都至少会有显著的效果,甚至治愈。如果治疗效果不满意,患者及其家属就会向医护人员发泄不满。另外一些媒体为了提高收视率也纷纷报道虚假的医疗纠纷。

至于医护人员本身,80%都认为自己劳动强度高,但二三级医院薪酬过低。即使在城市,很多医生的月收入只有不到5000人民币,大多数医院的高年资医生每次的诊疗费只有7块钱。医护人员常常不得不额外加班,放弃休息时间来诊治门诊患者或者做手术。

劳动强度大收入还低,还时不时受到患者及其家属恐吓,我怀疑在中国谁还会去当医生?

Which future for doctors in China?

Medical practice has become a high-risk job in China. Doctors' legitimate rights and interests cannot be fully guaranteed; many are under threat of intimidation and violence, and several have been killed because of their medical activities.

On Nov 29, 2012, the head of the acupuncture department of Tianjin University of Traditional Chinese Medicine, was killed in her clinic;1 and this is only one example of a long list. Although the Chinese Government has introduced policies to protect doctors, there are no meaningful measures at present to stop such tragedies. 12 cases of violence against doctors have been reported so far in 2013; by this time last year, 14 cases had been reported.2, 3

What is the source of so much tension between patients and doctors? According to Therese Hesketh and colleagues,4commodification of the health-care system is the main cause of deteriorating conditions. Patients pay most treatment costs themselves; even with health insurance, the proportion and the amount of reimbursement is limited, despite efforts of the Chinese Government to improve the situation. Moreover, some hospitals are self-financing or semi self-financing, and aim to increase revenue generation. So, there might not be short-term solutions to the financial problem.

Beyond that, many patients and their relatives misunderstand the medical profession. They believe that, no matter what the disease is, if they get treatment in hospital they will have a remarkable therapeutic effect or even be cured. If the treatment is not satisfactory, patients and their relatives will vent their dissatisfaction with doctors. Additionally, some media have reported false medical disputes to increase audience ratings.

As for doctors, 80% describe themselves as overworked and underpaid in secondary and tertiary facilities. Even in cities, many doctors earn as little as 5000 yuan (US$780) a month or less. Senior doctors earn consultation fees of just 7 yuan ($1·14) in most hospitals. Doctors' workloads have increased, and many forgo their rest hours to serve outpatients or do operations. The recent deaths of four doctors have been attributed to overwork.5

Overworked, underpaid, and under threat, I wonder who will be the next doctors in China?

参考文献:An Jingang. Which future for doctors in China? The Lancet, Volume 382, Issue 9896, Pages 936 - 937, 14 September 2013

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