威胁下生存的中国医生
威胁下生存的中国医生以下是一年前发表在国际知名学术杂志《柳叶刀》的一篇文章，也许很多人都看过，不过再细嚼还是意犹未尽。今天是小周末，权作茶座思想欣赏吧。 Chinese doctors are under threat 威胁下生存的中国医生许锐恒译 Editorial，The Lancet, Vol 376, 9742, 657；28 August 2010-3 September 2010 社论，柳叶刀， 376卷，9742期，657页， 2010年8月28日～9月3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. 体制改革，是8月18日至21日在中国深圳召开的世界抗癌大会的主题，也是中国卫生部部长陈竺在开幕致辞介绍当前中国医药卫生体制改革的主要内容。会上许多国际卫生政策的制定者和医生参与讨论体制改革的架构与实施，但没有中国本土医生参与讨论。 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. 与出席病人诊疗分会的人数比，参与体制改革全会的中国代表为何如此之少，要弄明白这问题，必须首先明白，许多中国医生更关心自身的安全问题。中国医生常常是恐怖暴力的受害者。 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. 许锐恒译
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6月，山东省一名医生和一名护士遭一名13 年前因肝癌死亡的患者的儿子致命性的刺伤，福建省一名儿科医生为躲避自己经治的死亡新生儿的愤怒亲属，从5楼窗口跳下而受伤。因此，7月沈阳27家医院聘请警官担任副院长也就不足为奇了。随着医院变成战场，在中国当医生已成为一种危险的职业。 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? 这个问题可能主要是观念的问题。许多中国患者认为医生和医院共谋，通过提供不必要的检查、检验和治疗来增加收费。此外，一些医生违规接受红包（现金礼物，以换取有利的服务）。许多患者将自身的健康恶化直接归咎于医生，并断言医生缺乏敬业精神与专业技能。古代中国的知识分子的理想是“不为良相，当为良医”，而现代中国的医生与护士曾被尊崇为“白衣天使”。为何今天中国医生的形象变得如此糟糕？ 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
Editorial， shaping health policy, by giving voice to their own experiences and constructive ideas about the health system. 不改善医生的社会和经济地位，中国医药卫生体制改革将不会成功。中国医生应该更多参与卫生政策的制订，就医药卫生体制方面根据自己的经历发言和提出建设性意见。 The Lancet, Vol 376, 9742, 657； 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. 中国媒体在激化医患紧张关系上无疑起重要作用。报纸、电视与互联网过度报道医疗卫生专业人员如何欺骗患者。就在几周前，《南方都市报》（广东最流行的报纸）不实指责一名助产士，为一产后患者治疗痔疮时故意缝闭了患者的肛门。2009年11月，中国最具权威的媒体之一CCTV（中国中央电视台）报道了著名的北京大学第一医院非法行医，允许医学生做外科手术而导致一名患者死亡。 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 hospital 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. 尽管医院和卫生部已澄清医科学生在有执业资格的医生指导下参与包括外科手术在内的临床工作是合法的，但医生与医院的信誉已严重受损。很难说清楚上述错误报导的原因是《南方都市报》和CCTV缺乏医学知识，还是刻意追求耸人听闻的故事。不管怎样，公众对医学职业的误解，肯定最终受伤害的是医生和患者双方。 Most hospitals in China, especially 28 August 2010-3 September 2010
以下是一年前发表在国际知名学术杂志《柳叶刀》的一篇文章，也许很多人都看过，不过再细嚼还是意犹未尽。今天是小周末，权作茶座思想欣赏吧。 Chinese doctors are under threat 威胁下生存的中国医生许锐恒译 Editorial，The Lancet, Vol 376, 9742, 657；28 August 2010-3 September 2010 社论，柳叶刀， 376卷，9742期，657页， 2010年8月28日～9月3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. 体制改革，是8月18日至21日在中国深圳召开的世界抗癌大会的主题，也是中国卫生部部长陈竺在开幕致辞介绍当前中国医药卫生体制改革的主要内容。会上许多国际卫生政策的制定者和医生参与讨论体制改革的架构与实施，但没有中国本土医生参与讨论。 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. 与出席病人诊疗分会的人数比，参与体制改革全会的中国代表为何如此之少，要弄明白这问题，必须首先明白，许多中国医生更关心自身的安全问题。中国医生常常是恐怖暴力的受害者。 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. 社论，柳叶刀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. 中国的大多数医院，尤其是大型医院，如北京协和医学院医院和复旦大学华山医院，都是政府管办的。1985年前中国的公立医院享受政府的全额拨款。自经济改革后，现在医院得到的政府财政支持十分有限，结果是医院必须搞创收来补偿成本费用。因医院收入的主要来源是诊断与治疗，由此产生了创收激励政策，便出现过度检查与过度治疗。 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. 为了避免不恰当的利益冲突，中国政府通过法律阻止医生接受医药公司的金钱回扣。由于中国医生的基准工资水平有点抱歉，即使按中国的标准，因此在中国经济高速发展的环境下，许多中国医生努力去权衡职业道德和维持收支相抵。这种压力，加上觉得自身价值被政府和全社会严重低估，促使许多医生改行进入其他职业。 China’s health-system reforms cannot be successful without reforming the social and economic status of doctors. Chinese doctors should be involved more in， 376 shaping health policy, by giving voice to their own experiences and constructive ideas about the health system. 不改善医生的社会和经济地位，中国医药卫生体制改革将不会成功。中国医生应该更多参与卫生政策的制订，就医药卫生体制方面根据自己的经历发言和提出建设性意见。 卷，9742the 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. 中国的大多数医院，尤其是大型医院，如北京协和医学院医院和复旦大学华山医院，都是政府管办的。1985年前中国的公立医院享受政府的全额拨款。自经济改革后，现在医院得到的政府财政支持十分有限，结果是医院必须搞创收来补偿成本费用。因医院收入的主要来源是诊断与治疗，由此产生了创收激励政策，便出现过度检查与过度治疗。 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. 为了避免不恰当的利益冲突，中国政府通过法律阻止医生接受医药公司的金钱回扣。由于中国医生的基准工资水平有点抱歉，即使按中国的标准，因此在中国经济高速发展的环境下，许多中国医生努力去权衡职业道德和维持收支相抵。这种压力，加上觉得自身价值被政府和全社会严重低估，促使许多医生改行进入其他职业。 China’s health-system reforms cannot be successful without reforming the social and economic status of doctors. Chinese doctors should be involved more in期，657Thus, 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6月，山东省一名医生和一名护士遭一名13 年前因肝癌死亡的患者的儿子致命性的刺伤，福建省一名儿科医生为躲避自己经治的死亡新生儿的愤怒亲属，从5楼窗口跳下而受伤。