Dina Martina - Medical College Commercial
I am the person with an achievement very serious thought, write a thing to always want to become presswork letter, otherwise achievement can be taken an examination of without book, banquet of uneasiness of at nightfall bedroom. How to become type? Contribute! Magazine press is grasped those who numerous students leads to a scholarly honour and official rank is unripe reduce power. Unripe kill authority to always want someone in control of, this is indifferent to; Can doesn‘t person of this in power have what level? Careless brandish knife, contributor not know what to do, style of writing is evil change... ; No wonder the implied meaning that has insight more very much is grown in eight -part essay on compasses. Square the person naturally outside is indifferent to, it is academic rise and fall only, although ordinary man is unaccountable, also want to scratch itching, still lying between boots, scratch also scratch in vain. You look, old still imp is unwilling suffer the heart that bend to be in jumpy, that is scratched.
Last year, april 2008, deputy office of hall of Guangdong province sanitation grows Liao Xinbo to be on rich guest about " by accident examine " view, cause a society attention, discuss and criticize. I support Liao Xinbo‘s point of view, spent 10 days of time to drive wrote an article " clinical by accident examine principle " , consciousness is quite complacent. The article guides to Liao Xinbo and the rich of a few place colleges point out mistakes so that they can be corrected passes, obtain self-identity, among them several people offer to be published on their rich guest, I did not agree, the heart that the reason is a scholarly honour and official rank is not dead. According to article characteristic, via person proposal, contribute " medical and philosophy " magazine. Manuscript pitching, disappear forever, via phone inquiry, its magazine company is building system of the contribute on the net, to new in June submit a piece of writing for publication, draft order: Yxzx-35193. Sex of effectiveness for a given period of time is to do not have, wait.
In July, magazine company gave an opinion: "Concept of article wh some of which has new idea, but careful deliberate, very unscientific. Be like notional sex disease, the author thinks to be put in two kinds of diseases, it is the patient‘s true illness, it is the doctor‘s fictitious disease. Actually this is not new issue. The objective existence of a kind of disease, it is the doctor understanding to the disease. The person that this is planted is discriminating, this also by accident the understanding reason that examine appears. Other and similar wording, be like by accident examine is 100 percent, also won‘t the person is accepted " (this opinion is all and textual copy) . Should read and edit to still calculate responsible, the philosophy that is him only, science and medical level are not high, did not understand greatly; Editor level is not high also, brains change trains not a few turns, can content with superficial understanding only, garble... .
Good, I also cannot play this learning problem foolishly, probably my experience is not much also, it is oneself feel to had not seen who can mix disease principle only by accident it is so clear like me that examine principle is told. In addition, I still feel medical philosophy should be my strong point, be necessary last year " clinical by accident examine principle " the article is carried come out, give everybody judge judge again, whether is looking I have a problem really? Am I looked down upon " medicine and philosophy " of the magazine read and edit? Thank! Old boy this compartment is civilized.
" clinical by accident examine principle " (2008.4. )
Likewei
Software of medicine of family approach force (Shenzhen) limited company
[summary] the article go up from Internet about ‘ 5 into by accident examine is led ‘ argumentative proceed with, elaborate from different point of view and administrative levels clinical by accident the structure of examine and principle, the culture setting that thinks to differ and play the method is right by accident the happening of examine is influential. The article is the each other of both sides of clinical doctors and patients the relation to be an incident independently, the structural sex problem of growth and decline of bilateral medicine state in discussing this incident; Point out the historical character of the disease and probability character at the same time, put forward disease examine to forbid a principle. The article thinks the doctor is to adopt probability method and method of trial and error to the assurance of the disease, of trial and error bear the weight of the fault tolerance feature that the foundation is life. To deal with human disease the much systematization of condition is mixed sex of much specialized subject, the hospital is formed through integrated doctor resource technical strategic advantage, also cause a doctor to answer the weak force that ability reduces individually at the same time. Final verdict is: By accident the method implementation that examine cannot rely on to have is solved thoroughly, must introduce digitlization new technology to just may achieve better result.
[keyword] by accident examine principle, disease cause of disease manages, disease examine forbids a principle, medical philosophy,
Abstract: Summary; Key Words: Summary.
