莫当摸象盲人

一次聚会,我突然发现有位医生朋友的腿有些瘸,一问,原来竟是误诊所致。无独有偶,一侠从事卫生新闻工作的资源记者,也有着与他同样的遭遇。     

总是,去安慰

我已经是他联系的第15个心理医生了。此前,在很多医生那里,他甚至无法得到预约——他们全都“太忙了”。而我认为,其中至少有一位医生之所以“太忙”,是因为Donal Casey（化名）是一位公开的同性恋。这是在20世纪80年代末。我敢打赌,其中5～6位医生拒绝见他,是因为Casey先生已经80岁了。我还确信,其余的人之所以拒绝他,是因为他直率地告诉了他们,他患有无法通过手术冶愈的肺癌。     

首位留学美英的医生黄宽

黄宽是我国第一位留学美国,学习西医于英国的医生。在美国盂松学校学习基础科学知识,两年后在英国爱丁堡大学接受医学教育并获得医学学位。他是我国早期杰出的外科医生。在传播西方医学方面作出重要贡献,在当时他被称为好望角以东最负盛名之良外科。他的业绩自当永垂中国医学史。     

中国近代第一位西医生--关韬

关韬(关亚杜,KuanA-To)是中国近代的第一位西医生和第一位西式军医,他出身于广东十三行(The13Hong;ThirteenFactories)商业画家的世家,19世纪十三行的文化氛围对他一生有重大的影响.他的叔父关乔昌(啉呱)和关联昌(庭呱)是著名的广东商业画家,关乔昌在十三行建立画室,和来自欧美的外国人有着广泛的接触,他不断的追随着晚年旅居澳门的英国有名画家乔治@钱纳利的西洋画风格.在关乔昌的指引下,1837年关韬随美国第一位来华医药传教士伯驾,在十三行的眼科医局学习西医.后来他成为一位具有优良品格、有能力和乐于奉献的医生.他的名字永远为中国人怀念.     

意大利医生眼中的中国医患陋习

彼路易·切奇博士是一位有着30多年临床经验的意大利儿科专家。两年前,他受意大利政府派遣,作为意方负责人到北京执行两国卫生合作项目。在北京儿童医院特需门诊坐诊的两年间,切奇先生以一位西方医生诚实、敏锐的眼光,观察到了目前在中国医学界普遍存在的难以理解的现象,而其中的某些现象决不能简单归结为是由中国的国情或中西方文化的差异造成的。以下是他在归国后整理的文件中摘抄出来的几段内容,希望国内的广大医生能有所借鉴。     

两名器官移植先驱者荣获1990年诺贝尔医学奖

两位热爱临床工作的医生获得了今年的诺贝尔医学奖。一位是波士顿的外科医生Joseph Murray,他首先成功地将一个孪生儿的肾脏移植给另一个。另一位是得克萨斯的EDonnall Thomas,他首创了骨髓移植技术,目前居住在西雅图。一位有影响的研究人员认为Thomas是在同行中最杰出的临床医生。Murray的‘极其     

布朗医生日记——道歉

Mark是位医生同时也是位有膀胱肿瘤病史的病人,他刚做过每年2次的膀胱镜检查.之前做的膀胱镜检查未见新生的肿瘤,不过膀胱后壁有些毛细血管扩张区,他非常担心.6个月后,从泌尿科医生Yamagushi那得到了第二种意见,Yamagushi医生当时还不能确定毛细血管扩张的原因,安慰他说那里未见癌肿.     

对改进医学伦理学教学的探讨

去年,北京发生了“眼球丢失案”.一位有着医学博士学历的医生,为了挽救两个患者的眼睛,情急之下,取下了太平间一个死者的角膜.两位患者重见了光明,而医生却陷入麻烦的境地.人们不仅要问:“救死扶伤还有错?”针对此事中国社科院应用伦理研究中心的王延光指出:“我觉得这个医生实在是个法盲、伦理盲”,“绝不能因为器官缺乏就随意摘取.我觉得,在医学界,医学伦理学的教育实在太差了.”伦理学专家邱仁宗也同意这是“我们医学伦理学教育的失败”,他认为这首先违反了“知情同意原则”.     

