世界著名医学期刊《柳叶刀杂志》如何评价中国医疗纠纷

QQ721766373

中国医生正面临重大危机。近年来，中国医生面临越来越多的人身安全威胁。他们受到来自病人及家属的辱骂、人身伤害、甚至是杀害。柳叶刀今日在线发表了一篇文章，报道了近期中国发生的一场惨剧，哈尔滨医科大学第一附属医院的一名男实习生被病人杀害身亡。 为了应对此危机，卫生部和公安部联合发表声明，宣布在医院内增设警卫力量。对于那些扰乱医院日常工作，携带危险品，或威胁医务人员的人都将被追究法律责任。医院应成为高安全性的场所，而目前这个措施只能作为短期内的解决方案。 中国医生为何面临威胁？可能的原因有很多，一方面，卫生系统、医生培训和工资等资金投入不足，这些会导致医疗失误，腐败，医患沟通不畅等；另外还存在一些社会性因素，如媒体的负面报道，公众对医学了解欠缺，病人过高的期望，过高的医疗费用等等，都是不可忽视的原因。 不论暴力的深层原因是什么，其对中国医学的影响都引起了极大关注。李杰，中国宁波大学医学院的学生，在信中写到，新一代的中国医生十分迷茫，他们不知道该不该继续学医，更不知道如何应对复杂的医患关系。 就像目前亚洲其他国家的医生一样，在中国，医生曾是倍受尊敬的。中国需要改变现状，让医生再次成为有吸引力、受尊敬、高薪、安全的职业，通过保护现在的、未来的医生，进而最终令患者受益。政府应迈出解决问题的第一步，调查暴力产生的原因并加以解决。 柳叶刀原文The Lancet, Volume 379, Issue 9828, Page 1764, 12 May2012 doi:10.1016/S0140-6736(12)60729-6 Cite or Link Using DOI Ending violence against doctorsin China OriginalText China’s doctors are in crisis. In recent years, they have faced increasing threatsto their personal safety at work.Doctors have been abused, injured, and evenmurdered by patients or relatives of patients in hospitals and clinics acrossthe country. In a recent tragic case, described in a letter published onlinetoday in The Lancet, a male intern at the FirstAffi liatedHospital of Harbin Medical University was stabbed todeath by a patient. Responding to this crisis, the Chinese Government announced last week thatit is increasing police vigilance inside hospitals. People who disrupt thedaily operation of hospitals, carry dangerous materials, or threaten medicalstaff will be held legally accountable, according to a joint statement by theMinistry of Health and the Ministry of Public Security. Although turninghospitals into high-security institutions may be a necessary step, it is ashort-term solution to this disturbing and desperate situation. There are many possible reasons why Chinese doctors are under threat.These causes are systemic poor investment in the health system and in trainingand paying doctors, which can lead to medical errors, corruption, and poorcommunication between health professionals and patients. Other factors aresocietal, and include negative media reports about doctors, poor publicunderstanding of medicine, unrealistic patient expectations about treatments,and catastrophic out of pocket health-care expenses for familes. Whatever underlies the violence, the impact on medicine in China is ofgreat concern. As Li Jie, a medical student at China’s Ningbo University, writes in his letter, thenew generation of Chinese doctors feels lost: “they do not know whether tocontinue to study medicine or not, and how to face the complex and uneasyrelationship with their patients.” Doctors in Chinawere once revered, as they still are in many other Asian countries. China needs tomake medicine an attractive, respected, rewarding, and safe profession again,to protect the doctors of today and those of tomorrow, for the benefi t ofpatients. The fi rst step should be a government inquiry to examine the causesof the violence and fi nd ways to end it. Chinese doctors are under threat 《柳叶刀》：中国医生—— 威胁下的生存 The Lancet, Volume 376, Issue 9742, Page 657, 28 August 2010 （《柳叶刀》卷376，第9742期，第657页，2010年8月28日）System change, the theme of the World Cancer Congress in Shenzhen, China, Aug18—21, was a central message in the opening address by the Chinese Minister ofHealth, Chen Zhu, as he described current health-care system reforms in China.At the Congress many international health policy makers and physicians leddiscussions on frameworks and actions for system change, but there was littleparticipation from local Chinese doctors. 八月十八- 二十一日在中国深圳召开的世界抗癌大会的主题是：体制变革。这个主题正是中国卫生部部长陈竺在开幕致辞上阐述当前正在进行的中国卫生保健体制改革时所传达的中心内容。在大会上，许多国际卫生政策的制定者与医生就体制变革的准则与行动各抒己见。但是，几乎没有来自中国本地的医生参与讨论。To understand why there were so few Chinese delegates in the plenary sessionson system change compared with sessions on patients' care, one must firstunderstand that for many Chinese doctors personal safety is of greater concern.Chinese doctors are often victims of terrible violence. 与患者护理会议相比，出席全体会议讨论体制变革问题的中国代表人数少得可怜。要剖析这个现象，首先必须理解：对许多中国医生来说，个人安全问题比参加会议来得更加重要。中国医生经常成为令人惊悚的暴力的受害者。In June this year, a doctor and a nurse were fatally stabbed in Shandong Provinceby the son of a patient who died of liver cancer 13 years ago, and apaediatrician in Fujian Province was injuredafter leaping out of a fifth-floor window to escape the angry relatives of anewborn baby who had died under his care. Thus, it is not surprising to seethat in July police officers were invited to be the vice-presidents of 27hospitals in Shenyang.With hospitals turned into battlegrounds, being a doctor has become a dangerousjob in China. 今年六月，山东省的一名医生与一名护士遇刺（医生当场死亡、护士重伤），凶手是13年前死于肝癌的一名患者的儿子；而福建省一名儿科医生因为跳出五楼窗口逃生而受伤，起因是这名医生接手治疗的新生儿因故死亡而受到愤怒的患者家属的暴力攻击。因此，七月份警官应邀担任沈阳27家医院副院长职务并不令人惊讶。医院已经成为战场，因此在中国当医生便是从事一种危险的职业。Many patients blame the deterioration of their health directly on doctors,claiming that doctors lack devotion and skills. The intellectual ideals ofancient China were “eitherto be a good prime minister or to be an excellent doctor”, while in modern China doctorsand nurses used to be worshipped as “angels in white”. How has the perceptionof Chinese doctors become so eroded? 许多患者将其健康的恶化直接归咎于医生，他们声称医生缺乏敬业精神与业务能力。中国古代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则被推崇为“白衣天使”。为何中国医生的会从昔日的道德楷模变成今天一副破落户的潦倒形象呢？