One, foreword
On April 9, 2008, the rich guest article that Guangdong saves wholesome hall deputy hall to grow Liao Xinbo " of the doctor diagnose is 3 is become by accident examine? " , say: "If see a doctor in outpatient service, by accident examine rate is 50% . If you live in the hospital, young doctor looked, the doctor of other also looked, everybody also goes around and inquire, discussed, this B that do exceeds, CT, assay finished completely, by accident examine rate is 30% " . Subsequently on April 12 " · news tracks southern Metropolis Daily " give tit for tat of Lin Shuguang of dean of hospital of report province people, say: "About these by accident examine data, he does not know come from where. ... every should make conclusions, with respect to need large-scale example is analysed, the data that must come so ability is reliable. Same, 50% by accident examine, the individual feels absolutely. If had not made investigation,be citation chapter only, not be very strict, may aggravate doctors and patients concerns " .
The problem of medical treatment health of dignity of work experience hospital and everybody, caused an another controversy upsurge. Is deserted hall long meeting is relation of doctors and patients of aggravate of exaggerate sth just to scare people contrary? Apparently it is completely OK that an office grows ground of lacking in initiative and overcautious sits in the office, need not billow of mouth of place oneself Yu Feng is pointed, but he pays close attention to medical treatment heat through Internet and rich guest however, communicate the people actively, cite data explains by accident the austere sex of examine, strive for the patient understanding to the doctor equally, very commendable. Article purpose is not to be deserted hall to grow appraise one‘s merits to had been placed, want to prove sexual ground answer however: By accident how is examine to return a responsibility? Does outpatient service have 5 to become really by accident is examine led?
The China and foreign countries that doctors and patients of level of two, society confronts each other is compared
Be in the United States, the psychology between doctors and patients confronts each other and confront each other directly should a lot of less, outside dividing humanitarian setting and social habit to differ, see a doctor process itself very the generation of can evasive confronting circumstance. The United States sees a doctor most need makes an appointment, and the patient amount that every doctor sees everyday is very few; Among them majority is diagnosed won‘t give out on the spot for the first time, want to await lab outcome, 2 should consult relevant data, revise a point of view stage by stage next, arrived to be sure to just fall quite diagnose. The United States by accident examine rate is very high also, seeing a data says before a few years is 60% . Be in the United States, generation by accident because the doctor is crackbrained,the most reason of examine is not, because think without time,also not be, because the doctor sees a doctor,should read law first however, ‘ see a doctor lawfully ‘ , from see a doctor beginning prepares evade responsibility, form so too rely on diagnostic equipment (have byelaw) , the experience that does not pay attention to blame equipment too is accumulated (without byelaw) feasibility condition. And, if appeared medical treatment liability accident, criterion this doctor this all one‘s life cannot practise medicine.
By accident examine, even about by accident the comment of examine causes doctors and patients possibly to confront each other, this has bit of China distinguishing feature probably, although the Chinese is atheistic more, but always think the move is advantageous in the bottom of the heart my miracle happens, form a kind of relatively common medical treatment to evaluate a system from this. On one hand, the people, media uses what the miracle in physical world pushs miracle of world of life of high people opposite to expect ceaselessly; On the other hand certain doctor also is complied with ‘ providential ‘ , feel to become big from personal can, blind and self-confident, imprudent and decision-making. Its are as a result: Once result into, affect rapid dilate, media by every means kittenish, sequel is meddlesome again and again; Once fail, wind direction mutation, confront each other along with case, patient accumulating is weak and indignant, the means that uses an extreme easily upholds his right, hospital force is powerful passive however, can by every means shuffle in order to maintain self interest. Of course, china also is in progressively abide west ‘ see a doctor lawfully ‘ way develops, but the circumstance that still is confronting vie or furtive mediation at present slants much, and litigate, the case that law settles slants little.
Three, the different situation between medical level doctors and patients
Have not see about ‘ the each other between doctors and patients is a relation ‘ rational research. Often the circumstance is: The view that the doctor is medical treatment incident square, strong ability advocates, and the view is full name proposition, have logistic weak point, easy by attack. Tell from social class, the hospital is strong to patient situation; From medical treatment rich play chess is told, the doctor is young to patient situation (from the back research is described) , of incident of doctor view medical treatment ‘ self-confident ‘ footing is very small. The doctor below very most circumstance must lean swashbuckling come the thing of round view, rely on figure softness to avoid back and forth the thing that goes against a view, so doctor sometimes although the certain of character, meantime of ceaseless however game, have to stay for oneself retreat the space that defend.
