在信任缺失的中國醫院切身體驗看病難大綱
Chinese patients are fed up with their doctors, and doctors are fed up with their patients.
中國的病人已經受夠了他們的醫生，而醫生也受夠了他們的病人。
During a two-week stay in a Beijing hospital, here’s what I wrote in my diary: ‘‘One has a curious sense of being in a machine, an irritant, like a grain of sand. … No one has the right to anything, not even medical care. You can only demand, beg or seize.’’
在北京一家醫院住院兩週期間，我在日記裏寫下了以下文字：“有一種奇怪的感覺，彷彿身處機器裏，彷彿令人生厭，像是一粒沙子……人沒有任何權利，就連獲得醫療護理的權利也沒有。你只能要求、懇求或盡力去抓。”
And people do. ‘‘Kan bing nan,’’ or ‘‘It’s hard to see a doctor,’’ they say about the country’s oversubscribed, underfunded, often corrupt, health system. In frustration, patients may attack their physicians. Bribery is common.
大家確實就在這麼做。提到中國的醫療體系需求過多、資金不足，而且經常出現腐敗現象時，人們將其概括爲“看病難”。一些心懷不滿的病人可能會攻擊醫生。收受賄賂的現象也頗爲常見。
Patients’ relatives gather in hospital waiting rooms and corridors, or camp out in wards cooking and tending to the sick, to make up for inadequate nursing. They may stage noisy protests to get the attention of staff members.
病人的親屬聚集在醫院的候診室和走廊裏，或者暫住在病房中，做飯並照顧病人，以此彌補醫院看護不足的問題。他們可能會故意進行激烈的抗議活動，爲的是引起工作人員的關注。
‘‘I think you will find that most doctors are good people,’’ said a doctor at another Beijing hospital. Yet, physicians are unpopular and need advice on ‘‘upholding their rights,’’ according to an article on the website of the Chinese Medical Doctor Association. Common problems: What should a doctor do when bitten by a patient with syphilis? Assaulted by a drunk? Besieged at home for 10 years by a couple angry over their daughter’s unsuccessful operation?
在北京另一家醫院工作的一名醫生表示，“我想，你會發現大多數醫生都是好人。”不過，中國醫師協會網站上的一篇文章卻顯示，醫生不受歡迎，需要“維權”方面的建議。常見問題包括：被梅毒攜帶者咬傷後，醫生該怎麼辦？遭到醉酒者攻擊時，該如何應對？被不滿女兒手術失敗的夫婦圍堵家門長達10年時，該做些什麼？
China’s medical system is a ‘‘market of distrust,’’ according to Cheris Shun- ching Chan, a sociologist at the University of Hong Kong. An emphasis on profits, a culture of ‘‘gift giving’’ and a lack of professional ethics have produced a difficult atmosphere, she said.
香港大學的社會學研究者陳純菁(Cheris Shun-ching Chan)稱，中國的醫療體系是一個“信任缺失的市場”。她表示，對盈利的重視、“送禮”文化的盛行，以及職業道德的缺乏產生了一種不利的氛圍。
‘‘During the Mao period, doctor-patient relationships were relatively harmonious,’’ Ms. Chan said. Money was scarce and resources were few, for all. But after decades of market liberalization as hospitals sought to generate revenue, contributing to treatment shaped by commercial rather than medical concerns, trust is gone. ‘‘The conflict really is between patients and doctors,’’ she said.
陳純菁說，“在毛澤東時代，醫患關係相對融洽。”儘管當時也存在經費和資源匱乏的問題。不過，經過數十年的市場自由化後，隨着醫院尋求盈利，出於商業而非醫療方面的考慮進行治療，這種信任已經蕩然無存。她表示，“這實際上就是病人與醫生之間的矛盾。”
The government says 90 percent of Chinese have some health insurance, but underfinanced state programs leave many patients covering the bulk of their costs themselves. One attempt to overcome the inefficiencies of the system and ensure a physician treats a patient well is to give ‘‘hongbao,’’ or red envelopes — bribes.
政府聲稱90%的中國人都有某種醫療保險，但資金不足的國家醫保導致很多病人需要自己支付大部分的醫療費用。要想克服醫療系統效率低下的問題，確保醫生認真治療，一種辦法就是送“紅包”——賄賂醫務人員。
Such payments are illegal. In 2014 the National Health and Family Planning Commission issued its 13th notice in two decades demanding that patients not give them and physicians not take them, Ms. Chan said.
此類報酬屬於非法所得。2014年，國家衛生和計劃生育委員會發布通知要求病人不送紅包，醫生不收紅包。陳純菁表示，這是20年來的第13份相關通知。
Hongbao, typically of 1,000 to 5,000 renminbi per envelope, or $160 to $800, are particularly common before major surgeries, said Ms. Chan, citing a survey she conducted. Of 572 people interviewed in Beijing, Shanghai and Guangzhou, 31 percent said they had offered hongbao, and these were accepted in 80 percent of cases, she said.
陳純菁稱，她所做過的一項調查顯示，在重大手術前送紅包是一種常見的現象，金額從1000元到5000元不等。她表示，應答者包括北京、上海及廣州的572人，其中31%表示，他們送過紅包，80%的情況下被對方收下。
‘‘You have to ‘buy’ a doctor’s effort to save the life of a person,’’ she said. ‘‘The main aim is to get the physicians to perform the surgery to the best of their ability. It’s what surgeons are supposed to do, of course.’’
“要想拯救一個人的生命，你得‘收買’醫生，”她說。“主要目的是讓醫生盡力做好手術。當然，醫生本來就應該這樣做。”
The government recognizes the problems. On April 1, a meeting of the Central Leading Group for Comprehensively Deepening Reforms discussed the need for change in the medical system.
政府承認存在上述問題。4月1日，中央全面深化改革領導小組舉行會議，討論醫療系統改革的必要性。
‘‘We must realize the responsibility of the state to provide medical care, break the system of public hospitals pursuing profit, and build an appropriate salary system that matches the special skills of the medical profession,’’ reported Xinhua, the state news agency. Leaders know more investment is needed.
官方新聞機構新華社報道，“要落實政府辦醫責任，破除公立醫院逐利機制，建立符合醫療行業特點的人事薪酬制度。”看來，領導人知道需要加大投入。
But money may not be enough. A lack of professionalism skews everything, according to a recent report by David Blumenthal and William Hsiao in The New England Journal of Medicine. A century into China’s quest to be a modern state, ‘‘the norms and standards of medical professionalism’’ and ‘‘the independent civic organizations that could promote and enforce them’’ are still missing, they write.
不過，光是加大投資可能還不夠。戴維·布魯門薩爾(David Blumenthal)和蕭慶倫(William Hsiao)近期在《新英格蘭醫學雜誌》(The New England Journal of Medicine)發表文章稱，職業精神的缺失會扭曲一切。文中寫道，中國尋求成爲現代國家已有一個世紀的時間，但仍舊缺乏“醫學職業精神的規範和標準”，以及“能夠推廣並加強這些規範和標準的獨立民間組織”。
Said Ms. Chan: ‘‘Doctors often joke that they are afraid to sit in offices with their backs to the door in case they’re stabbed.’’ And everyone feels the deficit of humanity.
陳純菁表示，“醫生們經常開玩笑說，他們不敢背對着門坐在辦公室裏，以防被捅。”大家都能感覺到這當中人性的缺失。