因此，7月沈阳27家医院聘请警官担任副院长也就不足为奇了。随着医院变成战场，在中国当医生已成为一种危险的职业。 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? 这个问题可能主要是观念的问题。许多中国患者认为医生和医院共谋，通过提供不必要的检查、检验和治疗来增加收费。此外，一些医生违规接受红包（现金礼物，以换取有利的服务）。许多患者将自身的健康恶化直接归咎于医生，并断言医生缺乏敬业精神与专业技能。古代中国的知识分子的理想是“不为良相，当为良医”，而现代中国的医生与护士曾被尊崇为“白衣天使”。为何今天中国医生的形象变得如此糟糕？ 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页， 2010 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. 中国媒体在激化医患紧张关系上无疑起重要作用。报纸、电视与互联网过度报道医疗卫生专业人员如何欺骗患者。就在几周前，《南方都市报》（广东最流行的报纸）不实指责一名助产士，为一产后患者治疗痔疮时故意缝闭了患者的肛门。2009年11月，中国最具权威的媒体之一CCTV（中国中央电视台）报道了著名的北京大学第一医院非法行医，允许医学生做外科手术而导致一名患者死亡。 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 hospital 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. 尽管医院和卫生部已澄清医科学生在有执业资格的医生指导下参与包括外科手术在内的临床工作是合法的，但医生与医院的信誉已严重受损。很难说清楚上述错误报导的原因是《南方都市报》和CCTV缺乏医学知识，还是刻意追求耸人听闻的故事。不管怎样，公众对医学职业的误解，肯定最终受伤害的是医生和患者双方。 Most hospitals in China, especially 年8Thus, 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6月，山东省一名医生和一名护士遭一名13 年前因肝癌死亡的患者的儿子致命性的刺伤，福建省一名儿科医生为躲避自己经治的死亡新生儿的愤怒亲属，从5楼窗口跳下而受伤。因此，7月沈阳27家医院聘请警官担任副院长也就不足为奇了。随着医院变成战场，在中国当医生已成为一种危险的职业。 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? 这个问题可能主要是观念的问题。许多中国患者认为医生和医院共谋，通过提供不必要的检查、检验和治疗来增加收费。此外，一些医生违规接受红包（现金礼物，以换取有利的服务）。许多患者将自身的健康恶化直接归咎于医生，并断言医生缺乏敬业精神与专业技能。古代中国的知识分子的理想是“不为良相，当为良医”，而现代中国的医生与护士曾被尊崇为“白衣天使”。为何今天中国医生的形象变得如此糟糕？ 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月28the 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. 中国的大多数医院，尤其是大型医院，如北京协和医学院医院和复旦大学华山医院，都是政府管办的。1985年前中国的公立医院享受政府的全额拨款。自经济改革后，现在医院得到的政府财政支持十分有限，结果是医院必须搞创收来补偿成本费用。因医院收入的主要来源是诊断与治疗，由此产生了创收激励政策，便出现过度检查与过度治疗。 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. 为了避免不恰当的利益冲突，中国政府通过法律阻止医生接受医药公司的金钱回扣。由于中国医生的基准工资水平有点抱歉，即使按中国的标准，因此在中国经济高速发展的环境下，许多中国医生努力去权衡职业道德和维持收支相抵。这种压力，加上觉得自身价值被政府和全社会严重低估，促使许多医生改行进入其他职业。 China’s health-system reforms cannot be successful without reforming the social and economic status of doctors. Chinese doctors should be involved more in日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6月，山东省一名医生和一名护士遭一名13 年前因肝癌死亡的患者的儿子致命性的刺伤，福建省一名儿科医生为躲避自己经治的死亡新生儿的愤怒亲属，从5楼窗口跳下而受伤。因此，7月沈阳27家医院聘请警官担任副院长也就不足为奇了。随着医院变成战场，在中国当医生已成为一种危险的职业。 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? 这个问题可能主要是观念的问题。许多中国患者认为医生和医院共谋，通过提供不必要的检查、检验和治疗来增加收费。此外，一些医生违规接受红包（现金礼物，以换取有利的服务）。许多患者将自身的健康恶化直接归咎于医生，并断言医生缺乏敬业精神与专业技能。古代中国的知识分子的理想是“不为良相，当为良医”，而现代中国的医生与护士曾被尊崇为“白衣天使”。为何今天中国医生的形象变得如此糟糕？ 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～9 shaping health policy, by giving voice to their own experiences and constructive ideas about the health system. 不改善医生的社会和经济地位，中国医药卫生体制改革将不会成功。中国医生应该更多参与卫生政策的制订，就医药卫生体制方面根据自己的经历发言和提出建设性意见。 月3 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. 中国媒体在激化医患紧张关系上无疑起重要作用。报纸、电视与互联网过度报道医疗卫生专业人员如何欺骗患者。就在几周前，《南方都市报》（广东最流行的报纸）不实指责一名助产士，为一产后患者治疗痔疮时故意缝闭了患者的肛门。2009年11月，中国最具权威的媒体之一CCTV（中国中央电视台）报道了著名的北京大学第一医院非法行医，允许医学生做外科手术而导致一名患者死亡。 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 hospital 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. 尽管医院和卫生部已澄清医科学生在有执业资格的医生指导下参与包括外科手术在内的临床工作是合法的，但医生与医院的信誉已严重受损。很难说清楚上述错误报导的原因是《南方都市报》和CCTV缺乏医学知识，还是刻意追求耸人听闻的故事。不管怎样，公众对医学职业的误解，肯定最终受伤害的是医生和患者双方。 Most hospitals in China, especially 日
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6月，山东省一名医生和一名护士遭一名13 年前因肝癌死亡的患者的儿子致命性的刺伤，福建省一名儿科医生为躲避自己经治的死亡新生儿的愤怒亲属，从5楼窗口跳下而受伤。因此，7月沈阳27家医院聘请警官担任副院长也就不足为奇了。随着医院变成战场，在中国当医生已成为一种危险的职业。 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? 这个问题可能主要是观念的问题。许多中国患者认为医生和医院共谋，通过提供不必要的检查、检验和治疗来增加收费。此外，一些医生违规接受红包（现金礼物，以换取有利的服务）。许多患者将自身的健康恶化直接归咎于医生，并断言医生缺乏敬业精神与专业技能。古代中国的知识分子的理想是“不为良相，当为良医”，而现代中国的医生与护士曾被尊崇为“白衣天使”。为何今天中国医生的形象变得如此糟糕？ 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
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.