The patient is medical treatment incident be advocated square, everything can be sent only look at the doctor, much portion expects heart of delay of much portion. Patient one party or bend its are all, or destroy the home to treat a disease, sincere heart, hang be precarious at a gleam of. Actually, life of home of patient detain the upper part of the body is to have what establish a value beforehand, if end product is inside the limits that the patient approbates, so everyone is happy; If the result exceeds the range that the patient permits, furious, brawl, complain, litigate etc. So, let a patient rationally know a doctor, let a doctor understand whole situation dispute to often be necessary. Deserted office grows to say ugly word in front for medical treatment bound, return true colors at the masses, change contradiction of after the event to be beforehand understanding, did not damage the intent of what person interest really.
Normally, when ‘ doctor ‘ when regarding a group as the concept, they are the Wang Zhe of domain of medical treatment health, stand high above the masses, omnipotent. But, in reality, the doctor is a stricture be been in by limitation inside specialized subject limits individual; When the doctor with individual face a patient alone, criterion the group concept that the situation is different from a doctor absolutely. What is treating a patient again? The patient is each system (division department) integrated and whole life style, an any a bit disease suffers from an influence to be able to produce the body of extensive correlation in each system, chiliad of number of a medicine is long the mountain stronghold that attacks cannot, a know exactly about sth 100000000 the biology course of evolution history, one is put in the sealed change condition of countless interference element. Confront such huge system, the doctor is individual be without an advantage but character.
The life foundation of four, historic disease and diagnosis and treatment of trial and error
The disease is life process, it is the history, have not reversibility and cannot repeatability, border is not affirmatory, essential factor is not certain, fluctuate the condition of random fork. So the disease of anybody is new episode, new episode is sheet weighs proposition; Do not have off-the-peg method to be able to answer the happening of new episode directly. So, the assurance of new to trends episode the method is ‘ trial and error ‘ . The doctor is diagnosed is a trial and error eliminates a process, the result of trial and error how by curative effect test and verify, should form those who lose feedback adjustment actually to close jointly by trial and error and curative effect annulus, advance the people understanding to the disease thereby.
Although trial and error is the main method that knows dynamic new episode, but the trial and error that anything begins from the beginning is very time-consuming, and the loss outweights the gain, similar sex analogy can be passed to shorten in a lot of moment process of trial and error, make trial and error is to build the base in relevant knowledge. Relevant knowledge is more substantial, course of trial and error is shorter. Motion of abide card medicine pledges actually for, it is namely shorten clinical a revolution that try bad process and starts, what it emphasizes ‘ evidence ‘ compare sufficient analogy data namely, want agglomeration always finally to judge ability to produce effect to the disease for some kind of knowledge. Knowledge, experience is the most advantageous tool that argues time with the disease.
The Rong Shouchi of clinical trial and error or the foundation that trial and error bilks to be in in order to put are: The fault tolerance ability of life. Life has ego error correction, fault tolerance, harmonious with self-healing ability, clinical cure is to move these capacity on degree quite. Although the fault tolerance sex of airframe gives trial and error obligate of diagnosis and treatment space, but trial and error whether continuously, stand attrib border decision by the look of airframe. Below circumstance of quite a few, the method that uses high of qualitative pure force blindly attacks cut down kill, the fault tolerance ability that makes airframe finally reachs border very quickly, will cause the consequence that ruins life.
Five, the probability of notional sex disease and disease holds a method
The illness development of the disease can have fluctuate change, along with time alignment but disease described as a curve, we can say some history expression is curve of some feature sex. From schoolbook, we perhaps can see complete disease is described; Below clinical circumstance, the doctor sees all curve that is less than a disease, can see an illness is sectional randomly only. This sectional be in normally namely clinical go up to often discuss alleged ‘ disease ‘ concept, it is not whole disease process certainly.
As ‘ disease ‘ the concept has state of two kinds of existence: It is patient voice disease, namely the patient suffers anguish really; 2 it is doctor condition disease, the diagnostic earning that is a doctor is fictitious disease, it is the description of pair of patient diseases. Two kinds of condition cannot be complete be identical, namely the doctor cannot be complete diagnose any diseases. The doctor sees an illness is sectional (patient voice disease) hind, the meeting will be sectional medium illness element compares pair of doctor mind in ‘ experience disease ‘ element (doctor condition disease) undertake diagnostic, form 3 parts after gather operation, include ‘ examine of diagnose, leakage, by accident examine ‘ , it is result of sex of a probability certainly.