哪些患者必须做影像复查

一天晚上,一位男青年用手捂着下腹部前来就诊。医生赶紧让他去做B超检查,结果未见异常。可就在这位男青年舒展眉头、满怀释然地准备离开时,医生又给他开了一张超声检查单,并一再叮嘱他明天来复查。男青年大惑不解,一脸不悦地质问道：“既然没事还来折腾干嘛？”第二天上午,这位男青年便开始感到腹部不适。他猛然想起那位医生的嘱咐,便赶紧打车去了医院。经过做B超检查证实,他的脾脏已经破裂了。     

开心乐翻天

想见的人一位病重的老人即将死去,医生认为已经不需要再向他隐瞒病情了,便来到老人的病床旁。“你的病情已经很严重了,”医生告诉老人:“我相信你非常想知道事实。现在,你还想见什么人吗?”虚弱的老人点了点头,用极其微弱的声音对他说:“是的,我非常想见另一位医生。”增强记忆病人:“医生,非常感谢您昨天把增强记忆的方法教给了我。”医生:“噢,有这回事吗?”再教几手“师傅,我照您教给我的推拿术,给一位病人推拿了几下,他就跑掉了。”“没关系,我再教你几手擒拿术,这样,你在给病人推拿时他就跑不了了。”看病有一同学,因感冒去医院看病。…     

A piece of my mind: the impossible choice

A physician tells of his encounter with a dying patient in severe pain who asks him to administer a lethal injection. He refuses the request for personal and professional reasons, the ultimate one being his concern about the potential harm to the physician patient relationship should doctors begin to kill.     

A case of informed consent obtained from a patient with terminal cancer and his family using family function by the primary care physician

We evaluated the contents and characteristics of informed consent obtained by the primary care physician from a male patient with advanced cancer and his family, and clarified the influences of the informed consent on family function. This patient was diagnosed as having advanced cancer at the age of 46 years, underwent surgery/chemotherapy, but died after 4 months at the hospital. Semi-structured interviews were held with the elder daughter of the patient, and notes on the patient's disease, the course of treatment, his family's responses, and the informed consent obtained by the primary care physician were taken during the interview. The informed consent obtained by the primary care physician had the following characteristics: (1) The physician transmitted accurate and detailed information on the treatment methods, side effects, and prognosis by appropriate communication techniques with consideration for the feelings of the patient and his family, and proposed choices so that they could participate in the decision of treatment principles. (2) During the entire course, the primary care physician frequently visited the bedside and encouraged the patient and his family to express their feelings of anxiety and to ask questions, giving continuous emotional support. With the progression of the disease and explanation by the primary care physician, the patient and his family expressed and shared feelings such as grief and powerlessness and supported each another. Gradually, they began to show practical/adaptive coping behavior and could accept the patient's death. Appropriate informed consent obtained by the primary-care physician promoted the family function of this family.     

Preventing physician suicide. The role of family, colleagues, and organized medicine

Psychological barriers in the minds of the failing physician, his family, and colleagues may thwart prevention of physician-suicide. The failing physician may be shunned by colleagues for his disturbed behavior. He denies illness, resorts to self-medication, and avoids treatment. Recognition and rational handling of this presuicidal state may be hindered by the need of the doctor, family, and colleagues to preserve a fantasy of the doctor's omnipotence. Treatment also may be impeded by the failing physician's reluctance to form a therapeutic relationship with the treating psychiatrist. The psychiatrist must help his doctor-patient to determine if he should continue practicing. The key to successful intervention may depend solely on our awareness and handling of these problems.     

The ethics of eating a drug-company donut.