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. 中国媒体在激化医患紧张关系上无疑起重要作用。报纸、电视与互联网过度报道医疗卫生专业人员如何欺骗患者。就在几周前，《南方都市报》（广东最流行的报纸）不实指责一名助产士，为一产后患者治疗痔疮时故意缝闭了患者的肛门。2009年11月，中国最具权威的媒体之一CCTV（中国中央电视台）报道了著名的北京大学第一医院非法行医，允许医学生做外科手术而导致一名患者死亡。 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 hospital 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. 尽管医院和卫生部已澄清医科学生在有执业资格的医生指导下参与包括外科手术在内的临床工作是合法的，但医生与医院的信誉已严重受损。很难说清楚上述错误报导的原因是《南方都市报》和CCTV缺乏医学知识，还是刻意追求耸人听闻的故事。不管怎样，公众对医学职业的误解，肯定最终受伤害的是医生和患者双方。 Most hospitals in China, especially
以下是一年前发表在国际知名学术杂志《柳叶刀》的一篇文章，也许很多人都看过，不过再细嚼还是意犹未尽。今天是小周末，权作茶座思想欣赏吧。 Chinese doctors are under threat 威胁下生存的中国医生许锐恒译 Editorial，The Lancet, Vol 376, 9742, 657；28 August 2010-3 September 2010 社论，柳叶刀， 376卷，9742期，657页， 2010年8月28日～9月3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. 体制改革，是8月18日至21日在中国深圳召开的世界抗癌大会的主题，也是中国卫生部部长陈竺在开幕致辞介绍当前中国医药卫生体制改革的主要内容。会上许多国际卫生政策的制定者和医生参与讨论体制改革的架构与实施，但没有中国本土医生参与讨论。 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. 与出席病人诊疗分会的人数比，参与体制改革全会的中国代表为何如此之少，要弄明白这问题，必须首先明白，许多中国医生更关心自身的安全问题。中国医生常常是恐怖暴力的受害者。 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. 体制改革，是8the 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. 中国的大多数医院，尤其是大型医院，如北京协和医学院医院和复旦大学华山医院，都是政府管办的。1985年前中国的公立医院享受政府的全额拨款。自经济改革后，现在医院得到的政府财政支持十分有限，结果是医院必须搞创收来补偿成本费用。因医院收入的主要来源是诊断与治疗，由此产生了创收激励政策，便出现过度检查与过度治疗。 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. 为了避免不恰当的利益冲突，中国政府通过法律阻止医生接受医药公司的金钱回扣。由于中国医生的基准工资水平有点抱歉，即使按中国的标准，因此在中国经济高速发展的环境下，许多中国医生努力去权衡职业道德和维持收支相抵。这种压力，加上觉得自身价值被政府和全社会严重低估，促使许多医生改行进入其他职业。 China’s health-system reforms cannot be successful without reforming the social and economic status of doctors. Chinese doctors should be involved more in月18 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. 中国媒体在激化医患紧张关系上无疑起重要作用。报纸、电视与互联网过度报道医疗卫生专业人员如何欺骗患者。就在几周前，《南方都市报》（广东最流行的报纸）不实指责一名助产士，为一产后患者治疗痔疮时故意缝闭了患者的肛门。2009年11月，中国最具权威的媒体之一CCTV（中国中央电视台）报道了著名的北京大学第一医院非法行医，允许医学生做外科手术而导致一名患者死亡。 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 hospital 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. 尽管医院和卫生部已澄清医科学生在有执业资格的医生指导下参与包括外科手术在内的临床工作是合法的，但医生与医院的信誉已严重受损。很难说清楚上述错误报导的原因是《南方都市报》和CCTV缺乏医学知识，还是刻意追求耸人听闻的故事。不管怎样，公众对医学职业的误解，肯定最终受伤害的是医生和患者双方。 Most hospitals in China, especially 日至 shaping health policy, by giving voice to their own experiences and constructive ideas about the health system. 不改善医生的社会和经济地位，中国医药卫生体制改革将不会成功。中国医生应该更多参与卫生政策的制订，就医药卫生体制方面根据自己的经历发言和提出建设性意见。 21日在中国深圳召开的世界抗癌大会的主题，也是中国卫生部部长陈竺在开幕致辞介绍当前中国医药卫生体制改革的主要内容。会上许多国际卫生政策的制定者和医生参与讨论体制改革的架构与实施，但没有中国本土医生参与讨论。
shaping health policy, by giving voice to their own experiences and constructive ideas about the health system. 不改善医生的社会和经济地位，中国医药卫生体制改革将不会成功。中国医生应该更多参与卫生政策的制订，就医药卫生体制方面根据自己的经历发言和提出建设性意见。
以下是一年前发表在国际知名学术杂志《柳叶刀》的一篇文章，也许很多人都看过，不过再细嚼还是意犹未尽。今天是小周末，权作茶座思想欣赏吧。 Chinese doctors are under threat 威胁下生存的中国医生许锐恒译 Editorial，The Lancet, Vol 376, 9742, 657；28 August 2010-3 September 2010 社论，柳叶刀， 376卷，9742期，657页， 2010年8月28日～9月3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. 体制改革，是8月18日至21日在中国深圳召开的世界抗癌大会的主题，也是中国卫生部部长陈竺在开幕致辞介绍当前中国医药卫生体制改革的主要内容。会上许多国际卫生政策的制定者和医生参与讨论体制改革的架构与实施，但没有中国本土医生参与讨论。 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. 与出席病人诊疗分会的人数比，参与体制改革全会的中国代表为何如此之少，要弄明白这问题，必须首先明白，许多中国医生更关心自身的安全问题。中国医生常常是恐怖暴力的受害者。 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. 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.