The Chinese media certainly have an important role in provoking tension betweendoctors and patients. There is disproportionate coverage in newspapers,television, and on the internet of how health professionals have cheatedpatients. 中国媒体在紧张的医患关系上显然扮演了重要角色。报纸、电视与互联网有关医生欺骗患者的报道辅天盖地，负面报道比例彻底压倒了正面报道。Just a few weeks ago the Southern Metropolis Daily (the most popular newspaperin Guangdong)falsely accused a midwife, who had treated haemorrhoids for a patient afterchildbirth, of stitching the patient's anus closed on purpose. 仅在几个星期前，《南方都市报》（广东发行量最大的报纸）无端指控一名助产士，声称其为产妇治疗痔疮时故意缝合了患者的肛门。In November, 2009, one of China'smost authoritative media outlets, CCTV (China Central Television), reportedthat the renowned Peking University First Hospital was carrying outillegal medical practices by allowing medical students to do surgicalprocedures, and as a result a patient had died. Even though the hospital andthe Ministry of Health made it clear that involving medical students inclinical procedures including surgery under the supervision of licensed doctorsis legal, trust in doctors and hospitals was seriously damaged. 2009年十一月，中国最权威的媒体之一CCTV（中国中央电视台）报道了著名的北京大学第一医院允许医学生非法行医做手术从而导致一名患者死亡。虽然该医院与卫生部解释在有执业资格的医生监督下医学生参与包括手术在内的临床工作是合法的，但社会对医生与医院的信任由此大打折扣。It is hard to tell whether the misreport resulted from a lack of medicalknowledge on the parts of the Southern Metropolis Daily and CCTV, or whether itwas motivated by a desire for a sensational story. However, the publicmisunderstanding of the medical profession will surely hurt both doctors andpatients in the end. 对《南方都市报》与CCTV而言，很难说这种错误报导是因为其缺乏医学知识、还是因为追求轰动性的新闻效果的动机所致。不过，公众对于医疗职业的误解肯定最终损害了医患双方的利益。Most hospitals in China,especially the large ones such as Peking Union Medical College Hospitaland Huashan Hospital of Fudan University, are run by the government. Publichospitals in China enjoyed full government funding before 1985. 中国的大多数医院，尤其是北京协和医院与复旦大学华山医院之类的大医院，都由政府运作。中国的公立医院在1985年前享受政府的全额资金支持。After economic reforms, the hospitals now receive very limited financialsupport from the government, with the result that hospitals must generateincome to cover costs. As the main source of hospitals' income is fromdiagnostics and treatment, there is a financial incentive to over-investigateand over-treat. 经济改革后，现在的医院收到的政府金融支持十分有限，其结果是医院必须生财有道来抵消其运作成本。而医院的主要收入来自于诊断与治疗，因此存在着过度检查与过度治疗的利益动机。To minimise inappropriate conflicts of interest, the Chinese Government passedlaws 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 aneconomically booming China.Such pressures, coupled with a sense of feeling seriously undervalued by thegovernment and society as a whole, drive many doctors out of medicine intoother jobs. 为使不适当的利益冲突最小化，中国政府通过立法防止医生接受来自医药公司的金融回扣。因为医生的标准工资即使从中国的标准来看也比较少，因此在经济迅速发展的中国环境下，许多医生就必须在职业道德与收支平衡问题面前挣扎。这种压力，加之感觉到自己的服务价值被政府与社会总体严重贬低，迫使许多医生改行易辙另谋生路。China'shealth-system reforms cannot be successful without reforming the social andeconomic status of doctors. Chinese doctors should be involved more in shapinghealth policy, by giving voice to their own experiences and constructive ideasabout the health system. 如果忽视医生的社会与经济地位的改革，中国的卫生体制改革是不会成功的。中国医生应该就自己的经历而畅所欲言、为医疗卫生系统的发展振兴建言献策，更多地加入到卫生政策的制定中来。 Howto end violence against doctors in China 如何终结中国医生面对的暴力 We are grateful toThe Lancet for the Editorial on violence against Chinese doctors (May12, p 1764).1,2In the past two decades, the incidence and severity of medical disputes havegreatly increased in China.We believe that the following could help end violence against Chinese doctors. First, investment in health resources should be increased. According tothe Ministry of Public Health, China,with 20% of the world's population, has a health expenditure that accounts foronly 3% of the world's total.3After the economic reforms of 1985, the Chinese Government contributed verylimited finances to health. There were very few medical disputes before 1985because most hospitals enjoyed full government funding. 第一，增加医疗卫生资源。据卫生部报道，拥有20%世界人口的中国，可医疗卫生资源却只占世界医疗总费用3%。经济改革之后，中国政府大幅减少对医院的财政拨款。在1985年之前，中国很少发生医疗纠纷，因为那时候大部分医院都享受政府的全额资助。 Second, the health literacy of Chinese adults should be improved. The poorpublic understanding of medicine could be an important factor in communicationbarriers between doctors and patients. 第二，提高中国国民的健康素养。较差的健康素养是造成医患之间沟通障碍的重要原因之一。 Finally, the professional morality of media workers should be addressed. Toincrease audience ratings, some Chinese media workers write negative or evenfalse reports of medical disputes. 最后，提升新闻媒体工作者的职业道德。中国的一些新闻媒体工作者为了提高观众的关注率，经常报道医疗纠纷的负面新闻，甚至错误报道。 We hope that thegovernment, patients, doctors, and media workers reflect on their individualresponsibilities to reduce the violence against Chinese doctors. 我们希望政府、患者、医生和媒体工作者都应该反思中国医生面临暴力的这个问题。 We declare that wehave no conflicts of interest. References 1 The Lancet.Ending violence against doctors in China.Lancet 2012; 379: 1764. FullText | PDF(93KB) | CrossRef | PubMed 2 The Lancet.Chinese doctors are under threat. Lancet 2010; 376: 657. Full Text | PDF(70KB) | CrossRef | PubMed 3 China News Service. Chen Zhu:most of 8·6 million doctors are good in China. http://www.chinanews.com/jk/2012/03-14/3744342.shtml.(accessed July 25, 2012). 4 Yin D. Law-regulated practice and evidence-basedself-protection. Chinese J Evidence-BasedMed 2005; 5: 1-2. PubMed

