Han Qide: The contradiction between doctors and patients is the necessity of medical progress and social development

medical effect, the greater the contradiction between doctors and patients.
gdp per capita is far from that of developed countries, but the medical requirements are in keeping with them, and it is naturally difficult to be satisfied.
I am very concerned that large medical institutions will see a new round of expansion after the new crown outbreak.
think that with technology, it's more dangerous than patients expecting too much from medicine.
" 2020 outbreak hurt a lot of people, but also let us see the doctor-patient relationship is the most ideal look. "During the outbreak of new crown pneumonia, this comment from netizens resonated with many people.
doctors and patients were once regarded as "two worlds", and the outbreak seemed to allow them to go deep into each other's worlds and feel each other's warmth and light.
19th is the third Chinese Physicians' Day. On this special day, China Science Daily interviewed Han Qide, Honorary Chairman of the Chinese Association of Science and Technology, China
, and Founding Director of the Department of Science, Technology and Medical History of Peking University, to examine what kind of living background exists in China's doctor-patient conflict. Will the once-severe doctor-patient relationship be "cured" by the new crown pneumonia outbreak?han Qidethe new coronary pneumonia outbreak, the public's understanding of medicine will change? Will it be a watershed for improved doctor-patient relations?the outbreak has t shed more on the epidemic and health, but there may not be much improvement in the overall understanding of medicine.
There is no special effects drugs, vaccine research and development difficult facts, to a certain extent, can let the people understand that medicine has its own limitations, but I also worry that in the process of promoting our good disease prevention and treatment results, the common people will unrealistically put medicine and famous doctors to a higher "god."
Our medical workers have always had the spirit of taking the national interests of the country in the face of the general trend, whether it is the new crown or SARS of that year, the health care workers are using their flesh and blood to block between hundreds of millions of people and the sick.
this time, because of various media dissemination, they set up a hero in the hearts of ordinary people, access to more respect and applause than ever before.
, in the past, there was no shortage of moving stories of doctors' benevolence, similar propaganda never stopped, the common people are not invisible, but the doctor-patient conflict has always existed.
fact, the real feeling of the doctor-patient relationship is formed by the common people in every process of dealing with hospitals, doctors and diseases. Once hospital operations return to normal after the outbreak, so will the real doctor-patient relationship.
that this outbreak will not fundamentally change the doctor-patient relationship, because the root causes of the doctor-patient conflict have not changed.the rapid development of chinese medicine, the knowledge gap is difficult to narrow, in the modern medical system, patients are easy to be "
" manipulation. Is
the root cause of the split between doctors and patients? knowledge
, as long as doctors exist, information asymmetries between them and patients will never be eliminated.
in the history of medicine, from Hippocrates to Zhang Zhongjing and Sun Siwei, advocating medicine and respecting doctors are the long-time public opinion of ancient and modern China and abroad.
Chinese doctors can always maintain a harmonious and close relationship with patients, even in the stormy old China, in the early days of the abandoned Republic, and even in the "decade
of disorderly times, doctors and patients do not see dust, get along without noise. Therefore, the split between doctors and patients is not necessarily due to the existence
knowledge.
, we may wish to think about why the doctor-patient relationship is harmonious in the less developed past of medicine.
from more than 2000 years ago when the profession of doctors was born, it is a noble cause, often only "nobility" will choose.
is noble? That is, once you become a doctor, you are no longer a "normal person", in addition to having professional knowledge and skills, more importantly, have a higher moral character than the average person, to have the feelings of hanging pot, to have a "pizza heart."
social evaluation also believes that "not for good, then for good medicine." Therefore, the doctor in the long-term teaching process, formed a deep-rooted cultural consciousness.
refore, in the process of contact with patients, they have always maintained a high degree of ethics and kindness, even if the disease can not be cured, will bring a lot of comfort to patients, the doctor-patient relationship is naturally benign development. , now the "nobility" temperament of the doctor is diminishing? 's true.
in some hospitals with a long tradition, we can still feel the influence and inheritance of moral teachings in the manners of doctors. But in many hospitals, especially primary hospitals, this temperament is relatively rare.
doctors and teachers, are the very few professions that are still recognized as "sacred" by society today. He must not be a good doctor if he only used practice as a means of making a living.
doctors face life, in any era, the moral requirements of doctors can not be reduced, otherwise, coupled with information asymmetry, medicine will become very terrible.
