Life threatening emergencies involving children in the literature of the doctor

Life threatening emergencies involving infants and children are inherently dramatic, tension-filled situations. It is no wonder, then, that depictions of such events can be found in literature by and about doctors. In many ways, too, such depictions can illuminate key aspects of such events, such as the physician's own anxiety and the tensions between the various people involved, better than the medical literature. Hence it is suggested that the study of literary depictions of pediatric emergencies might be a useful adjunct for those, physicians and other health care providers, who are called upon to manage them.     

常人疾病观及其对医患关系的影响

常人疾病观是普通人对于某一疾病的认知、解释和态度的集合。与专业医务人员相比, 普通人更关注心理、家庭和社会因素而非生物学因素的致病作用, 就医选择多元而并不遵循标准化的就医模式, 同时更愿意将疾病体验视为个人生活的特殊问题加以建构性理解。常人疾病观与科学医学观之间的不一致性可能降低患者的就医满意、对医信任和医嘱依从性, 从而影响治疗效果。立足中国社会的医学文化与医疗制度, 研究中国人的常人疾病观, 并探讨其对医患关系的影响作用与社会心理机制, 可为改善当下中国医患关系紧张现状提供有益建议。     

和谐医患环境与公民健康权的保障

在健康权保障体系中,卫生资源配置的公平与效率的失衡是导致现阶段我国公民健康权不平等的关键。而作为一级经济主体的医疗机构,在促进卫生资源配置和享用的公平性作用上,则是无效率的,因此国家应积极运用法律、政策等外部手段,实现其协调性的复位,以服务于建设和谐医患环境的需要。     

特需医疗服务供方意向调查分析

剖析目前特需医疗服务供方所存在的主要问题,初步探讨在我国发展特需医疗服务适宜的承担主体。采用个别访谈和问卷调查的方法对来自不同性质的医院的医护人员和医院管理人员进行了意向调查。结果显示,医院发展特需医疗服务并不是解决医务人员收入问题的有效手段;公立医院发展特需医疗服务势必会对其普通医疗服务带来负面影响。建议在确保大部分公立医院只提供普通医疗服务的基础上,由私立医院和一部分公立医院作为特需医疗服务的承担机构。     

临床检验科人文精神缺失及对策的思考

当今随着经济和社会的发展,在现有的医学教学模式、医疗体制和分配制度下,医院临床检验科越来越推崇医学技术主义和追求高额的经济利益,致使临床检验医生人文精神日益缺失,医生与患者之间最具人性的本质已被淹没,医患矛盾日益增加和凸显。如何以患者需求为导向,让患者满意,这迫切地需要在临床检验科加强人文素质教育,培育检验医生的“医者仁心”大医情怀,以减少和预防医患矛盾的发生,这是检验科管理者应该急需思考的问题。     

The importance of a holistic concept of health for health care. Examples from the clinic

One of my main points in this study is that the knowledge of orthodox medical theory is an incomplete guide for practical action when relating to our patients' specifically human problems. By following a holistic perspective on patients' health and on our medical enterprise we will be more efficient as doctors. This standpoint is illuminated by means of two case reports. Instead of focusing on symptoms as such and letting them refer to orthodox medical theory, I explicitly relate to the patients as if they are conveying a personal meaning by means of experienced symptoms. The experience of illness could be a successful strategy on the existential level although destructive on the technical biological level. A holistic theory of health can give doctors a good conceptual base when relating to people whose presented illnesses are to be regarded explicitly as their way of making themselves understood. The doctor's understanding of the patient's illness, of the theory of health, and of how health is regained, is dependent on the doctor's having the courage to reduce the distance to the patient, the courage to participate and be changed.     

异化现象与临床医生的处境

通过对异化理论的阐述,揭示了异化现象的普遍存在性,从医院管理、医疗体制、医疗技术等各个方面分析了异化现象对于临床医生的思维和判断的制约。提出向＂以人为本＂的思想回归才是弱化异化的消极影响的途径。     

Towards a Confucian Virtue Bioethics: Reframing Chinese Medical Ethics in a Market Economy

