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aries1988 : doctor   11

China’s Health Care Crisis: Lines Before Dawn, Violence and ‘No Trust’ - The New York Times
The country does not have a functioning primary care system, the first line of defense for illness and injury. China has one general practitioner for every 6,666 people, compared with the international standard of one for every 1,500 to 2,000 people, according to the World Health Organization.

Instead of going to a doctor’s office or a community clinic, people rush to the hospitals to see specialists, even for fevers and headaches. This winter, flu-stricken patients camped out overnight with blankets in the corridors of several Beijing hospitals, according to state media.

Hospitals are understaffed and overwhelmed. Specialists are overworked, seeing as many as 200 patients a day.

China’s “barefoot doctor” system was one of the Communist revolution’s most notable successes. In 1965, Chairman Mao, troubled by the lack of health care in the countryside, envisioned an army of people who spent half their time farming (many worked in the fields without shoes) and half their time treating patients. They weren’t doctors, but rather a sort of health care SWAT team. The authorities gave them a short training period — several months to a year — and a bag of limited medicine and equipment.

When Dr. Huang saw a newspaper article about general practitioners, he decided to enroll in a training program in 2007. He was inspired by his aunt, a “barefoot doctor” in Mingguang, a city in Anhui Province, one of the poorest regions in China.

As a boy, he had followed his aunt as she went to people’s homes to deliver babies and give injections. “After becoming a doctor, I’ve realized that the people’s needs for ‘barefoot doctors’ is still very much in demand,” he said.

Dr. Yang, 31, said her practice was largely free of grumpy patients and, as a result, “yi nao.” She sees 50 to 60 patients in a workday of about seven and a half hours. In the United States, a family doctor has 83 “patient encounters” in a 45-hour workweek, according to a 2017 survey by the American Academy of Family Physicians. That’s about 16 patients in a nine-hour workday.

She’s available to dispense round-the-clock advice to her patients on WeChat, a popular messaging app in China. A patient is generally kept in the waiting room for a brief period and, if necessary, gets to talk with her for at least 15 minutes.
doctor  hospital  china  today  reform  reportage 
october 2018 by aries1988
正午 | 丁香诊所的五个故事 - 中国数字时代
冯大辉说:我们要做内容。通过内容去改变人们对医疗和健康的认知,因为这几乎是现在中国人最欠缺的。我们能接触到的医疗信息可能九成是骗人的。

目前中国的私立医院大致可分为两种,一种是面向高收入人群的高端全科诊所或专科诊所;另一种则是以完全以盈利为目的的私立医院。这两种都不是丁香园的理想。在丁香园的决策层看来,目前中国的医疗资源呈现金字塔结构,最顶端是三甲公立医院,中层是二甲,底座是基层医疗机构,如社区医院和全科诊所。而老百姓现在看病只认三甲医院的招牌和专家,本应由中层和基层解决的常见病和慢性病还是集中在塔尖,这是对医疗资源极大的浪费——塔尖本应该是在医治重症、急症、肿瘤和癌症。所以丁香诊所的定位为中端全科诊所,提供常见病、多发病、慢病诊疗服务,同时建立诊疗前的咨询服务和诊疗后的慢病管理。

与阿聪相比,初洋实在是不太像个医生。他留着络腮胡,黑鞋黑裤,黑色圆领衬衫上绣着两个字承让,完全一副文艺青年模样。实际上,这个前骨科医生现在是丁香医生的内容负责人。

初洋从很小的时候就想当医生。他在医院大院长大,家人不是医生就是在医院工作。小时候看织田裕二主演的《回首又见他》,初洋到现在仍记得第一集,织田裕二在值班室里打麻将,很不情愿地把烟掐掉,跑到了抢救室。那个游离在大家传统印象以外的医生形象让他觉得,做医生也可以很酷。

从中学年代开始初洋就是个摇滚青年,在医学院里面留长发,他是独一个。因为崇尚工匠精神,他选择了骨科。病人看到初洋这个摇滚医生,要么眼前一亮要么眼前一黑。初洋说他挺喜欢这种感觉,一开始病人不太信任我,但接受了我的服务之后就会觉得这个医生特棒。

初洋出生于1979年,从2003年到2014年,他当了11年的骨科医生。

到2016年3月,丁香诊所共收到近3000封简历。目前诊所中有17名医生,20名护士。在职的医生大多数35岁左右,已在主治医生的位置上工作过4、5年。杨泽方说,丁香诊所给医生们的薪酬与体制内的至多是打平。愿意来丁香诊所的,一定是想法和追求被抑制的人。或者说他有很多诉求,别人觉得他很烦,包括护士也是这样。很难想象在公立医院里如鱼得水的人会想换个环境。他们向往的工作方式不能够实现,于是要找一个突破口。

