17 years old, out of a vague vision for a certain life, entered the best medical school in China. It was not until one month before I submitted my volunteer form that I thought I would become a medical student one day. At this time, my friend told me a documentary she had seen, about Lin, a famous doctor in obstetrics and gynecology at Union Medical College Hospital, about how her medical skills were superb, and about how the blue-brick and green-tiled medical college became famous and how to cultivate first-class medical students. The picture outlined in a few words instantly hit a nerve of mine. Because I 17 years old, I always hope that I can take a different road from others. On the one hand, I think these eight years of medical life will be full of hardships, on the other hand, I think it will be unusual and unconventional.
After meeting 30 new classmates at the same level, we began to exchange ideas. Most of the girls were inspired by Lin and entered the Union Medical College Hospital, determined to become contemporary famous doctors. Only soon, these glory and joy were diluted, and then there were waves of long-term tests in real life: we swore the Hippocratic oath, crustily dissected the body for half a year, gave needles to patients in the whole ward in the morning, rushed to operate on appendicitis patients, and learned by ourselves every night after 12. Until the end, we piled up several big and thick books of Chinese and foreign women who had studied for several years and trapped ourselves in the classroom for a month, in the dark. Then I passed the long graduation exam.
I counted, except for elective courses, in the past eight years, all students have taken 59 subjects. In the past eight years, I have been thinking about a problem: if medicine itself is an imperfect science, then doctors engaged in medicine have chosen a career with humanitarian burden and self-knowledge of the process. This profession carries the expectations of patients similar to God, but it can't get rid of the identity of a mortal and the trivial reality that needs to be faced around him.
I graduated eight years later and didn't become a doctor. On graduation day, I wore a doctoral suit and my tutor wore a tie with Yale printed on it. Let's take a group photo and say goodbye. My tutor who graduated from a missionary school at an early age looked at me and couldn't help saying, "It's a pity that you don't become a doctor." .
During that time, my mother often said on the phone that it was difficult to go upstairs, which indicated that her rheumatic heart disease had worsened. I asked her to come to Beijing for re-examination. If possible, I would do an interventional balloon dilation, which is not strong enough and can solve some problems. Relying on the relationship accumulated in the hospital, I made careful arrangements in advance. But just before the treatment, a necessary examination found that her valve was thrombi in addition to severe mitral stenosis. The doctor said that balloon expansion is definitely not allowed in this situation. If you want to do it, it must be an open chest. At the moment I got the list, my tears could not help falling.
For me, whose monthly living expenses are only in 200 yuan, the operation fee of 50,000 yuan is a huge figure. Where can I raise this huge sum of money? That night, according to the experimental plan, I will go to Dahongmen Slaughterhouse in Fengtai District to get 10 pig eyes and go back to do the experiment. Unlike the quiet world outside, slaughterhouses work at midnight. I waited in the dark for an hour first. After the workers went to work, I crossed the bloody ground, listened to the miserable cries of pigs before they died, and watched the workers gouge out the eyes of five pigs with knives. I quickly paid 50 yuan and fled the scene.
I carried the ice box with pig eyes back to the dark laboratory, tried to sleep, and was busy in the underground laboratory until dawn. When I came back, my mother was still waiting for me. She told me firmly: "I have decided not to have surgery for the time being." As a medical student, I failed to convince my mother. Of course, my mother and I both know that even if my mother is persuaded by me, I can't afford this huge operation fee.
This night is unforgettable for me.
At lunch the next day, my tutor said to me, "I heard that the number of places in the department is tight, and all of them have been used up this year." Things are a mess now. But it doesn't matter. Do you think this will work? I still have about 30 thousand dollars in my research fund account. I can tell the dean to let you stay in ophthalmology, and I will pay you with the research fund and take you to the clinic. So father and son can spare two and a half days a week to go to the library, discuss problems together and teach you everything I know. I believe you will be a very promising doctor. "The life he described made me yearn for and be tempted for an instant, but it was quickly overwhelmed by reality.
I dare not look the old man in the eye. I really don't know how to tell him. Just yesterday, I made up my mind to leave the hospital and go to America for scientific research. I finally gritted my teeth and said to my tutor, "I'm not going to be a doctor."
"What a pity, why?" The old man was surprised.
