The Lancet， Volume 376， Issue 9742， Page 657， 28 August 2010

    （《柳葉刀》卷376，第9742期，第657頁(yè)，2010年8月28日）

    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.

    八月十八- 二十一日在中國(guó)深圳召開的世界抗癌大會(huì)的主題是：體制變革。這個(gè)主題正是中國(guó)衛(wèi)生部部長(zhǎng)陳竺在開幕致辭上闡述當(dāng)前正在進(jìn)行的中國(guó)衛(wèi)生保健體制改革時(shí)所傳達(dá)的中心內(nèi)容。在大會(huì)上，許多國(guó)際衛(wèi)生政策的制定者與醫(yī)生就體制變革的準(zhǔn)則與行動(dòng)各抒己見。但是，幾乎沒有來(lái)自中國(guó)本地的醫(yī)生參與討論。

    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.

    與患者護(hù)理會(huì)議相比，出席全體會(huì)議討論體制變革問題的中國(guó)代表人數(shù)少得可憐。要剖析這個(gè)現(xiàn)象，首先必須理解：對(duì)許多中國(guó)醫(yī)生來(lái)說，個(gè)人安全問題比參加會(huì)議來(lái)得更加重要。中國(guó)醫(yī)生經(jīng)常成為令人驚悚的暴力的受害者。

    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.

    今年六月，山東省的一名醫(yī)生與一名護(hù)士遇刺（醫(yī)生當(dāng)場(chǎng)死亡、護(hù)士重傷），兇手是13年前死于肝癌的一名患者的兒子；而福建省一名兒科醫(yī)生因?yàn)樘�出五樓窗口逃生而受傷，起因是這名醫(yī)生接手治療的新生兒因故死亡而受到憤怒的患者家屬的暴力攻擊。因此，七月份警官應(yīng)邀擔(dān)任沈陽(yáng)27家醫(yī)院副院長(zhǎng)職務(wù)并不令人驚訝。醫(yī)院已經(jīng)成為戰(zhàn)場(chǎng)，因此在中國(guó)當(dāng)醫(yī)生便是從事一種危險(xiǎn)的職業(yè)。

    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.

    這個(gè)問題可能主要是認(rèn)識(shí)上的問題。許多中國(guó)患者相信醫(yī)生與醫(yī)院沆瀣一氣，通過提供不必要的檢查、檢驗(yàn)與治療提高了看病費(fèi)用。此外，一些醫(yī)生不顧相關(guān)法規(guī)接受紅包（現(xiàn)金禮物，患者以此換取有利的醫(yī)療服務(wù)）。

    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？

    許多患者將其健康的惡化直接歸咎于醫(yī)生，他們聲稱醫(yī)生缺乏敬業(yè)精神與業(yè)務(wù)能力。中國(guó)古代的知識(shí)分子的理想是：“不為良相，當(dāng)為良醫(yī)”，而現(xiàn)代中國(guó)的醫(yī)生與護(hù)士則被推崇為“白衣天使”。為何中國(guó)醫(yī)生的會(huì)從昔日的道德楷模變成今天一副破落戶的潦倒形象呢？

    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.

    中國(guó)媒體在緊張的醫(yī)患關(guān)系上顯然扮演了重要角色。報(bào)紙、電視與互聯(lián)網(wǎng)有關(guān)醫(yī)生欺騙患者的報(bào)道輔天蓋地，負(fù)面報(bào)道比例徹底壓倒了正面報(bào)道。

    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.

    僅在幾個(gè)星期前，《南方都市報(bào)》（廣東發(fā)行量最大的報(bào)紙）無(wú)端指控一名助產(chǎn)士，聲稱其為產(chǎn)婦治療痔瘡時(shí)故意縫合了患者的肛門。

    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.

    2009年十一月，中國(guó)最權(quán)威的媒體之一CCTV（中國(guó)中央電視臺(tái)）報(bào)道了著名的北京大學(xué)第一醫(yī)院允許醫(yī)學(xué)生非法行醫(yī)做手術(shù)從而導(dǎo)致一名患者死亡。雖然該醫(yī)院與衛(wèi)生部解釋在有執(zhí)業(yè)資格的醫(yī)生監(jiān)督下醫(yī)學(xué)生參與包括手術(shù)在內(nèi)的臨床工作是合法的，但社會(huì)對(duì)醫(yī)生與醫(yī)院的信任由此大打折扣。

    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.

    對(duì)《南方都市報(bào)》與CCTV而言，很難說這種錯(cuò)誤報(bào)導(dǎo)是因?yàn)槠淙狈︶t(yī)學(xué)知識(shí)、還是因?yàn)樽非筠Z動(dòng)性的新聞效果的動(dòng)機(jī)所致。不過，公眾對(duì)于醫(yī)療職業(yè)的誤解肯定最終損害了醫(yī)患雙方的利益。

    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.

    中國(guó)的大多數(shù)醫(yī)院，尤其是北京協(xié)和醫(yī)院與復(fù)旦大學(xué)華山醫(yī)院之類的大醫(yī)院，都由政府運(yùn)作。中國(guó)的公立醫(yī)院在1985年前享受政府的全額資金支持。

    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.

    經(jīng)濟(jì)改革后，現(xiàn)在的醫(yī)院收到的政府金融支持十分有限，其結(jié)果是醫(yī)院必須生財(cái)有道來(lái)抵消其運(yùn)作成本。而醫(yī)院的主要收入來(lái)自于診斷與治療，因此存在著過度檢查與過度治療的利益動(dòng)機(jī)。

    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.

    為使不適當(dāng)?shù)睦�益沖突最小化，中國(guó)政府通過立法防止醫(yī)生接受來(lái)自醫(yī)藥公司的金融回扣。因?yàn)獒t(yī)生的標(biāo)準(zhǔn)工資即使從中國(guó)的標(biāo)準(zhǔn)來(lái)看也比較少，因此在經(jīng)濟(jì)迅速發(fā)展的中國(guó)環(huán)境下，許多醫(yī)生就必須在職業(yè)道德與收支平衡問題面前掙扎。這種壓力，加之感覺到自己的服務(wù)價(jià)值被政府與社會(huì)總體嚴(yán)重貶低，迫使許多醫(yī)生改行易轍另謀生路。

    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.

    如果忽視醫(yī)生的社會(huì)與經(jīng)濟(jì)地位的改革，中國(guó)的衛(wèi)生體制改革是不會(huì)成功的。 中國(guó)醫(yī)生應(yīng)該就自己的經(jīng)歷而暢所欲言、為醫(yī)療衛(wèi)生系統(tǒng)的發(fā)展振興建言獻(xiàn)策，更多地加入到衛(wèi)生政策的制定中來(lái)。