Hippocrates:
See the letter.
From 1990 to 1998, I studied medicine seriously for eight years at the Union Medical College. I studied for a doctor of medicine in a serious course, from DNA and RNA to cells to tissues to gross anatomy, from physiology to pathology to pharmacology, from traditional Chinese medicine to internal medicine to neurology to psychiatry to obstetrics and gynecology.
More than ten years ago, after studying medicine for eight years, after drinking, vomiting and sitting and thinking, I decided not to be a doctor any more.
At that time, I decided not to be a doctor for two main reasons:
The first reason is to doubt what doctors can do.
In the last three years of my medical studies, I studied ovarian cancer at the genetic and histological levels.
The more I study it, the more I feel that the connection between life and death is too close. It can even be said that life and death are one thing and one thing.
Some diseases do not need treatment, and most diseases are not well treated. I watched the ovarian cancer patients I followed in the past three years, with surgery, chemotherapy, recurrence, resurgery and chemotherapy. Within three years, no matter how doctors handle them, less than half of the patients will still die.
To die slowly and painfully, with infinite attachment to life and uncertainty about death, to die.
The second reason is that it is becoming more and more difficult to be a doctor.
After studying medicine for a while, I basically understood that medicine has never been a pure science, but:
To cure, sometime. To alleviate, more often. To comfort, always
What I was worried about at that time was that in addition to the spiritual pleasure of saving the dead and helping the wounded, doctors could also reap what? How long can doctors be happy without sufficient financial foundation?
There are diseases on the tissue structure and anatomical structure of the human body. There is a patient above the disease. There is a doctor next to the patient, There is a hospital above the doctor. Above the hospital are the Ministry of Health, the National Development and Reform Commission and the Ministry of Finance. Next to the hospital are insurance institutions. Above the insurance institutions are the CIRC and the Ministry of Social Security. In modern society, doctors’ treatment of patients has never been a simple commercial activity. In terms of medical and health care, the domestic emphasis is on average and equality, [the whole people enjoy medical care], and the adjustment of plans is emphasized to stay away from the market.
Medicine is already so expensive that it can only depress doctors’ income and hospitals can only use medicine to support doctors.
Doctors in the United States earn better incomes, but not only are lawsuits rampant, but also the balance between fairness and efficiency cannot be fundamentally solved:
If a new life-saving drug is produced, is it reasonable to cost 100,000 yuan and price 10 million yuan? Should I? The new drug is priced at 10 million yuan. Should it be given to patients who can afford it, or should it be given to all patients with applicable diseases? Is it reasonable that 30% of the medical expenses in the United States are spent on people who will die within two years?
After graduating from medical school, After more than a decade without medical treatment, The main health indicators (life expectancy, neonatal mortality, etc.) are getting better and better, However, the medical environment seems to be getting more and more worrying: the medical care group whose overall quality is deteriorating at an accelerated pace, the aging patient group who vents a variety of dissatisfaction on the medical care individual, and the self-righteous media that only join in the fun, seek sensationalism and basically do not think deeply.
However, there are still the same things as in the past: medical students continue to be poor and cannot afford beautiful nurses to eat midnight snacks. Even, compared with the past, small doctors are poorer.
And the house price is five to ten times higher than in the past. It used to buy a small house of more than 20 to 30 square meters on the edge of Beijing’s 3rd Ring Road and commute by bike. Now it is too far away to commute by bike in the Yan suburbs of Hebei Province. Pregnant, crowded subway and bus afraid of premature delivery, want to buy a QQ car instead of walking, but Beijing vehicle purchase restrictions issued.
The little doctor stayed up until the associate professor. There were still more than 40 full professors in the same department in the hospital. There was less than one operation a week. Each operation started after 5 pm.
Compared with the past, the registration fee for big doctors has increased a little, still around the price of a fashion magazine. I still have to see dozens of patients in the morning, or I have to endure urine, excrement, hunger and hunger. Each patient can only be given a few minutes of consultation time.
Large hospitals continue to be like wartime hospitals or post-disaster hospitals. From night to day, large hospitals are full of patients and their families accompanying them. All eyes are on temporary beds and suspended bottles. Patients continue to be not cared for like people, and few doctors have the time and patience to comfort, relieve and cure them.
In addition to poverty, doctors began to worry about their lives. Some patients who did not enjoy basic services began to do so:
A few years ago, we only got angry every few months. Now we have to get angry every few days.
In a month’s time, a doctor was hacked to death by the patient, the genitals of a hospital director were kicked to pieces, a director of the people’s hospital was beaten to a fracture, and Nanchang medical trouble fought with 100 doctors…
In view of the increasing threats to personal safety, our doctors are ready to organize groups to learn kung fu. The coaches offer the following choices: Wing Chun Boxing, Taekwondo, Boxing and Sanda. I don’t know which one to learn.
I tried to find out.
The phenomenon of illness coexists with life. The history of the profession of doctors is as old as that of assassins, prostitutes and witches. How can doctors basically lead a decent life? How can patients basically have the same dignity as human beings? I tried to reread the doctor’s oath you wrote 2400 years ago to find the answer.
2400 years ago, you swore: [Apollo, Escrapes and the gods of heaven and earth testify, I, Hippocrates swear.]
Therefore, first, doctors should have a heart of awe, respect God, heaven and earth, and respect their conscience and moral law.
Even in the face of the sharp sword of extreme poverty, even in the face of the sharp sword of patients, one must not forget the heart of awe and do something.
2400 years ago, you swore: “I will respect everyone who teaches me medical skills as I respect my parents. I will pass on the medical skills I have, whether expressed orally or written, to my children, to the children of my teachers and students who swear to abide by this oath.” Except for these three cases, it will not be passed on to others.]
Therefore, second, medical skill is a craft. Doctors should continue this craft, unite sincerely and love each other.
2400 years ago, You swear: [I will do my best to abide by the moral principle of working for the benefit of the patients within my judgment, and put an end to all depravity and harmful acts… No matter in what, no matter whether the patients to be treated are men or women, free people or handmaidens, I will treat them equally, and seeking happiness for them is my only purpose.]
Therefore, third, the interests of patients are higher than those of doctors.
Patients are first and foremost human beings, and all patients are equal in the face of pain. Doctors should not have any difference. There is no distinction between rich and poor or rich or poor on the sickbed or operating table. Although doctors cannot guarantee that patients enjoy the same drugs, at least they can guarantee that they will be given the same comfort and care.
In addition to your oath, I think that in order to [let Apollo, Escrapes and the gods of heaven and earth give me the supreme glory in life and medicine], doctors must have enough income.
The health care system of any good developing country adopts a two-track system. Not too much emphasis is placed on absolute fairness. While ensuring basic medical care, high-end medical services are provided to meet differentiated medical needs. I firmly believe that in this country with rapid economic development, which contributes 25% of LV sales every year, there are enough people willing to pay a reasonable price for their own medical care. How to establish this two-track system will not be discussed in detail here.
Before the basic changes in the system, system and world style, I still suggest that doctors should learn to protect themselves and practice hard to escape in the face of sharp swords. While studying medical skills every day, they should also study Ling Bo’s micro-step and 50-meter accelerated turn-back run. In order to escape conveniently, it is suggested to refer to Hu Fu’s riding and shooting and turn white overcoat into white trousers.
Hippocrates, do you have a better way?
Bye again