当前在线人数16207
首页 - 博客首页 - 美国医学教育博客 - 文章阅读 [博客首页] [首页]
彦彬:对丁香园网友LIN LU关于中美医学体系比较问题的答复
作者:USMedEdu
发表时间:2007-10-03
更新时间:2007-10-03
浏览:2063次
评论:1篇
地址:75.
::: 栏目 :::
现代医学vs“中医”
社会、艺术与医学
住院/FELLOW单位
中外医学网站精选
国内外医学交流信息
生物医学人物
力刀美加医学教育专
临床见习/实习/义工
医学生理学诺贝尔奖
医生助理(PA)职业
医学书籍照片及图谱
社会与医学瞬间定格
医学典故/医史杂谈
USMLE复习和考试
申请和面试住院医生
住院医生生活和工作
FELLOWSHIP
医生就业、工作及生
医学科普及问题解答
美加医学院申请/MCA
中美医学临床教育比
医学新进展及新闻
社会医学伦理

彦彬:对丁香园网友LIN LU关于中美医学体系比较问题的答复



恕我直言,这是典型的中国医生的观点。这是由于对美国医疗系统不了解的表现。

病经验是必不可少的,但是得需要有科学来指导,否则就与江湖中医没有什么不同。


医生的对象是人,人有主观意识,主观意识会影响人们对于疾病治疗效果的观察。

因此寻症医学正是来解决此问题的,即排除主观因素,去伪存真。在研究一个疾病

时一定要排除其他因素的干扰,但这不等于在看病人时,一定要机械地去教条。

看病人的数目不能取代科学地研究疾病诊断与治疗。中国人在医学上还没有与世界

接轨的原因是,中国医生对于西方医学只了解皮毛,不懂实质。举个例子来说吧,

中国的医生来美国参观,只看技术和设备,不去了解医疗的体制,教学体制,社区

医院的操作系统。国内美国开会或短期参观的医生到临床探头探脑地看看,然后跟

同事小声耳语:“这美国的医疗设备也不过是如此,大同小异“,查房也听不懂。

第二天,干脆就去买东西,逛风景了。回国后想想“它美国的医生一天看几个病人,

我们一天看个上百个,经验比他们的丰富多了”如此一想,心里便很踏实。

来丁香园以后更加体会到中国的医疗水平相差太大,没有诊断治疗指南,专科医生

缺乏适当的训练,医德普遍缺乏。我们真心希望国内的战友们能更多的了解美国医

疗好的地方,早日与世界接轨。


linlu wrote:
力刀老兄好,您的帖子仔细拜读过,有些问题期待指点
1 我承认美国是世界上医学最发达的国家,其医疗制度也很成熟,但如果抛去经
济实力,单就一般水平而言,我觉得美国医生并不比我们更有经验.虽然他们咨询发达
,对循证医学比较认可,但疾病是变化多端的,只依靠循证医学指导临床实践是很教条
的,对医生而言,面对的是每一个病人个体,所以否认经验是不对的,但指南循证等有
指导意义我不否认.
2 我承认他们基础扎实比较扎实,善于协同作战(比如临床,统计,病理等),他们
比较认真.而且理念不同,细节上,行医的氛围和工作氛围上我们有差距,而且这差距
主要表现在医疗制度和西方思维方式上,仅此而已.我们同样用功,同样训练临床思维
.我不知道,既然临床思维是最重要的,请您诚实的讲一讲,遇到疑难病例,他们是靠临
床症状+必要化验检查+临床思维推理出来的,还是因为不怕花钱,查个遍才诊断出来
的,
就想是电脑下棋,走一步要思维好几百万遍,一般人当然下不过它,但它就比人脑
高级了吗?
总之我佩服您的毅力,也承认美国医疗在很多方面比我们发达,但这主要表现在
基础方面,我们中国临床医生也是好样的,至少不比他们差.
看看在美国有多少优秀的基础类的科学家就知道了,难道中国人只能做好基础?凭
什么我们临床就一定比他们差?这不合逻辑.

[上一篇] [下一篇] [发表评论] [写信问候] [收藏] [举报] 
 
共有1条评论
1   [USMedEdu 于 2007-10-03 03:25:03 提到] [FROM: 75.]
BoYang1998: comments on Dr. Yan Bin's post


this is an in-depth analysis and comment. i agree with Dr. Yan.

i have heard my friends here in the US complaining about their doctors not taking good care of them and were not as good as they expected, also comments like linlu's. i don't want to deny the fact that in the United states, there are doctors not taking very good care of patients, depending on extensive tests and studies. i have been frustrated by ER doctors frequently for not taking good care of emergeny surgery patients or trauma patients. however, there is room for improvement for chinese medical system and doctors. let me just give you some examples from surgical stand point.

first, at the present time, there is still no such subspecialty, trauma surgery , in china. there is no such team to save patients in the golden hour after traumatic events. i suggested to set up a sub-block of "trauma surgery" in "general surgery block"at DXY.COM, but i was told it is not the time yet (i really don't know what that means). so i started a discussion of trauma surgery in "general surgery block" just to introduce the idea of "trauma surgery".
http://www.dxy.cn/bbs/post/view?bid=48&id=8002631&sty=1&tpg=1&age=0

i also post two cases at xytown.cn when i was on call to show how we handle multiple severe trauma patients at the same time with limited force.
http://www.xytown.cn/viewthread.php?tid=106051&highlight=%2Bbo%20yang

after you read those two posts, you probably can tell some difference of medical care for trauma patients between china and US.

Second, in big hospitals in china, surgeons may do a lot cases, such open heart surgery. the quantity is there. however, the complexity and difficulty is very different. if you look at the numbers of cases were done at Stanford univ., you may not be impressed. however, the major cases they do are repair of aortic aneurysm, aortic dissection, redo-redo CABG, complecated valve repair, Ventricular assistant devices. i worked there in 2005 for my elective rotation and that is why i am going there for my cardiothoracic surgery fellowship.

third, there is no standard care in china. after medical school, every doc can do whatever he or she wants to do. also patient's follow up is very poor. cancer patients disappear after operation, nobody knows he or she is still alive or dead, or whether the patient needs any further treatment? here, cancer patients are part of the doctor's family, they have life-time follow-ups with the surgeon.

fourth, doctors in china are reluctant to accept the standard care in the US. simple example, for T1, T2 breast cancer without palpable axillary LN, lumpectomy + sentinel lymph node biopsy(SLN) + radiation has been standard care for years. however, i was told by breast surgeons in china that most time they offer patients mastectomy + axillary LN dissection (remove all the axillary LNs) which has much higher morbidity. In china, SLN biopsy is just some surgical graduate student's research project. why do you want to do any research about something that has been confirmed by many studies years ago and already become a standard care.......

we all know the fact that medicine is still somehow behind in china compared to developed countries. that is not the end of the world. the important thing is that we should realize the difference, and work hard to catch up or even do better, then we can take good care of our patients in china.
 
用户名: 密码:
发表评论
评论:
[返回顶部] [刷新]  [给USMedEdu写信]  [美国医学教育博客首页] [博客首页] [BBS 未名空间站]
 
Site Map - Contact Us - Terms and Conditions - Privacy Policy

版权所有BBS 未名空间站(mitbbs.com) since 1996