An illness sectional or a life is sectional in have too much variable, include a patient‘s condition kind variable, physiology kind variable, environment kind variable is waited a moment, cannot overall limit, hold impossibly entirely, and the doctor in diagnose and treating a meeting to catch its‘ foregone a few or a few points, other is sealed and variable the blind area that belongs to a doctor. Sealed variable can produce implicative effect likewise, its principle is the gets used to mechanism adjustment body oneself whole state that carries airframe. Because be put in doctor blind area and body,getting used to a mechanism oneself, somebody thinks to be able to discover some is planted oneself consistent after all mechanism gets medicine and even all to lead life with all; They or catch from inside a philosophical sect in the Wei and Jin dynasties certain specious concept, or a certain index in seeking certain test result regards gold as index, or use newest gene practice to solve all-embracing human life problem to wait a moment. Actually, this is theology longing adds scientific thinking! The structural feature of life form is different from corporeal configuration greatly, the argument that should avoid to use corporeal world as far as possible goes explaining, guess, subjective life world.
Land, by accident examine hundred
The place on put together is narrated, by accident examine is diagnosed in any diseases in it is the existence of 100% , without can dispute. Alleged ‘ outpatient service 5 into by accident examine ‘ problem, it is to differentiate by accident this line of examine delimits in what position, the investigation of the big sample book that asks as to Dean Lin place also is done not have necessary. By accident although examine always exists, clinical in or must differentiate is clear: Be ‘ by accident examine ‘ the general orientation with dominant current diagnosis and treatment, or ‘ diagnose ‘ the general orientation with dominant current diagnosis and treatment? It is long the trial and error below blind condition, be still the exploration below substantial knowledge condition? And more important is: This kind of diagnosis and treatment is to take current temporarily curative effect, can you still assure healthy direction of the patient truly?
Had listened to a few all corners of the country to swim cure or illegal examine place boast say when their experience: "We should earn money must get effect instantly, the most effective method uses hormone to cover disease in great quantities namely, go up to pin disease together with a variety of antibiotic " . Also have certain hospital is born to earn money to adopt excessive therapy with the cure that do not have fine, regard children cold as for nothing obviously children is pneumonic make a diagnosis and give treatment, regard vulva eczema as serious and venereal make a diagnosis and give treatment is waited a moment. This kind in cold blood by accident examine is treated by accident not be article discussion. The caustic below market economy environment provokes shade action, providential conscience naturally cannot resist.
The strategic contradiction of seven, hospital and actual state
Majority hospital will never swim like all corners of the country cure in that way act as if human life is not worth a straw, life border of the patient also does not allow medical treatment of trial and error to last for long. To avoid a doctor individual weak force, expand joint force of the doctor with because answer disease, appeared of integrated doctor resource ‘ hospital ‘ form; Hospital interior doctor undertakes professional division of labor, many doctor consultation is organized when need, the forked firepower of strategic sexual intercourse that forms the mankind to cope with a disease, namely every doctor is familiar with a specialized subject, the disease that if encounter,exceeds this specialized subject range is passed turn examine or consultation will solve.
The issue came, had said range of doctor individual knowledge is narrow in front, disease state of the patient always is met very wide, such, is consultation to want a large number of happening? According to " round-the-world times " to Beijing assist with the hospital cover news, the professor says: "The country stipulates every patient time seeing a doctor is 20 minutes, actual condition doctor sees 90 ～ via often can appearing a long time the circumstance of 100 people. " if not be difficulty serious illness, the hospital does not squeeze the strategic advantage that gives a doctor to develop a hospital at all, the doctor also hinders at face, public opinion, competition, allocate wait for a relation, be willing to appeal not quite at other staff.