今日的杨泽方,比网上的那些照片显得更加愉快。他说他觉得很幸福。一个工作跟自己的乐趣能够紧密地结合在一起的人是很爽的。我最大的幸福,就是我能够再搞一家医疗诊所,再拉一个团队,跟现有的体制进行某种程度上的较量,这是一件非常爽的事,虽然很辛苦。我们可以给病人送礼物,病人也可以给我们送礼物,我们可以跟他们像朋友那样聊天,能安抚他们的焦虑,能解决他们的问题,他们很信任我们,我们也很信任他们,这多好啊。
doctor  hospital  private  service  instapaper_favs 
may 2016 by aries1988
Doctors Who Don't Know How to Talk About Death - The Atlantic
The one time I remember discussing mortality was during an hour we spent on The Death of Ivan Ilyich, Tolstoy’s classic novella. It was in a weekly seminar called Patient-Doctor — part of the school’s effort to make us more rounded and humane physicians.
death  doctor  ethic  opinion 
november 2014 by aries1988
The Physical Exam as Refuge - NYTimes.com

Countless times, I have found that it is only during the physical exam that patients reveal what is truly on their mind. Whether it is the cough that they are reminded of now that I am listening to their lungs, or whether it is the domestic violence, the eating disorder or the genital symptoms that they feel comfortable revealing once we are in a more intimate setting — there is something about touch that changes the dynamic.

But then the doctor and patient move to the exam table, and everything changes. This is often the first moment that they can talk directly, without the impediment of technology. They are physically closer to each other, actually touching. This is an intimacy, albeit of the nonromantic type, but an intimacy nonetheless. And all intimacies have an effect of changing the dynamics of the interaction. Obviously, there is a risk of changing for the worse, but in my experience it is almost always a change for the better. Once a doctor and patient are at the exam table, touching, talking without the computer between them, conversation of a different sort is possible.
doctor  people  temoignage  body  medicine  opinion  psychology  human  communication  practice 
october 2014 by aries1988
The Best Possible Day

Neither seemed right. But for more than a decade in medical practice, I had not really understood what other choices might exist. I wasn’t effective in these situations. And it bothered me — as a surgeon caring for patients with problems I often could not fix and then as a son with a father in his 70s experiencing mounting difficulties in his life. So for three years, I researched a book on what has gone wrong with the way we manage mortality and how we could do better.

I also discovered that the discussions most successful clinicians had with patients involved just a few important questions that often unlocked transformative possibilities: (1) What is their understanding of their health or condition? (2) What are their goals if their health worsens? (3) What are their fears? and (4) What are the trade-offs they are willing to make and not willing to make? These discussions must be repeated over time, because people’s answers change. But people can and should insist that others know and respect their priorities.

Someone in her position who was offered “death with dignity” — assisted death — might have taken it as the only chance for control in the absence of other options. But hearing her fears, I suggested that Peg try hospice. It’d at least let her get home, I said, and might help her more than she knew. Hospice’s aim, at least in theory, I explained, is to give people their best possible day, however they might define it under the circumstances. It seemed as if it had been a while since she’d had a good day.
death  doctor  life  story 
october 2014 by aries1988
南方周末 - 【南瓜学堂】医学生,你们准备好披上白大褂了吗?
第一,好好学习通识教育课。虽然综合性大学和医学专科院校的氛围可能略有不同,但临床医学专业第一年的课程设置还是通识教育为主,学习英语、数学、化学、物理、生物等。英语太差,你以后没法接触医学前沿;数学学不好,你难以学习统计-流行病学和循证医学,没法完成现代医学训练;化学不甚了了,你甚至没法记住那些饶舌的药物名称;物理太次,当心血管医生你却没法深入理解血流动力学,想学骨科却连基本的力学分析都困难……

第三,临床医学很重要的一面是人与人相处的艺术,医生和患者都会受到社会大环境的影响,回首自己的从医历程,似乎对于人文的理解欠缺不少,建议有空多读读涉及医学内容的人文作品。具体随各自兴趣,开始医学专业课程后,学业负担不轻,同时陷入专业思维后也许会有忽略。
doctor  advice  stage 
september 2014 by aries1988
南方周末 - 【科学松鼠会】当医生的心灵受伤时
【科学松鼠会】当医生的心灵受伤时:很多人都误以为医生、护士都是坚韧的人。其实在工作的背后,每一个医护人员都承担着巨大的身心压力,而患者对于医护人员的理解,就好像家人的问候,能让我们体验到格外的温暖。
www.instapaper.com/read/304308375
china  crisis  doctor 
july 2012 by aries1988
冯唐:大医
希波克拉底: 见信好。 1990年到1998年,我在协和医科大学认真学过八年医术,正经科班念到医学博士,从DNA、RNA到细胞到组织到大体解剖... http://www.instapaper.com/read/312203285
doctor  letter 
november 2011 by aries1988

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