sunfly

柳叶刀杂志 都可以发什么？
论文？还是评论？

QQ721766373

sunfly 发表于 2015-6-18 11:44
柳叶刀杂志 都可以发什么？
论文？还是评论？

The Lancet（中文译名《柳叶刀》）杂志是目前世界医学界最权威的学术刊物之一，也是影响因子最高的SCI刊物之一，其在医学界的影响甚至超过了《Nature》和《Science》。近20年来，中国人在该杂志上发表的学术文章仅18篇。

QQ721766373

sunfly 发表于 2015-6-18 11:44
柳叶刀杂志 都可以发什么？
论文？还是评论？

The Lancet于1823年10月25日发行创刊号。自创立伊始，威克利便以激发兴趣，指导实践和推动革新为目标。指导实践起初将来自伦敦教学机构中抄录的医学讲座整理刊出， 激发兴趣在早些日子则参照戏剧评论和辛辣有趣的政论，借鉴这两者的形式予于呈现。但首要也是最重要的是，The Lancet是秉持革新主义的医学刊物。托马斯. 威克利及其继任者旨在在世界范围内将最卓越的医学科学出版物和一腔热忱相结合以对抗那些侵蚀医学之价值的力量，这些力量可能是政治的，社会的亦或是商业的。
该杂志从创立至今始终保持独立，未曾加入任何一个医学或科学组织。在180多年后，The Lancet在整个医学界的发言仍保持着其独立性和权威性。我们探寻发表可引发医学实践变革的高质量临床试验；我们致力于世界健康的使命以确保广泛覆盖来自世界各区域的研究分析。我们强大的评论部和通信部可确保对研究及回顾性文章的严格评审；The Lancet的主张及格调则在每周由三位主编交流后而确定； 优先发表的论文则通过thelancet.com提前快速发表；并且The Lancet系列专业月刊的持续成功可确保The Lancet深入探讨医学中主要学科的知识

syhorchid

医患关系比较突出

wwdn

麻烦请问在哪可以看到柳叶刀医学杂志的电子版，最好是中文版的？