I don't agree that patients can be neglected because they are too hard and tired to work, or because they are wronged in a doctor-patient relationship. As long as you see the patient, you must sympathize with them, love them, you must do everything possible to treat them.
is why a nation should let the best people become doctors and teachers, so that this nation can have hope.
question is, how can these occupations be attractive enough to them? They deserve their rightful place and decent treatment.
have to say that although the treatment of doctors in the country has improved significantly compared with before, it is still not enough, and the gap between large and small hospitals, between doctors and doctors is widening. do you think is the root cause of the break-up of the doctor-patient relationship? we have to clarify the fact that the doctor-patient conflict is not only happening in China, in fact, the deepening of the doctor-patient conflict is a common phenomenon all over the world. Its deep-seated reason is precisely the progress of medicine and social progress.
from the point of view of medical progress, first of all, for more than a century, the rapid development of medical technology has brought about a fundamental change in the medical model. Before the 20th century, whether in the West or China, patients and doctors were often one-on-one acquaintances, and even if they didn't see well, there would be no excessive contradictions.
the development of medical technology, hospital visits have become the main channel, doctors and patients have become strangers, the degree of trust between people has decreased.
, the improvement of medical effect leads to a significant increase in patient expectations.
The assumption is that only 20 per cent of patients had a chance of being cured, and now 80 per cent of patients are available, and people should be satisfied now compared to before, but the opposite is true, and that is the result of higher expectations."
when the uncured become a minority, it is more likely to produce psychological imbalances. Therefore, the better the medical effect, the greater the contradiction between doctors and patients.
, the development of medical technology has allowed doctors to shift almost all their energy and attention to technology, and to get along with patients to a secondary position, and the distance between doctors and patients is increasing.
past, most medical problems were unsolvable to doctors, who had to devote more energy to comforting patients and meeting their inner needs.
, the immediate consequence of the increase in modern medical technology is that medical costs and prices have increased significantly. Increased costs multiply the pressure on patients and reduce satisfaction, which in turn exacerbates the conflict.
addition, the development of modern medical technology has brought about many ethical problems that were not originally, and cannot be solved at this stage.
e.g. in organ transplantation, how to prioritize the recipient donor, whether life-assisted technology should be used or not, when it can be stopped, and whether a child with a birth defect should be saved in the diagnosis and treatment of genetic disorders... These dilemmas, which do not have standard answers, have created more differences between doctors and patients. did not expect that the deep-seated cause of the doctor-patient conflict is actually medical progress, then how does social progress affect the doctor-patient relationship? "social progress" has led to more and more "strangers by the bedside". Since the development of medicine, disease treatment is no longer just a matter between doctors and patients, lawyers, ethicists, sociologists, philosophers, politicians, entrepreneurs are all around the doctor-patient conflict is becoming more and more complex.
A key turning point occurred in the 1960s and 1970s, when a series of civil rights movements, including the women's rights movement, the anti-racial discrimination movement, the libertarian movement, and so on, began to take place in the United States.
legal and legal communities are increasingly involved in medical cases, most not known as the patient's right to informed consent. Patients and their families need to sign an informed consent form before the hospital can perform the operation, which can guarantee the patient's right to know and choose, is an equal performance of doctors and patients.
, sociologists, ethicists, and even philosophers have joined in, focusing on "what is the value of life" because of the problems involved in the medical process, such as how life support systems are used and how babies are disposed of.
political involvement, and under the Western electoral system, a surge of public opinion can kidnap politics. A classic example is Nixon's signing of the National Cancer Act in the 1970s during a booming anti-cancer campaign, which mobilized the nation to defeat cancer in the short term and ultimately failed.
the involvement and intervention of pharmaceutical companies in medical treatment is beyond doubt, and the unhealthy relationship between them and hospitals and doctors is often one of the important reasons that trigger the contradiction between doctors and patients.
