2020年12月3日星期四

what does a hemorrhoids look like,The Lancet: The Threat Faced by Chinese Doctors

    Original source:

    https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61315-3/fulltext

    tangdl2000 free translation

    The World Anti-Cancer Congress was held in Shenzhen from August 18th to 21st. Minister of Health Chen Zhu introduced China's current medical and health system reform in his opening speech. System reform is also one of the themes of this conference. Although a large number of international medical and health policy makers and doctors have led discussions on the framework and regulations involved in the system reform, there are few voices from local doctors in China.

    Many Chinese delegates at the conference pay more attention to special reports involving patients and diseases, rather than plenary reports involving institutional reforms. One's own safety is the most concerned issue of Chinese doctors. Chinese doctors often fall victim to violence in medical disputes. In June this year, a doctor and a nurse in Shandong Province were stabbed to death by the son of a patient who died of liver cancer 13 years ago. In another case, a Fujian pediatrician jumped from a broken window on the 15th floor and escaped from a broken window on the 15th floor in order to avoid being besieged by the relatives of his dead newborn. Therefore, it is not surprising that in July this year, 27 hospitals in Shenyang hired police-cha as the vice president. When the hospital was surrounded by medical violence, doctors became a dangerous profession. One of the main reasons for the tension between doctors and patients is that many Chinese patients believe that doctors and hospitals have done unnecessary examinations, treatments and treatments on themselves, leading to increased medical expenses for patients. In addition, the illegal receipt of red packets by doctors has aggravated the occurrence of medical disputes and violence. Many patients blame the doctor for lack of love and professional skills, which directly leads to the deterioration of the patient's own condition. Doctor is a beautiful profession with a beautiful metaphor. For example, in ancient times, many people dreamed of becoming prime ministers or good doctors. In modern times, medical staff are called angels in white.

    Why has the status quo of Chinese doctors become so precarious? There is no doubt that the Chinese media have played an important role, and they have exacerbated the tensions in the doctor-patient relationship today. There are numerous reports on how health professionals and doctors deceive patients in newspapers, television, and the Internet. A few weeks ago, the influential Southern Metropolis Daily in Guangdong Province untruely reported that a middle-aged woman had a hemorrhoid surgery and had her anus sutured after giving birth. In November 2009, Chinese state media CC-TV reported that medical students of Peking University School of Medicine illegally practiced medical treatment, which resulted in the death of the patient after surgery. On the contrary, the hospital and the Ministry of Health stated that it is legal for medical students to perform surgical operations on patients under the supervision of doctors with medical licenses. Such false reports have seriously affected the reputation of doctors and hospitals. At present, in these two cases, it is difficult to judge whether it is the false report caused by the reporter's lack of medical knowledge, or whether the reporter and the media have deliberately made grandstanding. But the report caused misunderstandings among the public, and in the end it was the doctors and patients that hurt.

    In China, most hospitals, especially super-large hospitals, are government-run public hospitals. Public hospitals enjoyed full government funding before 1985. After the economic reform, hospitals received government financial subsidies drastically reduced, and hospitals need to increase revenue and reduce expenditure to support their operations. The main income of the hospital comes from diagnosis and examination. And hospitals have corresponding incentive policies to encourage such over-diagnosis and over-treatment. In order to avoid improper conflicts of interest, the Chinese government has issued laws prohibiting doctors from taking kickbacks from drug dealers. Even according to Chinese standards, the wages of Chinese doctors are low. Many Chinese doctors strive to find a balance between the requirements of professional ethics and the current situation of China's rapid economic development. Some of this pressure is intertwined with the devaluation of the doctor profession by society and the government, driving many doctors to switch careers. If the social and economic status of doctors is not improved, China's medical and health system reform will not succeed. Chinese doctors should be more involved in the medical reform process, make their own voices, and use their own experience and constructive opinions to help improve the medical reform system.

    Original source:

    https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61315-3/fulltext

    system change, the theme of the World Cancer Congress in Shenzhen, China, Aug 18—21, was a central message in the opening address by the Chinese Minister of Health,Chen Zhu, as he described current health-care system reforms in China. At the Congress many international health policy makers and physicians led discussions on frameworks and actions for system change, but there was little participation from local Chinese doctors.

    To understand why there were so few Chinese delegates in the plenary sessions on system change compared with sessions on patients' care, one must first understand that for many Chinese doctors personal safety is of greater concern. Chinese doctors are often victims of terrible violence. In June this year, a doctor and a nurse were fatally stabbed in Shandong Province by the son of a patient who died of liver cancer 13 years ago, and a paediatrician in Fujian Province was injured after leaping out of a fifth-floor window to escape the angry relatives of a newborn baby who had died under his care. Thus, it is not surprising to see that in July police officers were invited to be the vice-presidents of 27 hospitals in Shenyang. With hospitals turned into battlegrounds, being a doctor has become a dangerous job in China.

    The problem may be largely one of perception. Many Chinese patients believe that doctors and hospitals conspire to increase charges by providing unnecessary examinations, investigations, and treatments. Additionally, some doctors accept red envelopes (a monetary gift in exchange for favourable service) against the rules. Many patients blame the deterioration of their health directly on doctors, claiming that doctors lack devotion and skills. The intellectual ideals of ancient China were “either to be a good prime minister or to be an excellent doctor”,while in modern China doctors and nurses used to be worshipped as “angels in white”. How has the perception of Chinese doctors become so eroded?

    The Chinese media certainly have an important role in provoking tension between doctors and patients. There is disproportionate coverage in newspapers, television, and on the internet of how health professionals have cheated patients. Just a few weeks ago the Southern Metropolis Daily (the most popular newspaper in Guangdong) falsely accused a midwife, who had treated haemorrhoids for a patient after childbirth, of stitching the patient's anus closed on purpose. In November, 2009, one of China's most authoritative media outlets, CCTV (China Central Television), reported that the renowned Peking University First Hospital was carrying out illegal medical practices by allowing medical students to do surgical procedures, and as a result a patient had died. Even though the hospital and the Ministry of Health made it clear that involving medical students in clinical procedures including surgery under the supervision of licensed doctors is legal, trust in doctors and hospitals was seriously d amaged. It is hard to tell whether the misreport resulted from a lack of medical knowledge on the parts of the Southern Metropolis Daily and CCTV, or whether it was motivated by a desire for a sensational story. However, the public misunderstanding of the medical profession will surely hurt both doctors and patients in the end.

    Most hospitals in China, especially the large ones such as Peking Union Medical College Hospital and Huashan Hospital of Fudan University,are run by the government. Public hospitals in China enjoyed full government funding before 1985. After economic reforms, the hospitals now receive very limited financial support from the government, with the result that hospitals must generate income to cover costs. As the main source of hospitals' income is from diagnostics and treatment, there is a financial incentive to over-investigate and over-treat. To minimise inappropriate conflicts of interest, the Chinese Government passed laws to prevent doctors receiving financial kickbacks from drug companies. Because the standard salary of a doctor is modest, even by Chinese standards, many doctors struggle to balance professional ethics and making ends meet in an economically booming China. Such pressures, coupled with a sense of feeling seriously undervalued by the government and society as a whole, drive many doctors out of medicine into other jobs.

    China's health-system reforms cannot be successful without reforming the social and economic status of doctors. Chinese doctors should be involved more in shaping health policy, by giving voice to their own experiences and constructive ideas about the health system.

    Translation of the last paragraph: If the social and economic status of doctors is not improved, China's medical reform will not succeed. Chinese doctors should be more involved in the medical reform process, speak out, and use their experience and constructive opinions to help improve the medical reform system

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