How does a physician make medical decisions? Is medical ethics a field that shifts according to the views of individual doctors? A physician who recently completed his residency muses on some of the ethical decision making he witnessed during his training.     

Tacit components of medical ethics: making decisions in the clinic.

When a patient visits his doctor there is, as well as a spoken dialogue, also an unspoken, or tacit, dialogue between them. This may not be evident unless that dialogue breaks down when the psychological or moral terms of reference of each are seen to be different. The author of this paper tries to elucidate the framework in which physician and patient think, and in so doing allow an understanding of why the physician may appear to be rigid and authoritarian in his dealing with his patients and the patient uncooperative.     

Tremendous benefits

In this essay, a physician describes the personal and professional satisfaction he gained from his volunteer work with Doctors Without Borders (DWB). The account begins with an explanation of why the physician chose a career in medicine and how his interest in international public health was enhanced during a year of volunteer work in a children's hospital in the West Indies. This and later volunteer work with Boston's Health Care for the Homeless Program caused him to realize that volunteers gain far more from their experiences than they can possibly contribute. DWB, which sponsors more than 2000 international volunteers working in approximately 80 countries, is the largest private, nonprofit, nongovernmental, volunteer aid organization in the world. When the physician was given the chance to manage a malaria control project for DWB in Myanmar, he was given a first-hand opportunity to see the interrelationship between human rights and public health that had been stressed by his mentor, the late Dr. Jonathan Mann. While the physician found only a limited opportunity to improve on the human rights situation, some progress was made in controlling the malaria. The physician ends by noting that, while US physicians are experiencing increasing frustration because their practices are increasingly dictated by business concerns, DWB volunteers can make an important difference in the lives of many people and can practice medicine without unnecessary distractions.     

How to become comfortable talking about sex to your patients.

Dealing with patients' sex-related complaints is uncomfortable for many physicians. It can become more comfortable if the physician learns to apply his or her clinical knowledge of sexuality in combination with specific interpersonal interviewing skills. The level of comfort can be increased if the physician accepts his or her professional limitations in providing therapy and knows what other sources of care are available.     

The medical career of Robert Seymour Bridges,FRCP (1844-1930): physician and Poet Laureate

Robert Bridges OM is the only medical graduate (he was elected to the Fellowship of the Royal College of Physicians of London in 1900) to have held the office of Poet Laureate. Educated at Corpus Christi College, Oxford and St Bartholomew's Hospital he practised as a casualty physician at his teaching hospital (where he made a series of highly critical remarks of the Victorian medical establishment) and subsequently as a full physician to the Great (later Royal) Northern Hospital. He was also a physician to the Hospital for Sick Children. It had for long been his intention to retire from the medical profession at the early age of 40! In 1913, Bridges was appointed Poet Laureate by King George V, and following a disappointingly sparse output of "official" work, published his greatest literary contribution-The Testament of Beauty-on his 85th birthday.     

Confidentiality and law in Lebanon

Everyone is entitled to one's privacy and cannot be denied this right. Illness affects human beings, exposing them to outside influences. The physician is given access to the patient's privacy, only because of his professional status. The relation between the patient and his physician is based on full trust. Confidentiality is a must that should be protected by law. The related Lebanese law includes incoherence, subject to abuse. The physician must protect the interests of his patient without misleading insurance companies. Physicians, hospitals, insurance companies and all health organisms should talk and work together for a global health policy to preserve confidentiality, and the interests of all actors. A campaign should be launched to promote a better understanding of the concept of confidentiality in order to finally bring about its enforcement in Lebanon.     

A Practice-Related Educational Program

A Practice-Related Educational Program has been developed to help the physician in primary practice meet the mounting pressures for continuing medical education. Based on analysis of his practice, the physician tests himself to identify areas of potential improvement. Learning resources appropriate to his educational needs are then made available to him at his home base. A follow-up test determines if the person's learning has been effective, and where further emphasis may be placed.