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.
这篇文章被业内同行疯狂的转发着,看完之后,倒是觉得一边倒的为医生说话也不能说明问题的全部,也完全不利于问题的解决。医院是社会的缩影,医患关系是当今中国人际关系的全反射。医生并不是一群道德高尚的人,也不要如此期望,因为他们都客观的存在于这个社会之中;当贪污腐败、走后门、送红包、闯红灯、扔垃圾、插队占座等等等等人们完全无视规则而只顾最大程度的为自己攫取利益的现状没有改变之前,在自我意识、民主精神、契约精神还没有深入人心之前,不要奢望医院这个貌似特殊的地方成为一片“净土”。当然,医院、医生走在改变的前列是应该的。