This essay addresses a moral and cultural challenge facing health care in the People’s Republic of China: the need to create an understanding of medical professionalism that recognizes the new economic realities of China and that can maintain the integrity of the medical profession. It examines the rich Confucian resources for bioethics and health care policy by focusing on the Confucian tradition’s account of how virtue and human flourishing are compatible with the pursuit of profit. It offers the Confucian account of the division of labor and the financial inequalities this produces with special attention to China’s socialist project of creating the profession of barefoot doctors as egalitarian peasant physicians and why this project failed. It then further develops the Confucian acknowledgement of the unequal value of different services and products and how this conflicts with the current system of payment to physicians which has led to the corruption of medical professionalism through illegal supplementary payments. It further gives an account the oblique intentionality of Confucian moral psychology that shows how virtuous persons can pursue benevolent actions while both foreseeing profit and avoiding defining their character by greed. This account of Confucian virtue offers the basis for a medical professionalism that can function morally within a robustly profit-oriented market economy. The paper concludes with a summary of the characteristics of Confucian medical professionalism and of how it places the profit motive within its account of virtue ethics.     

信任是改善医患关系的关键

目前医患关系紧张,医疗纠纷频繁,同时又是新闻媒体追逐的热点,追究其原因是医患之间的不信任。如果医患之间成为相互信任的朋友,医患之间多一些相互理解,医生掌握精湛的医术,具备良好的沟通能力,做一个充满阳光的常常带给患者乐观情绪、鼓励话语、轻松气氛的医生,加上医疗体制的改革,应该可以有效改善紧张的医患关系。     

The patient in the family and the family in the patient

The notion that the family is “the unit of care” for family doctors has been enigmatic and controversial. Yet systems theory and the biopsychosocial model that results when it is imported into medicine make the family system an indispensable and important component of family medicine. The challenge, therefore, is to provide a coherent, plausible account of the role of the family in family practice. Through an extended case presentation and commentary, we elaborate two views of the family in family medicine — treating the patient in the family and treating the family in the patient — and defend both as appropriate foci for care by family doctors. The practical problem that arises when the family is introduced into health care is deciding when to concentrate on the family system. The moral problems that arise concern how extensively doctors may become involved in the personal lives of their patients and families. The patient-centered clinical method provides a strategy for handling both problems. Thus, making the family a focus of care in family medicine can be justified on theoretical, practical, and moral grounds.     

前景理论在重症医学临床决策中的应用

临床决策是每一个医生每天面临的工作,正确的临床决策不仅可以带给患者较好的结果,同时也可以让医生与患者及家属沟通更加良好。本文首先论述了重症医学的临床决策特点,每一个救治方案的收益与损失的权衡不仅仅是取决于患者病情,而且与决策者的风险偏好有明显关系。为了更好地解决这个问题,把诺贝尔奖获奖者丹尼尔的前景理论引入到重症患者的...     

AN ISLAMIC APPRAISAL OF MINDING THE GAP

The neglect of psycho‐spiritual needs of patients as they traverse the modern healthcare system has been a featured theme in medical literature over the past decade. This literature, which often highlights in‐patient palliative care, as well as acute and critical care settings, influences practice guidelines and protocols of doctors and nurses. In this essay, I review some of the pertinent issues raised in the literature and examine the validity of placing an ethical perspective on this issue. I also compare Islamic theocentric perspectives with secular, non‐theistic perspectives on restoring psycho‐spiritual care for patients. I then develop a framework for pastoral intervention based on aspects of the Islamic tradition and elaborate this framework by addressing clinical contexts and cases. The essay is an exposition based upon a review of the modern medical literature, an analysis of some of the traditional Islamic written sources, and the observations of the investigator, a practicing physician and an American Muslim.     

医学伦理学——欧洲与中国的桥

跨文化医学伦理学研究,要求我们以理智的方式去应对全球化。既要维护多样性,又要明确共同利益、亦要追求共同目标。任何文化都不能强行提出一些标准去规范国际间的生物医学。自主权应坚持义务论的解释,否则一个强势风气将会支配利益的选择解释,将文化多样性在伦理学中铸成一个统一的模式,形成自主权的“通货膨胀倾向”。     

血液病治疗中的人文关怀

新医学模式指出人文关怀在医疗服务中有重要意义。目前我们在血液病治疗中对人文关怀重视不够。由于大部分血液系统疾病起病隐匿,发病机制不清,病程长,并发症多,所以预后差,再加上治疗费用高,社会角色转变困难,很容易使患者产生焦虑、抵触、恐惧、多疑、抑郁等心理问题,并影响和谐医患关系的建立。人文关怀有助于缓解患者的心理问题,促进良好医患关系的建立,加速疾病的恢复,提高患者的生存质量。     