Why not be a doctor? There are some reasons why I can't tell the old man. He has been so simple-minded and optimistic all his life. Can he understand the contradiction between spiritual and material division of an ordinary doctor in our time? Will he think that medicine needs to solve not only technology and knowledge, but also other problems that can't be solved because they are too grand and complicated? Can he accept that the era of Zhang Helin is gone forever like a pure fairy tale? He can tell me how a young medical student who has a sense of destiny and pursues richness and diversity, as a medical professional, can get inner happiness and peace in life?
Eight years ago, I chose to study medicine because of forests, glazed tiles and saving lives. In the past eight years, I have tasted the joy of studying medicine, and like my classmates, I have paid unimaginable hardships for learning medical knowledge. But this happiness, this hardship, has been gradually diluted in the hodgepodge of small individuals, huge society, rapidly changing times and scientific progress.
Little-known secret pain
At a class reunion, a classmate who was rotating in the emergency department asked everyone: "A patient with traumatic bleeding from a car accident was sent to the emergency department. There is no guarantor, and no one pays the hospitalization deposit. The economic situation is unknown. Do you want to treat him? " If we follow the education we received at school to heal the wounded and rescue the dying, of course, we don't have to think much and go to the rescue immediately. But according to the educational results of real hospitals, the first question is who will pay the medical expenses? If the doctor on duty, driven by the sense of responsibility, saves people regardless of the cost, he is likely to be reprimanded by the hospital in the end.
Besides, if the patient can't get the medicine because he has no money, it's a bit wrong to accuse the doctor of not saving lives. As we all know, modern hospitals have strict division of labor, and doctors are only a small molecule in a large system. He can't direct the whole hospital, even the pharmacy. It is different from the authority of the old Chinese medicine doctor who used to see a doctor at home and take medicine. But in the social news section of the newspaper, we can often see such a report: the patient's life is at stake, and the doctor is not destroyed. It seems that all doctors are snobs, only treating the rich, not the poor.
When it comes to seeing a doctor, we often simplify it as a matter between doctors and patients, and forget the medical environment in which doctors and patients are located. All we can see is the doctor. A doctor is a person who appears face to face with us on behalf of medical treatment. However, patients' dissatisfaction and disgust with medicine, medical care and insurance systems should not be passed on to doctors.
A survey asked, "Have you ever had a doctor-patient dispute in clinical work?" ? Among the more than 200 doctors surveyed, most of them answered "too many", "just met one" and "my colleague was beaten two days ago". Basically, every doctor surveyed has encountered a doctor-patient dispute. Light is condemned, but heavy is breaking up; In addition, patients go to court and even doctors are subjected to violence. When asked what they were most afraid of, the doctors interviewed almost unanimously said, "Medical disputes."
In the impression of more and more people, the image of doctors has never been so ambiguous as it is today. But few people know exactly the hardships and risks of the profession of doctor. A survey concluded: "Nowadays, doctors have become the most unhealthy people in the world. They die earlier than most people, are more likely to commit suicide, suffer from heart disease and gastric ulcer, need psychological counseling more than others, and are more likely to drink and take drugs than their contemporaries. Their marriage didn't last long, and they struggled under great pressure and were at a loss. "
When a doctor becomes a patient,
There was an old American professor who practiced medicine for 50 years and learned that he had laryngeal cancer in his later years. He became a patient. He changed from "standing by the bed" to "lying on the bed". Re-examining the medicine, hospitals and doctors in front of him, he suddenly gained a different meaning-the meaning of belonging to patients. He recalled that he used to be a doctor and used to give orders, but after he became a cancer patient, his experience and mood were exactly the same as those of other patients: he dared not face the truth of the disease, was ridiculed by nurses for "short neck", and medical staff ignored his dignity. The current commercial medical environment blindly pursued profit maximization. ...
He began to realize that in fact, "of course, these problems existed before I got sick, but my vision was not opened until I became a patient and returned to work." (Sun) When can doctors really understand the problems faced by patients? Maybe only when he becomes a patient can he realize this.