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6月，山东省一名医生和一名护士遭一名13 年前因肝癌死亡的患者的儿子致命性的刺伤，福建省一名儿科医生为躲避自己经治的死亡新生儿的愤怒亲属，从5楼窗口跳下而受伤。因此，7月沈阳27家医院聘请警官担任副院长也就不足为奇了。随着医院变成战场，在中国当医生已成为一种危险的职业。 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? 这个问题可能主要是观念的问题。许多中国患者认为医生和医院共谋，通过提供不必要的检查、检验和治疗来增加收费。此外，一些医生违规接受红包（现金礼物，以换取有利的服务）。许多患者将自身的健康恶化直接归咎于医生，并断言医生缺乏敬业精神与专业技能。古代中国的知识分子的理想是“不为良相，当为良医”，而现代中国的医生与护士曾被尊崇为“白衣天使”。为何今天中国医生的形象变得如此糟糕？ 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
与出席病人诊疗分会的人数比，参与体制改革全会的中国代表为何如此之少，要弄明白这问题，必须首先明白，许多中国医生更关心自身的安全问题。中国医生常常是恐怖暴力的受害者。
shaping health policy, by giving voice to their own experiences and constructive ideas about the health system. 不改善医生的社会和经济地位，中国医药卫生体制改革将不会成功。中国医生应该更多参与卫生政策的制订，就医药卫生体制方面根据自己的经历发言和提出建设性意见。
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.
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. 中国媒体在激化医患紧张关系上无疑起重要作用。报纸、电视与互联网过度报道医疗卫生专业人员如何欺骗患者。就在几周前，《南方都市报》（广东最流行的报纸）不实指责一名助产士，为一产后患者治疗痔疮时故意缝闭了患者的肛门。2009年11月，中国最具权威的媒体之一CCTV（中国中央电视台）报道了著名的北京大学第一医院非法行医，允许医学生做外科手术而导致一名患者死亡。 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 hospital 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. 尽管医院和卫生部已澄清医科学生在有执业资格的医生指导下参与包括外科手术在内的临床工作是合法的，但医生与医院的信誉已严重受损。很难说清楚上述错误报导的原因是《南方都市报》和CCTV缺乏医学知识，还是刻意追求耸人听闻的故事。不管怎样，公众对医学职业的误解，肯定最终受伤害的是医生和患者双方。 Most hospitals in China, especially
今年 以下是一年前发表在国际知名学术杂志《柳叶刀》的一篇文章，也许很多人都看过，不过再细嚼还是意犹未尽。今天是小周末，权作茶座思想欣赏吧。 Chinese doctors are under threat 威胁下生存的中国医生许锐恒译 Editorial，The Lancet, Vol 376, 9742, 657；28 August 2010-3 September 2010 社论，柳叶刀， 376卷，9742期，657页， 2010年8月28日～9月3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. 体制改革，是8月18日至21日在中国深圳召开的世界抗癌大会的主题，也是中国卫生部部长陈竺在开幕致辞介绍当前中国医药卫生体制改革的主要内容。会上许多国际卫生政策的制定者和医生参与讨论体制改革的架构与实施，但没有中国本土医生参与讨论。 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. 与出席病人诊疗分会的人数比，参与体制改革全会的中国代表为何如此之少，要弄明白这问题，必须首先明白，许多中国医生更关心自身的安全问题。中国医生常常是恐怖暴力的受害者。 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. 6月， 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. 中国媒体在激化医患紧张关系上无疑起重要作用。报纸、电视与互联网过度报道医疗卫生专业人员如何欺骗患者。就在几周前，《南方都市报》（广东最流行的报纸）不实指责一名助产士，为一产后患者治疗痔疮时故意缝闭了患者的肛门。2009年11月，中国最具权威的媒体之一CCTV（中国中央电视台）报道了著名的北京大学第一医院非法行医，允许医学生做外科手术而导致一名患者死亡。 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 hospital 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. 尽管医院和卫生部已澄清医科学生在有执业资格的医生指导下参与包括外科手术在内的临床工作是合法的，但医生与医院的信誉已严重受损。很难说清楚上述错误报导的原因是《南方都市报》和CCTV缺乏医学知识，还是刻意追求耸人听闻的故事。不管怎样，公众对医学职业的误解，肯定最终受伤害的是医生和患者双方。 Most hospitals in China, especially 山东省一名医生和一名护士遭一名13 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. 中国媒体在激化医患紧张关系上无疑起重要作用。报纸、电视与互联网过度报道医疗卫生专业人员如何欺骗患者。就在几周前，《南方都市报》（广东最流行的报纸）不实指责一名助产士，为一产后患者治疗痔疮时故意缝闭了患者的肛门。2009年11月，中国最具权威的媒体之一CCTV（中国中央电视台）报道了著名的北京大学第一医院非法行医，允许医学生做外科手术而导致一名患者死亡。 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 hospital 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. 尽管医院和卫生部已澄清医科学生在有执业资格的医生指导下参与包括外科手术在内的临床工作是合法的，但医生与医院的信誉已严重受损。很难说清楚上述错误报导的原因是《南方都市报》和CCTV缺乏医学知识，还是刻意追求耸人听闻的故事。不管怎样，公众对医学职业的误解，肯定最终受伤害的是医生和患者双方。 Most hospitals in China, especially 年前因肝癌死亡的患者的儿子致命性的刺伤，福建省一名儿科医生为躲避自己经治的死亡新生儿的愤怒亲属，从5 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. 中国媒体在激化医患紧张关系上无疑起重要作用。报纸、电视与互联网过度报道医疗卫生专业人员如何欺骗患者。就在几周前，《南方都市报》（广东最流行的报纸）不实指责一名助产士，为一产后患者治疗痔疮时故意缝闭了患者的肛门。2009年11月，中国最具权威的媒体之一CCTV（中国中央电视台）报道了著名的北京大学第一医院非法行医，允许医学生做外科手术而导致一名患者死亡。 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 hospital 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. 尽管医院和卫生部已澄清医科学生在有执业资格的医生指导下参与包括外科手术在内的临床工作是合法的，但医生与医院的信誉已严重受损。很难说清楚上述错误报导的原因是《南方都市报》和CCTV缺乏医学知识，还是刻意追求耸人听闻的故事。不管怎样，公众对医学职业的误解，肯定最终受伤害的是医生和患者双方。 Most hospitals in China, especially 楼窗口跳下而受伤。