Actually, the implementation of hospital strategy goal, it is really in order to close narrow (get greatly) professional knowledge face of the doctor is cost. The doctor is installed each its duty, the doctor is individual be in weak force, but the integral advantage of the hospital came out now with respect to body. Here has a problem again, chinese hospital is clinical the work way of a gleam of still is with the doctor individual give priority to, the constituent sex framework that difficult disease of a serious illness just may employ a hospital, that is to say, the hospital is in only to the strategic advantage of the disease certain be thought necessary when just may show come. Nevertheless, the hospital gives a doctor the largest support is mentally. Came a patient, hospital doctor can think: Sure, all sorts of examining do complete, be no good can turn division, a few divisions turn come down neat, what should do exclusively is to cannot make mistake. It is float is alterable to the border with the fault, must come down its regulation by superior, the doctor goes by the regulation, ability is insurable without anxiety. Come a few this years so, the west ‘ see a doctor lawfully ‘ the influence also has been in China rooted blossom and bear fruit. Is the doctor to be in does the patient see a doctor? It is in order to treat a patient 4 minutes exemple: 1 minute listens the patient is recounted, 1 minute examines system and search experience, 1 minute of considerations are sequential, 1 minute remembers legal regulations. The security that uses him doctor of balance of half the time is not new issue, if you have an opportunity to go to the United States becoming a doctor, regular meeting somebody persuades you: The thing that can not do is not done, the money that you earn when 10 years of doctors, cannot carry lawsuit on the head. Also be the United States, urgent disease of a gastralgia by air 2 days, remand finally, the reason is all sorts of examining the report does not have a result, the doctor starts work anything but.
Look back on, if doctor level is a fixed cost, assume the doctor encounters his unsharpness problem, the behavior that solves a problem may spread out along two direction: It is to last trial and error, the fault tolerance that uses patient airframe is characteristic; It is change perspective, use a hospital turn the advantage condition of division or consultation. Face the restriction of pedigree of complex with each passing day disease and doctor resource, specialized subject fractionize can grow day and day, extensive consultation gets too great progress very hard, by accident examine problem and contradiction of doctors and patients cannot get fundamental improvement through having a method already.
Eight, by accident examine is on guard with intelligent tool
How be on guard by accident examine, deserted office grows to tell everybody a principle in rich guest: "If was in a hospital to be diagnosed by a doctor, you must ask for those who get the 2nd hospital to check, this is the simplest decrease by accident the method of examine " . This is to say actually: Change a perspective. If two perspectives crossing is identical, criterion disease by by accident the possibility of examine is reduced greatly. Look from the associated character of airframe, any disease of the person suffer from impossible very pure, diagnosis and treatment of much angle across is similar consultation, it is to be on guard by accident a of examine serious train of thought. Have better idea to finish much angle across to make a diagnosis and give treatment? Have! Use the artificial intelligence technology that is based on medical knowledge base for example, learn proceed with of examine train of thought from full medical service, with enhancing a doctor individual actual strength is a target, for doctor research and development tool of a special software, strive for auxiliary doctor clinical by accident examine rate reduces 20 ％ from 50 ％ .
Return to medical treatment reality, the patient regards medical treatment as incident by view object, below most circumstance, the patient is not the consequence that cannot bear a disease, do not hope the doctor has blind spot to his disease however, do not hope to relapse do sth over and over again, qian Youshe of do sth over and over again vacates a person, end up with a do sth over and over again not result. Itself of medical treatment process is thing of a do sth over and over again, how ability not Where is do sth over and over again? That gives patient know the inside story authority and speech right namely. Itself of medical treatment incident is the alternant process of doctor and patient, if diagnosis and treatment is transparent with reciprocity of know the inside story, the doctor‘s responsibility can be partaken actually by the patient. The doctor should not carry frame work, should step down altar, do not think practise deception, be born in the Communist Party of China of human health facilities however in all flourish. But the disease is too complex, the doctor below a lot of circumstances is judged to the disease and knowledge is indecisive, how he explains to the patient, share with the patient? So, study a comprehensive, justice, transparent, fast, handy intelligence turns consultation tool, will be the potential demand that hospital, doctor, patient just has need each.
Bibliographical reference:
Liao Xinbo: " is the doctor‘s diagnosis has 3 to become by accident examine? " , www.bokee.com, rich guest China, on April 9, 2008
Zhu Fengjun: " outpatient service 5 into by accident examine? Do not have absolutely! " , southern Metropolis Daily, on April 12, 2008
Field, Wang Xiao: " assist with check of true substance of hospital outpatient service - large hospital has many to squeeze after all " , round-the-world times, on June 5, 2007
Likewei: " by accident examine problem and informatization are on guard " , chinese wholesome information runs a magazine, 2006 the 6th period
Likewei: " abide card medicine is decision-making system " , magazine of Chinese number medicine, 2008 the 3rd period
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