The old professor compared his feelings after the role change: when he was a doctor, he was used to making decisions that would affect the life and death of patients and to having power. But when he was a patient, these rights disappeared without a trace. After becoming a patient, although he knows several acquaintances, like all patients, he can only do one thing-wait, wait, wait, etc. He always meets the situation that he waits for an hour and only takes five minutes to see a doctor. Being in the role of "patient", he finally realized how far-reaching the doctor's little sympathy was to the patient. After this respected doctor became a patient, he also experienced the unfortunate experience of being "misdiagnosed" by doctors twice. He could have sued the doctor who was misdiagnosed, but in retrospect, he has been a doctor for so many years and has never been sued by a patient, but he must have made similar mistakes himself.
As he said, every painful experience in front of me can remind me of my medical experience in those days. I prefer to tell these experiences to myself and young doctors as teaching materials for their future medical practice. In the preface to the book Taste My Own Prescription, he said: "If I could start over, I would practice medicine in a completely different way. Unfortunately, life doesn't give people a chance to start over. All I can do is tell you what happened to me. I hope you and I can learn from it. "
About the patient: Who is the good doctor you need?
Is a doctor with a kind attitude a good doctor we need? Is a famous doctor a good doctor we need?
I have seen three doctors like this.
One is a female doctor who treats people kindly. She always whispers and cares about her patients. In the process of communicating with her, the patient can certainly meet the strong demand of human kindness. But the doctor remained an associate professor until he was 50 years old. Colleagues commented that her clinical logic was unclear, she rarely updated her knowledge, and there were no available scientific research results.
One, as an associate professor, went abroad to study for a doctorate in pharmacology, set up his own laboratory in the United States and published many scientific research articles. Then one day, he returned to China for development and continued to return to clinic. Because of his scientific research advantages, he soon got the title of professor in the hospital and became the director of the department. But in real surgery, his skill is actually not as good as that of an attending doctor who spends every day in the consulting room. However, such an inside story is not known or judged by an ordinary outpatient.
There is also a doctor who is very good at cardiac catheterization, but there is a fatal weakness in his career, that is, his education is undergraduate. The defect of this diploma directly affects his promotion and the possibility of obtaining a glamorous title by joining various societies. In the eyes of an unsuspecting patient, he can't understand his real clinical skills at all, that is, the medical skills that patients are most concerned about.
So, how do we choose a good doctor for ourselves? In the current doctor evaluation system, a senior doctor's academic achievements or administrative titles will bring more fame to doctors. But for specific patients, what is more important is actually human feelings and medical skills. If you really can't have it both ways, it should be that medical skills are more important to patients.
A friend has uterine fibroids and needs surgery. I thought laparoscopy could solve it, so I asked who it was. I gave her the names of two experts. As a result, she told me after reading it, and some experts told her that because the location of fibroids is tricky, there are blood vessels and urinary catheters around, laparoscopy may not solve it, and I am afraid that laparotomy is needed. I asked my fellow doctors, and the doctor understood at once, saying that because the doctor's surgical style is too meticulous, some people may need two hours of surgery, and she may need three hours. Someone may not feel dangerous, but she may feel very risky.
I told my friend about it at once, and she exclaimed: There is too much knowledge here! I asked her, "Would you rather have three holes in your stomach for laparoscopy? Or are you willing to risk caesarean section? " Since this is the only operation, you should try to find a good doctor who is most suitable for your condition.
So, what is the medical skill of Dr. China? A domestic immunology professor told me bluntly: "Don't think how strong rheumatism immunology is in the United States. They just have the right to speak in scientific research, have the funds to do basic research, and the laboratory results are more than ours. From the clinical experience, I feel that they are really not as good as us, or some doctors in China are better. I came into contact with several cases of systemic lupus erythematosus in the clinic all morning. We have many patients and many diseases. But in the United States, if a patient with systemic lupus erythematosus lives in a ward, almost all internal medicine interns, residents and professors will come to see it. "
Modern intelligent patient
A friend of mine lives in the oncology ward of obstetrics and gynecology. When she went in, she had it in her hand. Don't let the doctor kill you. Her behavior strongly challenges the authority of doctors. Such patients are called "patients with thorns" by doctors. For example, my college classmates in obstetrics and gynecology bluntly said: I like patients from rural areas who honestly don't ask questions, while those intellectuals in cities, especially female intellectuals, are numb with a lot of questions, and I don't know when they will find you trouble.