因此，7 以下是一年前发表在国际知名学术杂志《柳叶刀》的一篇文章，也许很多人都看过，不过再细嚼还是意犹未尽。今天是小周末，权作茶座思想欣赏吧。 Chinese doctors are under threat 威胁下生存的中国医生许锐恒译 Editorial，The Lancet, Vol 376, 9742, 657；28 August 2010-3 September 2010 社论，柳叶刀， 376卷，9742期，657页， 2010年8月28日～9月3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. 体制改革，是8月18日至21日在中国深圳召开的世界抗癌大会的主题，也是中国卫生部部长陈竺在开幕致辞介绍当前中国医药卫生体制改革的主要内容。会上许多国际卫生政策的制定者和医生参与讨论体制改革的架构与实施，但没有中国本土医生参与讨论。 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. 与出席病人诊疗分会的人数比，参与体制改革全会的中国代表为何如此之少，要弄明白这问题，必须首先明白，许多中国医生更关心自身的安全问题。中国医生常常是恐怖暴力的受害者。 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. 月沈阳27 shaping health policy, by giving voice to their own experiences and constructive ideas about the health system. 不改善医生的社会和经济地位，中国医药卫生体制改革将不会成功。中国医生应该更多参与卫生政策的制订，就医药卫生体制方面根据自己的经历发言和提出建设性意见。 家医院聘请警官担任副院长也就不足为奇了。随着医院变成战场，在中国当医生已成为一种危险的职业。
shaping health policy, by giving voice to their own experiences and constructive ideas about the health system. 不改善医生的社会和经济地位，中国医药卫生体制改革将不会成功。中国医生应该更多参与卫生政策的制订，就医药卫生体制方面根据自己的经历发言和提出建设性意见。
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?
以下是一年前发表在国际知名学术杂志《柳叶刀》的一篇文章，也许很多人都看过，不过再细嚼还是意犹未尽。今天是小周末，权作茶座思想欣赏吧。 Chinese doctors are under threat 威胁下生存的中国医生许锐恒译 Editorial，The Lancet, Vol 376, 9742, 657；28 August 2010-3 September 2010 社论，柳叶刀， 376卷，9742期，657页， 2010年8月28日～9月3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. 体制改革，是8月18日至21日在中国深圳召开的世界抗癌大会的主题，也是中国卫生部部长陈竺在开幕致辞介绍当前中国医药卫生体制改革的主要内容。会上许多国际卫生政策的制定者和医生参与讨论体制改革的架构与实施，但没有中国本土医生参与讨论。 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. 与出席病人诊疗分会的人数比，参与体制改革全会的中国代表为何如此之少，要弄明白这问题，必须首先明白，许多中国医生更关心自身的安全问题。中国医生常常是恐怖暴力的受害者。 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.
以下是一年前发表在国际知名学术杂志《柳叶刀》的一篇文章，也许很多人都看过，不过再细嚼还是意犹未尽。今天是小周末，权作茶座思想欣赏吧。 Chinese doctors are under threat 威胁下生存的中国医生许锐恒译 Editorial，The Lancet, Vol 376, 9742, 657；28 August 2010-3 September 2010 社论，柳叶刀， 376卷，9742期，657页， 2010年8月28日～9月3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. 体制改革，是8月18日至21日在中国深圳召开的世界抗癌大会的主题，也是中国卫生部部长陈竺在开幕致辞介绍当前中国医药卫生体制改革的主要内容。会上许多国际卫生政策的制定者和医生参与讨论体制改革的架构与实施，但没有中国本土医生参与讨论。 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. 与出席病人诊疗分会的人数比，参与体制改革全会的中国代表为何如此之少，要弄明白这问题，必须首先明白，许多中国医生更关心自身的安全问题。中国医生常常是恐怖暴力的受害者。 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.
这个问题可能主要是观念的问题。许多中国患者认为医生和医院共谋，通过提供不必要的检查、检验和治疗来增加收费。此外，一些医生违规接受红包（现金礼物，以换取有利的服务）。许多患者将自身的健康恶化直接归咎于医生，并断言医生缺乏敬业精神与专业技能。古代中国的知识分子的理想是“不为良相，当为良医”，而现代中国的医生与护士曾被尊崇为“白衣天使”。为何今天中国医生的形象变得如此糟糕？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. 中国的大多数医院，尤其是大型医院，如北京协和医学院医院和复旦大学华山医院，都是政府管办的。1985年前中国的公立医院享受政府的全额拨款。自经济改革后，现在医院得到的政府财政支持十分有限，结果是医院必须搞创收来补偿成本费用。因医院收入的主要来源是诊断与治疗，由此产生了创收激励政策，便出现过度检查与过度治疗。 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. 为了避免不恰当的利益冲突，中国政府通过法律阻止医生接受医药公司的金钱回扣。由于中国医生的基准工资水平有点抱歉，即使按中国的标准，因此在中国经济高速发展的环境下，许多中国医生努力去权衡职业道德和维持收支相抵。这种压力，加上觉得自身价值被政府和全社会严重低估，促使许多医生改行进入其他职业。 China’s health-system reforms cannot be successful without reforming the social and economic status of doctors. Chinese doctors should be involved more in
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. 中国的大多数医院，尤其是大型医院，如北京协和医学院医院和复旦大学华山医院，都是政府管办的。1985年前中国的公立医院享受政府的全额拨款。自经济改革后，现在医院得到的政府财政支持十分有限，结果是医院必须搞创收来补偿成本费用。因医院收入的主要来源是诊断与治疗，由此产生了创收激励政策，便出现过度检查与过度治疗。 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. 为了避免不恰当的利益冲突，中国政府通过法律阻止医生接受医药公司的金钱回扣。由于中国医生的基准工资水平有点抱歉，即使按中国的标准，因此在中国经济高速发展的环境下，许多中国医生努力去权衡职业道德和维持收支相抵。这种压力，加上觉得自身价值被政府和全社会严重低估，促使许多医生改行进入其他职业。 China’s health-system reforms cannot be successful without reforming the social and economic status of doctors. Chinese doctors should be involved more in
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.