Spiritual care in psychiatry: Professionals’ views

In this study we explored the views of Mental Health professionals and general practitioners (GPs) regarding spiritual care and the effect of personal and cultural background on their views. Data were collected through anonymous questionnaires posted to hospital nursing and medical staff at Hollins Park Hospital, Warrington, UK, and to all GPs within the hospital catchments area. Forty-five percent of GPs, 33% of psychiatrists, and 76% of nursing staff (p < 0.05) felt strongly that human beings are made up of spirit as well as body. More nurses felt that spiritual care is equally as important as other forms of care (52%) compared with psychiatrists (33%) and GPs (29%). A higher percentage of nursing than medical staff had previous training in this area and were more likely than medical staff to consider themselves appropriate to give spiritual advice. A total of 20% of GPs and 33% of psychiatric staff stated the need for training in this area and GPs especially felt they lacked time. Professionals’ views are influenced by cultural and religious backgrounds, with significantly more non-UK born respondents feeling strongly that human beings all have a spiritual component. Many doctors do not consider spiritual care has a role for them to be involved in and many feel too pressured in daily life to take this on. Nurses are more inclined to take a holistic approach to care in this respect. Some people with mental health problems have spiritual care needs and we should be aware of this as an important facet to therapy.     

应当重视医生“公共人”的角色定位

“经济人”的价值理念刺激了医疗行业的逐利行为,我国公立医院公益性淡化已然是事实,医生的“公共性”日渐缺失.医患之间的信任危机从来没有像今天这样严峻,很重要的原因是医生的价值取向的迷失.医生确实面临多价值选择冲突,但过分强调“经济人”特性,而忽视公共性的重要,已然导致了种种恶果.所以,应当重视医生“公共人”的角色定位.医生和医院要回归对医疗职业本性的认识,让医生成长为“为了人类的幸福和自身的完美而工作”的“公共人”,让医院回归“为社会公众谋取利益,追求社会效益目标”的公益性.     

Sanitary Worker’s Death Unnerves Pakistan’s Health Care Ethics to the Core

Health care ethics is a sensitive domain, which if ignored, can lead to patient dissatisfaction, weakened doctor–patient interaction and episodes of violence. Little importance has been paid to medical ethics within undergraduate medical education in developing countries such as Pakistan. Three doctors in Pakistan are currently facing an official police complaint and arrest charges, following the death of a sanitary worker, who fell unconscious while cleaning a drain and was allegedly refused treatment as he was covered in sewage filth. The medical license of the doctors in question should be cancelled, if found guilty following a thorough investigation into the case. The ‘right to life’ has been universally assured by all moral, cultural and legal codes and no society can ever argue against the sacredness of a human life. It is quite clear that the aforesaid doctors’ actions are not only against the core principles of the physicians’ code, but also go against the doctrine of human rights. If serious efforts on an urgent basis are not made by the regulatory and governing bodies, one can definitely expect similar incidents for at least a few more decades before any noticeable change is seen.     

Attitudes to doctors and medicine: The preliminary development of a new scale

Abstract

The preliminary development of a new scale to measure attitudes towards medicine and doctors is described. The scale comprises four factors: “positive attitude towards doctors,” “positive attitude towards medicine,” “negative attitude towards doctors,” and “negative attitude towards medicine.” Alpha coefficients for the four scales were satisfactory, ranging from 0.69 to 0.76. Test re-test reliabilities ranged from 0.69 to 0.81. Evidence of criterion-related validity was obtained from comparison of the attitudes of five groups involved in health care: nurses, medical students, patients, and sociologists and psychologists who are teachers in medical schools. Patients and medical students held significantly more positive attitudes towards doctors and medicine that did nurses and behavioural scientists. While nurses were as negative towards doctors as sociologists and psychologists, they were significantly less negative about medicine.     

The demand for effectiveness,efficiency and equity of health care

Effectiveness, efficiency and equity in health care are discussed in this article against the background of concerns that ‘cost containment’ may lead to reductions in quality of care. It is suggested that effectiveness is best seen from the patient's point of view and that it relates to more than simply improved health status. Efficiency and equity are better viewed from a societal stance. The paper discusses the role of the medical profession in effectiveness, efficiency and equity and argues that the role of medical doctors needs to be constrained.