Friends who hold "Don't let the doctor kill you" continue to act according to their inner goals and wishes. Because in her view, her ultimate goal is to get the best medical care and plan for her health. Why do you watch Don't let the doctor kill you? Her explanation is: this is my first time in hospital. I have to know the real situation of the medical industry, and I have to look at all aspects, good and bad, before I know how to nip in the bud.
Naturally, in the face of doctors, she also has a lot of problems. For example, when the doctor chooses a treatment plan for her, she will ask the doctor why she suggested surgery before chemotherapy, and why she suggested chemotherapy before surgery. As a result, she found that there was no obvious difference between the two treatment schemes, but the two doctors had different treatment concepts and habits.
According to her memory, almost every day when the doctor came to her bed, she smiled and prepared at least two or three questions to ask. Not only that, she also found a medical college obstetrics and gynecology textbook and read it back and forth several times. She has a detailed understanding of the treatment history, evolution and the latest international progress of her disease. There are some anecdotes and stories that I have never heard of.
When she was given chemotherapy drugs by intravenous intubation, the pain made her scream, only to find the most experienced old nurse in the ward to intubate her. The old nurse did her best and left briskly. When she finally left the hospital, she asked the old professor in the ward: Is my understanding of this disease equivalent to that of a medical student? The old professor nodded admiringly and said: Your level is not only medical school, but some undergraduates may not learn as deeply as you.
In the process of treatment, such a "thorny patient" has been striving for the best medical treatment in a strong but friendly way, striving to maintain equality with doctors and trying to put himself in a position where he can talk to doctors. Finally, she won the doctor's attention and went home healthy and satisfied. Not only that, she even made friends with one or two doctors. So that when she reexamines, as long as she stops at the clinic, the doctor will turn around and greet her like an old friend and ask questions.
Are doctors and patients always enemies? The softest communication between two mortals is frankness and sincerity. To be a patient who can attract the doctor's attention but won't disgust the doctor requires certain public relations skills. This sounds sad and tragic, but it is also a solution for us to face reality calmly at present. What is the current reality? The doctor has not learned communication skills at school, and there is no competitive environment and no vocational training after work, which requires him to pay attention to communication skills. The doctor-patient relationship is developing in the opposite direction, and more and more doctors and patients are beginning to plan ahead instead of talking.
When a patient becomes a doctor
The experience of a female patient in the United States is thought-provoking: she has dual identities all her life: full-time patient and full-time doctor. She suffers from a rare congenital immunodeficiency syndrome and has been hospitalized many times because of infection. She has suffered from various infectious diseases, had many bone marrow biopsies, and doctors have warned her again and again that you may get lymphoma or other cancers at any time. She was lying in bed in such pain that she begged to die. Later, she decided to study medicine. The reason is only because a sick person wants to know more about his illness, so as to better understand his body and regain the right to control his body.
Another reason is that she has to inject antibodies and interferon intravenously every month. The cost alone is a huge astronomical figure for her, and being a doctor can reduce this cost. Together, the two reasons show a person's dual needs in the face of illness, mental and material. If no one else can help, do it yourself! Being a doctor also solved the medical expenses. Later became a doctor, she wrote:
"The patients I met have shaped what kind of doctor I will become in the future. I know this industry like the back of my hand. I not only know what's wrong with my body, but also know what it means to the people behind my sick body.
"Anyway, you are ill, the last thing you want to hear is the doctor's own problems.
"I can use my own patient experience in turn. I treat patients as I ask doctors to treat me. This experience is more conducive to my communication with patients. "
This female doctor with congenital immunodeficiency understands the diseases, fears and impermanence throughout her life in a unique way. What she told everyone was that the world was not as bad as we thought.
Both doctors and patients should be grateful for every kind word and check it carefully every time. You know, "it's not easy to control the disease." Also, "the disease is widespread and eventually wins." It is natural that we will fail, and death will eventually win. When I was a medical student, I knew that my chosen career was doomed-a beautiful and glorious failure. "
The Dilemma of Modern Medicine: Good Doctors and "Cow" Doctors
A friend has a lump in his chest. She went to see a 70-year-old breast surgeon six months ago. One day, I got a call from this friend, and her tone was very anxious. She said that she had just had a B-ultrasound, and the list said: The breast lump has unclear edge and rich blood flow, and it is suspected to be a malignant tumor. My friend is extremely depressed.