shaping health policy, by giving voice to their own experiences and constructive ideas about the health system. 不改善医生的社会和经济地位，中国医药卫生体制改革将不会成功。中国医生应该更多参与卫生政策的制订，就医药卫生体制方面根据自己的经历发言和提出建设性意见。
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. 中国的大多数医院，尤其是大型医院，如北京协和医学院医院和复旦大学华山医院，都是政府管办的。1985年前中国的公立医院享受政府的全额拨款。自经济改革后，现在医院得到的政府财政支持十分有限，结果是医院必须搞创收来补偿成本费用。因医院收入的主要来源是诊断与治疗，由此产生了创收激励政策，便出现过度检查与过度治疗。 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. 为了避免不恰当的利益冲突，中国政府通过法律阻止医生接受医药公司的金钱回扣。由于中国医生的基准工资水平有点抱歉，即使按中国的标准，因此在中国经济高速发展的环境下，许多中国医生努力去权衡职业道德和维持收支相抵。这种压力，加上觉得自身价值被政府和全社会严重低估，促使许多医生改行进入其他职业。 China’s health-system reforms cannot be successful without reforming the social and economic status of doctors. Chinese doctors should be involved more in中国媒体在激化医患紧张关系上无疑起重要作用。报纸、电视与互联网过度报道医疗卫生专业人员如何欺骗患者。就在几周前，《南方都市报》（广东最流行的报纸）不实指责一名助产士，为一产后患者治疗痔疮时故意缝闭了患者的肛门。2009 以下是一年前发表在国际知名学术杂志《柳叶刀》的一篇文章，也许很多人都看过，不过再细嚼还是意犹未尽。今天是小周末，权作茶座思想欣赏吧。 Chinese doctors are under threat 威胁下生存的中国医生许锐恒译 Editorial，The Lancet, Vol 376, 9742, 657；28 August 2010-3 September 2010 社论，柳叶刀， 376卷，9742期，657页， 2010年8月28日～9月3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. 体制改革，是8月18日至21日在中国深圳召开的世界抗癌大会的主题，也是中国卫生部部长陈竺在开幕致辞介绍当前中国医药卫生体制改革的主要内容。会上许多国际卫生政策的制定者和医生参与讨论体制改革的架构与实施，但没有中国本土医生参与讨论。 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. 与出席病人诊疗分会的人数比，参与体制改革全会的中国代表为何如此之少，要弄明白这问题，必须首先明白，许多中国医生更关心自身的安全问题。中国医生常常是恐怖暴力的受害者。 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. 年11 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. 中国媒体在激化医患紧张关系上无疑起重要作用。报纸、电视与互联网过度报道医疗卫生专业人员如何欺骗患者。就在几周前，《南方都市报》（广东最流行的报纸）不实指责一名助产士，为一产后患者治疗痔疮时故意缝闭了患者的肛门。2009年11月，中国最具权威的媒体之一CCTV（中国中央电视台）报道了著名的北京大学第一医院非法行医，允许医学生做外科手术而导致一名患者死亡。 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 hospital 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. 尽管医院和卫生部已澄清医科学生在有执业资格的医生指导下参与包括外科手术在内的临床工作是合法的，但医生与医院的信誉已严重受损。很难说清楚上述错误报导的原因是《南方都市报》和CCTV缺乏医学知识，还是刻意追求耸人听闻的故事。不管怎样，公众对医学职业的误解，肯定最终受伤害的是医生和患者双方。 Most hospitals in China, especially 月，中国最具权威的媒体之一CCTV 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. 中国媒体在激化医患紧张关系上无疑起重要作用。报纸、电视与互联网过度报道医疗卫生专业人员如何欺骗患者。就在几周前，《南方都市报》（广东最流行的报纸）不实指责一名助产士，为一产后患者治疗痔疮时故意缝闭了患者的肛门。2009年11月，中国最具权威的媒体之一CCTV（中国中央电视台）报道了著名的北京大学第一医院非法行医，允许医学生做外科手术而导致一名患者死亡。 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 hospital 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. 尽管医院和卫生部已澄清医科学生在有执业资格的医生指导下参与包括外科手术在内的临床工作是合法的，但医生与医院的信誉已严重受损。很难说清楚上述错误报导的原因是《南方都市报》和CCTV缺乏医学知识，还是刻意追求耸人听闻的故事。不管怎样，公众对医学职业的误解，肯定最终受伤害的是医生和患者双方。 Most hospitals in China, especially （中国中央电视台）报道了著名的北京大学第一医院非法行医，允许医学生做外科手术而导致一名患者死亡。
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6月，山东省一名医生和一名护士遭一名13 年前因肝癌死亡的患者的儿子致命性的刺伤，福建省一名儿科医生为躲避自己经治的死亡新生儿的愤怒亲属，从5楼窗口跳下而受伤。因此，7月沈阳27家医院聘请警官担任副院长也就不足为奇了。随着医院变成战场，在中国当医生已成为一种危险的职业。 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? 这个问题可能主要是观念的问题。许多中国患者认为医生和医院共谋，通过提供不必要的检查、检验和治疗来增加收费。此外，一些医生违规接受红包（现金礼物，以换取有利的服务）。许多患者将自身的健康恶化直接归咎于医生，并断言医生缺乏敬业精神与专业技能。古代中国的知识分子的理想是“不为良相，当为良医”，而现代中国的医生与护士曾被尊崇为“白衣天使”。为何今天中国医生的形象变得如此糟糕？ 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
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 hospital 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.