, more strangers are involved in doctor-patient relationships, both as a manifestation of social progress and as a double-edged sword for patients.
the patient's right to informed consent as an example, itself is an important measure to protect the rights and interests of patients, but in fact, it tends to deepen the contradiction between doctors and patients.
such as the patient has lost consciousness, immediate family members are not around, who will sign? You can't have surgery without signing, often by mistake. Informed consent stipulates that any risk should be informed to the patient, the patient does not understand the doctor, but also to make their own decision whether to receive treatment, often resulting in the patient is very tangled and even hurt, which leads to medical disputes.
in the past, patients were left to doctors, and of course if doctors were irresponsible, they could cause harm to patients, but in most cases doctors felt responsibility and patients were not forced to make decisions.
developed countries, because of the perfection of the legal system and the strength of the whole support system, as well as the cultural background with freedom as the core, ordinary people can adapt to this complex doctor-patient relationship. But in a rapidly changing China, it is difficult for us to deal with all kinds of relationships in a short period of time, and problems will naturally arise between doctors and patients. the common problem of medicine and social progress, does China's doctor-patient contradiction have its special background? First of all, China's rapid development of more than 40 years has created a world miracle, large hospital medical equipment, conditions and developed countries, others have the same technology we almost have, patients can see hope, "even if the pot selling iron to save lives", helpless high-quality resources are limited, it is impossible to meet the needs of all people.
china's PER capita GDP and developed countries are far from the common people's medical requirements to the developed countries, naturally difficult to be satisfied.
, China's medical service architecture is seriously unreasonable. Due to the lack of a hierarchical diagnosis and treatment system, high-quality medical resources are concentrated in a small number of hospitals in large cities, the level of treatment and service of primary medical institutions is low, and patients are flocking to large hospitals.
hospitals, even as they desperately expand, can't keep up with the rate of patient growth and are overcrowded, making it difficult to satisfy the masses. And the primary medical institutions, the level is more difficult to improve, forming a vicious circle.
I am very worried that after the new crown outbreak, large medical institutions will usher in a new round of expansion. The unreasonable allocation of medical resources must be vigorously reversed, and the determination must be made to shift resources to the grass-roots level, and it must be directed to the "people" at the grass-roots level, rather than to the equipment, so as to guide more good doctors to work at the grass-roots level.
once China can establish a hierarchical diagnosis and treatment system, coupled with the application of Internet technology, I believe that the current stage of the allocation of medical resources can greatly change the huge disadvantages, and thus make the tension between doctors and patients to ease.
, our concept and positioning of health care is not accurate enough. China's health-care policy of "low-level, wide coverage" now covers at least 95% of the country's population, which is a remarkable achievement.
the problem is that the graded treatment is broken, the disorderly expansion of large hospitals, the high cost of medical care, which is not matched with the "low-level, wide coverage" of the health care system, and thus caused people's dissatisfaction with health insurance.
problems are the result of our rapid development and the inability of the reform of the health care system to adapt quickly during the transition period. At present, the above-mentioned problems are intertwined, which is an important reason for the tension between doctors and patients in our country. , apart from the reform of the medical and health system, what can we do to improve the doctor-patient relationship? further deepening the reform of the medical and health system is indeed the most fundamental way to improve the doctor-patient relationship. In addition, first of all, to improve the relevant legal system, medical trouble, injury behavior will not condone, this is the bottom line, can not touch.
to carry out more extensive and in-depth medical science, so that people correctly understand what medicine is, what medicine can solve, what medicine can not solve, reduce the unrealistic expectations of medicine.
in understanding the doctor-patient relationship, although doctors and patients are partners, in theory there is no question of who is strong and who is weak, but at the micro-realistic level, more changes need to be made by doctors, especially doctors. This includes doctors to enhance the humanistic quality of medicine. Medical humanities is not possible to overcome the dilemma of medical modernity