The next day, she went to see the old expert with the results of B-ultrasound. The old expert still insisted: "It is hard to say that it is malignant at present. Trust my hand and find a master to do B-ultrasound. " My friend found a B-ultrasound master and did it again. The second result of B-ultrasound was: unclear margin, poor blood flow and hyperplasia of mammary glands. Suggest to follow up. The two results were diametrically opposed, and she was very upset and didn't know who to trust.
Tortured by these two results, my friend seems to be a persistent "autumn chrysanthemum" and has been seeing many doctors in other hospitals in Beijing non-stop. Without exception, the advice of these doctors is: cut it off, and everything will be clear as soon as the pathological results come out. She asked me for advice from medical students, and what I said was exactly the same as those doctors. She asked the old expert again, but the old expert still said: Don't operate casually, trust my hand.
She went for a molybdenum target examination, and the results also suggested hyperplasia of mammary glands. On the day when she went to see the old expert's clinic with the results, there were several patients in front, and she sat in the corridor and waited. At this time, a middle-aged woman suddenly broke into the consulting room of the old expert, rushed forward and threw her fist at the old expert. The 70-year-old expert was beaten with messy hair and painful expression. * * * When he took the old expert and the female patient away, he was very tall. He saw my friend in the crowd and said, "Come and see me another day. You don't need to register. Just come."
The female patient who started hitting people saw an old expert five years ago. At that time, because the condition of breast cancer had reached the advanced stage, the old experts mobilized patients to have total mastectomy, otherwise there was a great possibility of recurrence. The female patient had a wound, but it never recurred. However, her life has changed a lot because of this disease and this operation: she has left her job, divorced, financially embarrassed and has no life. The female patient blamed the current miserable life on the advice of an old expert who had an operation five years ago. So, five years later, she came to the clinic and vented her resentment against the old expert in her own way.
My friend asked me why other doctors advised her to cut the lump and see the pathological results. Why did the old expert risk being roughed up by the patient to persuade her not to operate easily and ask her to trust her own hands?
When the law intervenes in the doctor-patient relationship, when our life is full of complaints, vigilance and even hostility to doctors, doctors get less and less humanized returns from patients. When they make decisions for patients, they gradually learn to protect themselves, make steady decisions and give patients a clear, definite and measurable result. Advice from a friend The doctor who operated on her advised her to forget all this because they didn't know the nature of the tumor. After the pathological results came out, the truth came out. Such a doctor is a good doctor in a legal society. To be on the safe side, they all look at breast lumps. When they are uncertain about benign and malignant, they will advise patients to cut them off and pick them out themselves.
But the old experts hope to affect the quality of life of patients as little as possible, and don't want patients to get a knife for no reason. "* * * is of great symbolic significance to women. A * * * that has been cut by a knife is incomplete after all. " At the risk of being complained and misunderstood, he told the patient what he thought was the most suitable choice. "Please trust my hand." I don't know how many doctors will be able to talk about this situation now, and I don't know how many patients who come with vigilance and vigilance are willing to believe this sincere doctor. Will the tumor really turn malignant in the future and take the doctor to court?
"What do you think he wants?" My friend asked me this question.
I said, this may be the difference between a modern good doctor and an endangered "cow" doctor. Master surgeons like Qiu Fazu don't blindly advocate the principle of "scalpel first", but advocate that "those who can operate don't need surgery, those who can perform minor surgery and solve problems should be operated, and those who must open a big knife should be thoroughly done".
Only cure, not cure.
If you have two doctors in front of you, one with excellent medical skills is indifferent to people, and the other with mediocre medical skills is kind to people, which one would you choose? Friend Xiao He said that if she could only choose one, she would choose the latter. Doctors are human first. Xiao He's experience of seeing a doctor happened in the months when he was abused by his boss. As a victim of "office politics", she is extremely depressed and often feels chest tightness, dyspnea, rapid heartbeat and numbness in her hands and feet. Her neck looks a little swollen, too She thought it was hyperthyroidism. She went to the hospital to see several departments, and the doctor gave her a test list. Then she looked at the test results and said, it's okay. Go home and stay.