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. 中国的大多数医院，尤其是大型医院，如北京协和医学院医院和复旦大学华山医院，都是政府管办的。1985年前中国的公立医院享受政府的全额拨款。自经济改革后，现在医院得到的政府财政支持十分有限，结果是医院必须搞创收来补偿成本费用。因医院收入的主要来源是诊断与治疗，由此产生了创收激励政策，便出现过度检查与过度治疗。 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. 为了避免不恰当的利益冲突，中国政府通过法律阻止医生接受医药公司的金钱回扣。由于中国医生的基准工资水平有点抱歉，即使按中国的标准，因此在中国经济高速发展的环境下，许多中国医生努力去权衡职业道德和维持收支相抵。这种压力，加上觉得自身价值被政府和全社会严重低估，促使许多医生改行进入其他职业。 China’s health-system reforms cannot be successful without reforming the social and economic status of doctors. Chinese doctors should be involved more in
以下是一年前发表在国际知名学术杂志《柳叶刀》的一篇文章，也许很多人都看过，不过再细嚼还是意犹未尽。今天是小周末，权作茶座思想欣赏吧。 Chinese doctors are under threat 威胁下生存的中国医生许锐恒译 Editorial，The Lancet, Vol 376, 9742, 657；28 August 2010-3 September 2010 社论，柳叶刀， 376卷，9742期，657页， 2010年8月28日～9月3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. 体制改革，是8月18日至21日在中国深圳召开的世界抗癌大会的主题，也是中国卫生部部长陈竺在开幕致辞介绍当前中国医药卫生体制改革的主要内容。会上许多国际卫生政策的制定者和医生参与讨论体制改革的架构与实施，但没有中国本土医生参与讨论。 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. 与出席病人诊疗分会的人数比，参与体制改革全会的中国代表为何如此之少，要弄明白这问题，必须首先明白，许多中国医生更关心自身的安全问题。中国医生常常是恐怖暴力的受害者。 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. 尽管医院和卫生部已澄清医科学生在有执业资格的医生指导下参与包括外科手术在内的临床工作是合法的，但医生与医院的信誉已严重受损。很难说清楚上述错误报导的原因是《南方都市报》和CCTVThus, 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6月，山东省一名医生和一名护士遭一名13 年前因肝癌死亡的患者的儿子致命性的刺伤，福建省一名儿科医生为躲避自己经治的死亡新生儿的愤怒亲属，从5楼窗口跳下而受伤。因此，7月沈阳27家医院聘请警官担任副院长也就不足为奇了。随着医院变成战场，在中国当医生已成为一种危险的职业。 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? 这个问题可能主要是观念的问题。许多中国患者认为医生和医院共谋，通过提供不必要的检查、检验和治疗来增加收费。此外，一些医生违规接受红包（现金礼物，以换取有利的服务）。许多患者将自身的健康恶化直接归咎于医生，并断言医生缺乏敬业精神与专业技能。古代中国的知识分子的理想是“不为良相，当为良医”，而现代中国的医生与护士曾被尊崇为“白衣天使”。为何今天中国医生的形象变得如此糟糕？ 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缺乏医学知识，还是刻意追求耸人听闻的故事。不管怎样，公众对医学职业的误解，肯定最终受伤害的是医生和患者双方。
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6月，山东省一名医生和一名护士遭一名13 年前因肝癌死亡的患者的儿子致命性的刺伤，福建省一名儿科医生为躲避自己经治的死亡新生儿的愤怒亲属，从5楼窗口跳下而受伤。因此，7月沈阳27家医院聘请警官担任副院长也就不足为奇了。随着医院变成战场，在中国当医生已成为一种危险的职业。 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? 这个问题可能主要是观念的问题。许多中国患者认为医生和医院共谋，通过提供不必要的检查、检验和治疗来增加收费。此外，一些医生违规接受红包（现金礼物，以换取有利的服务）。许多患者将自身的健康恶化直接归咎于医生，并断言医生缺乏敬业精神与专业技能。古代中国的知识分子的理想是“不为良相，当为良医”，而现代中国的医生与护士曾被尊崇为“白衣天使”。为何今天中国医生的形象变得如此糟糕？ 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
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.
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6月，山东省一名医生和一名护士遭一名13 年前因肝癌死亡的患者的儿子致命性的刺伤，福建省一名儿科医生为躲避自己经治的死亡新生儿的愤怒亲属，从5楼窗口跳下而受伤。因此，7月沈阳27家医院聘请警官担任副院长也就不足为奇了。随着医院变成战场，在中国当医生已成为一种危险的职业。 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? 这个问题可能主要是观念的问题。许多中国患者认为医生和医院共谋，通过提供不必要的检查、检验和治疗来增加收费。此外，一些医生违规接受红包（现金礼物，以换取有利的服务）。许多患者将自身的健康恶化直接归咎于医生，并断言医生缺乏敬业精神与专业技能。古代中国的知识分子的理想是“不为良相，当为良医”，而现代中国的医生与护士曾被尊崇为“白衣天使”。为何今天中国医生的形象变得如此糟糕？ 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
以下是一年前发表在国际知名学术杂志《柳叶刀》的一篇文章，也许很多人都看过，不过再细嚼还是意犹未尽。今天是小周末，权作茶座思想欣赏吧。 Chinese doctors are under threat 威胁下生存的中国医生许锐恒译 Editorial，The Lancet, Vol 376, 9742, 657；28 August 2010-3 September 2010 社论，柳叶刀， 376卷，9742期，657页， 2010年8月28日～9月3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. 体制改革，是8月18日至21日在中国深圳召开的世界抗癌大会的主题，也是中国卫生部部长陈竺在开幕致辞介绍当前中国医药卫生体制改革的主要内容。会上许多国际卫生政策的制定者和医生参与讨论体制改革的架构与实施，但没有中国本土医生参与讨论。 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. 与出席病人诊疗分会的人数比，参与体制改革全会的中国代表为何如此之少，要弄明白这问题，必须首先明白，许多中国医生更关心自身的安全问题。中国医生常常是恐怖暴力的受害者。 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.
中国的大多数医院，尤其是大型医院，如北京协和医学院医院和复旦大学华山医院，都是政府管办的。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. 中国的大多数医院，尤其是大型医院，如北京协和医学院医院和复旦大学华山医院，都是政府管办的。1985年前中国的公立医院享受政府的全额拨款。自经济改革后，现在医院得到的政府财政支持十分有限，结果是医院必须搞创收来补偿成本费用。因医院收入的主要来源是诊断与治疗，由此产生了创收激励政策，便出现过度检查与过度治疗。 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. 为了避免不恰当的利益冲突，中国政府通过法律阻止医生接受医药公司的金钱回扣。由于中国医生的基准工资水平有点抱歉，即使按中国的标准，因此在中国经济高速发展的环境下，许多中国医生努力去权衡职业道德和维持收支相抵。这种压力，加上觉得自身价值被政府和全社会严重低估，促使许多医生改行进入其他职业。 China’s health-system reforms cannot be successful without reforming the social and economic status of doctors. Chinese doctors should be involved more in1985年前中国的公立医院享受政府的全额拨款。自经济改革后，现在医院得到的政府财政支持十分有限，结果是医院必须搞创收来补偿成本费用。因医院收入的主要来源是诊断与治疗，由此产生了创收激励政策，便出现过度检查与过度治疗。
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. 中国的大多数医院，尤其是大型医院，如北京协和医学院医院和复旦大学华山医院，都是政府管办的。1985年前中国的公立医院享受政府的全额拨款。自经济改革后，现在医院得到的政府财政支持十分有限，结果是医院必须搞创收来补偿成本费用。因医院收入的主要来源是诊断与治疗，由此产生了创收激励政策，便出现过度检查与过度治疗。 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. 为了避免不恰当的利益冲突，中国政府通过法律阻止医生接受医药公司的金钱回扣。由于中国医生的基准工资水平有点抱歉，即使按中国的标准，因此在中国经济高速发展的环境下，许多中国医生努力去权衡职业道德和维持收支相抵。这种压力，加上觉得自身价值被政府和全社会严重低估，促使许多医生改行进入其他职业。 China’s health-system reforms cannot be successful without reforming the social and economic status of doctors. Chinese doctors should be involved more in
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. 中国的大多数医院，尤其是大型医院，如北京协和医学院医院和复旦大学华山医院，都是政府管办的。1985年前中国的公立医院享受政府的全额拨款。自经济改革后，现在医院得到的政府财政支持十分有限，结果是医院必须搞创收来补偿成本费用。因医院收入的主要来源是诊断与治疗，由此产生了创收激励政策，便出现过度检查与过度治疗。 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. 为了避免不恰当的利益冲突，中国政府通过法律阻止医生接受医药公司的金钱回扣。由于中国医生的基准工资水平有点抱歉，即使按中国的标准，因此在中国经济高速发展的环境下，许多中国医生努力去权衡职业道德和维持收支相抵。这种压力，加上觉得自身价值被政府和全社会严重低估，促使许多医生改行进入其他职业。 China’s health-system reforms cannot be successful without reforming the social and economic status of doctors. Chinese doctors should be involved more inTo 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.
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. 中国的大多数医院，尤其是大型医院，如北京协和医学院医院和复旦大学华山医院，都是政府管办的。1985年前中国的公立医院享受政府的全额拨款。自经济改革后，现在医院得到的政府财政支持十分有限，结果是医院必须搞创收来补偿成本费用。因医院收入的主要来源是诊断与治疗，由此产生了创收激励政策，便出现过度检查与过度治疗。 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. 为了避免不恰当的利益冲突，中国政府通过法律阻止医生接受医药公司的金钱回扣。由于中国医生的基准工资水平有点抱歉，即使按中国的标准，因此在中国经济高速发展的环境下，许多中国医生努力去权衡职业道德和维持收支相抵。这种压力，加上觉得自身价值被政府和全社会严重低估，促使许多医生改行进入其他职业。 China’s health-system reforms cannot be successful without reforming the social and economic status of doctors. Chinese doctors should be involved more in
为了避免不恰当的利益冲突，中国政府通过法律阻止医生接受医药公司的金钱回扣。由于中国医生的基准工资水平有点抱歉，即使按中国的标准，因此在中国经济高速发展的环境下，许多中国医生努力去权衡职业道德和维持收支相抵。这种压力，加上觉得自身价值被政府和全社会严重低估，促使许多医生改行进入其他职业。 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. 中国媒体在激化医患紧张关系上无疑起重要作用。报纸、电视与互联网过度报道医疗卫生专业人员如何欺骗患者。就在几周前，《南方都市报》（广东最流行的报纸）不实指责一名助产士，为一产后患者治疗痔疮时故意缝闭了患者的肛门。2009年11月，中国最具权威的媒体之一CCTV（中国中央电视台）报道了著名的北京大学第一医院非法行医，允许医学生做外科手术而导致一名患者死亡。 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 hospital 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. 尽管医院和卫生部已澄清医科学生在有执业资格的医生指导下参与包括外科手术在内的临床工作是合法的，但医生与医院的信誉已严重受损。很难说清楚上述错误报导的原因是《南方都市报》和CCTV缺乏医学知识，还是刻意追求耸人听闻的故事。不管怎样，公众对医学职业的误解，肯定最终受伤害的是医生和患者双方。 Most hospitals in China, especially
shaping health policy, by giving voice to their own experiences and constructive ideas about the health system. 不改善医生的社会和经济地位，中国医药卫生体制改革将不会成功。中国医生应该更多参与卫生政策的制订，就医药卫生体制方面根据自己的经历发言和提出建设性意见。
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.
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. 中国媒体在激化医患紧张关系上无疑起重要作用。报纸、电视与互联网过度报道医疗卫生专业人员如何欺骗患者。就在几周前，《南方都市报》（广东最流行的报纸）不实指责一名助产士，为一产后患者治疗痔疮时故意缝闭了患者的肛门。2009年11月，中国最具权威的媒体之一CCTV（中国中央电视台）报道了著名的北京大学第一医院非法行医，允许医学生做外科手术而导致一名患者死亡。 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 hospital 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. 尽管医院和卫生部已澄清医科学生在有执业资格的医生指导下参与包括外科手术在内的临床工作是合法的，但医生与医院的信誉已严重受损。很难说清楚上述错误报导的原因是《南方都市报》和CCTV缺乏医学知识，还是刻意追求耸人听闻的故事。不管怎样，公众对医学职业的误解，肯定最终受伤害的是医生和患者双方。 Most hospitals in China, especially
shaping health policy, by giving voice to their own experiences and constructive ideas about the health system. 不改善医生的社会和经济地位，中国医药卫生体制改革将不会成功。中国医生应该更多参与卫生政策的制订，就医药卫生体制方面根据自己的经历发言和提出建设性意见。
不改善医生的社会和经济地位，中国医药卫生体制改革将不会成功。中国医生应该更多参与卫生政策的制订，就医药卫生体制方面根据自己的经历发言和提出建设性意见。
shaping health policy, by giving voice to their own experiences and constructive ideas about the health system. 不改善医生的社会和经济地位，中国医药卫生体制改革将不会成功。中国医生应该更多参与卫生政策的制订，就医药卫生体制方面根据自己的经历发言和提出建设性意见。
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