"Finally see the little doctor of endocrinology. After she finished reading the test paper, she might like me, or she might just be not too busy that day. She asked me if I had been hit by anything or encountered any difficulties recently. I saw that she was so kind, so I told the whole story of being bullied by my boss for several months. I feel much better after I said it. Later she told me it was called hyperventilation syndrome. I used the method she taught me. When I was uncomfortable, I inhaled and exhaled into the plastic bag and felt much better. "
But the development of medicine may be at the expense of losing warmth. George Sarton, known as the "father of modern science", asserted as early as the 1940s: "The progress of science makes most scientists deviate from their paradise more and more to study more specialized and technical problems, and the depth of research is increasing day by day, but the scope is shrinking day by day. Broadly speaking, a considerable number of scientists are no longer scientists, but become technical experts and engineers, or become administrative officials and operators, smart and good at making money. "
This passage also applies to modern medicine. Medicine, originally a science that needs people-oriented all the time, is increasingly showing the cold nature of professionalism.
Xiao He decided to go to the hospital again because of his frequent backache. When she asked my opinion, I said that if you can take the trouble to do it, you can go, but you can't get the doctor's conclusion on the same day. She is going to the hospital. First, the hospital's guidance desk assigned her to gynecology. She signed up as an associate professor. The doctor gave her a bunch of tests: blood routine, blood biochemistry, cervical curettage, B-ultrasound ... She couldn't even name all the tests and didn't know what they were for. The doctor said to wait until the results of these tests came out. A week later, after all the results came out, the doctor said: gynecology is fine, go to the nephrology department to have a look. She went to the Department of Nephrology and had another batch of tests. A week later, the results were normal. The doctor said coldly, I am fine here. Let's go to orthopedics. Xiao He asked me, "Is that what these medical students tell their patients? It seems that I only have anatomical structures in their eyes, and I am also divided according to the organ system. "
In addition to simply blaming the decline in medical ethics, in fact, the embarrassing situation between doctors and patients that is difficult to clean up like today cannot be completely attributed to individual doctors. In fact, each of them faces two difficult problems: one is the patient's demand for doctor's humanity as always, and the other is the reality that the division of labor in modern medicine is becoming more and more detailed. No wonder a wise man lamented, "the technologist is so immersed in his own problems that nothing else exists in the world in his eyes, and his human touch may disappear." Because of the rapid development of modern medicine, the dialogue atmosphere of a doctor facing a patient for thousands of years has suddenly become "a doctor facing an organ" or even "several doctors facing a patient" in just a few decades. When we entered the hospital, it was like becoming a machine with defective parts. When we go to the assembly line, the doctor looks at the parts he is responsible for, but for the doctor, no matter who comes, the parts are the same. He only cares about maintenance, just like the workers in the garage.
100 years ago, it was still the case that doctors only faced one patient. At that time, there were not so many accurate and quantitative inspection instruments and indicators in medicine, which were mainly done by experience and feeling in the process of direct contact between doctors and patients. "Human touch" became an important seasoning between doctors and patients at that time.
Today, doctors' mood is getting colder and colder, because they have lost their previous concentration. Modern medicine seems to have entered an embarrassing situation with no dead ends on the humanistic level. When medical scientism has gradually become everyone's belief, being close to the warmth of civilians may be a good medicine to cure people's indifference and prejudice against medicine.
My alma mater is a medical school funded by Rockefeller Foundation in the early 20th century. Its original origin in China is inextricably linked with medical missionaries. At that time, "medical missionaries" faced patients including body and soul.
At school, the teacher once told us a history: John B Grant, the first professor of public health in the school, took the lead in sending warmth to the cold "white coat". His solution is to set up a "social service department" in Beijing, advocating doctors and nurses to go out of hospitals and into hutongs, so as to close the relationship with citizens. Professor Lan Ansheng also invited Yan, the "father of international civilian education", to give a lecture at Union Medical College Hospital. Warn the future Concord doctor with earnest words: "You need a scientist's mind and a missionary's heart."
Chen Ye, who was still a student at that time, was deeply moved in the audience. Later, he took off his "white coat" and put on a "gray gown". The doctor went to the countryside and came to the countryside of China. The "father of public health in China" is a doctor and his wife is a nurse. He is determined to give more warmth to medicine and seek a wider solution between doctors and patients.