The Lancet， Volume 376， Issue 9742， Page 657， 28 August 2010

    （《柳叶刀》卷376，第9742期，第657页，2010年8月28日）

    System change， the theme of the World Cancer Congress in Shenzhen， China， Aug 18—21， was a central message in the opening address by the Chinese Minister of Health， Chen Zhu， as he described current health-care system reforms in China. At the Congress many international health policy makers and physicians led discussions on frameworks and actions for system change， but there was little participation from local Chinese doctors.

    八月十八- 二十一日在中国深圳召开的世界抗癌大会的主题是：体制变革。这个主题正是中国卫生部部长陈竺在开幕致辞上阐述当前正在进行的中国卫生保健体制改革时所传达的中心内容。在大会上，许多国际卫生政策的制定者与医生就体制变革的准则与行动各抒己见。但是，几乎没有来自中国本地的医生参与讨论。

    To understand why there were so few Chinese delegates in the plenary sessions on system change compared with sessions on patients' care， one must first understand that for many Chinese doctors personal safety is of greater concern. Chinese doctors are often victims of terrible violence.

    与患者护理会议相比，出席全体会议讨论体制变革问题的中国代表人数少得可怜。要剖析这个现象，首先必须理解：对许多中国医生来说，个人安全问题比参加会议来得更加重要。中国医生经常成为令人惊悚的暴力的受害者。

    In June this year， a doctor and a nurse were fatally stabbed in Shandong Province by the son of a patient who died of liver cancer 13 years ago， and a paediatrician in Fujian Province was injured after leaping out of a fifth-floor window to escape the angry relatives of a newborn baby who had died under his care. Thus， it is not surprising to see that in July police officers were invited to be the vice-presidents of 27 hospitals in Shenyang. With hospitals turned into battlegrounds， being a doctor has become a dangerous job in China.

    今年六月，山东省的一名医生与一名护士遇刺（医生当场死亡、护士重伤），凶手是13年前死于肝癌的一名患者的儿子；而福建省一名儿科医生因为跳出五楼窗口逃生而受伤，起因是这名医生接手治疗的新生儿因故死亡而受到愤怒的患者家属的暴力攻击。因此，七月份警官应邀担任沈阳27家医院副院长职务并不令人惊讶。医院已经成为战场，因此在中国当医生便是从事一种危险的职业。

    The problem may be largely one of perception. Many Chinese patients believe that doctors and hospitals conspire to increase charges by providing unnecessary examinations， investigations， and treatments. Additionally， some doctors accept red envelopes （a monetary gift in exchange for favourable service） against the rules.

    这个问题可能主要是认识上的问题。许多中国患者相信医生与医院沆瀣一气，通过提供不必要的检查、检验与治疗提高了看病费用。此外，一些医生不顾相关法规接受红包（现金礼物，患者以此换取有利的医疗服务）。

    Many patients blame the deterioration of their health directly on doctors， claiming that doctors lack devotion and skills. The intellectual ideals of ancient China were “either to be a good prime minister or to be an excellent doctor”， while in modern China doctors and nurses used to be worshipped as “angels in white”。 How has the perception of Chinese doctors become so eroded？

    许多患者将其健康的恶化直接归咎于医生，他们声称医生缺乏敬业精神与业务能力。中国古代的知识分子的理想是：“不为良相，当为良医”，而现代中国的医生与护士则被推崇为“白衣天使”。为何中国医生的会从昔日的道德楷模变成今天一副破落户的潦倒形象呢？

    The Chinese media certainly have an important role in provoking tension between doctors and patients. There is disproportionate coverage in newspapers， television， and on the internet of how health professionals have cheated patients.

    中国媒体在紧张的医患关系上显然扮演了重要角色。报纸、电视与互联网有关医生欺骗患者的报道辅天盖地，负面报道比例彻底压倒了正面报道。

    Just a few weeks ago the Southern Metropolis Daily （the most popular newspaper in Guangdong） falsely accused a midwife， who had treated haemorrhoids for a patient after childbirth， of stitching the patient's anus closed on purpose.

    仅在几个星期前，《南方都市报》（广东发行量最大的报纸）无端指控一名助产士，声称其为产妇治疗痔疮时故意缝合了患者的肛门。

    In November， 2009， one of China's most authoritative media outlets， CCTV （China Central Television）， reported that the renowned Peking University First Hospital was carrying out illegal medical practices by allowing medical students to do surgical procedures， and as a result a patient had died. Even though the hospital and the Ministry of Health made it clear that involving medical students in clinical procedures including surgery under the supervision of licensed doctors is legal， trust in doctors and hospitals was seriously damaged.

    2009年十一月，中国最权威的媒体之一CCTV（中国中央电视台）报道了著名的北京大学第一医院允许医学生非法行医做手术从而导致一名患者死亡。虽然该医院与卫生部解释在有执业资格的医生监督下医学生参与包括手术在内的临床工作是合法的，但社会对医生与医院的信任由此大打折扣。

    It is hard to tell whether the misreport resulted from a lack of medical knowledge on the parts of the Southern Metropolis Daily and CCTV， or whether it was motivated by a desire for a sensational story. However， the public misunderstanding of the medical profession will surely hurt both doctors and patients in the end.

    对《南方都市报》与CCTV而言，很难说这种错误报导是因为其缺乏医学知识、还是因为追求轰动性的新闻效果的动机所致。不过，公众对于医疗职业的误解肯定最终损害了医患双方的利益。

    Most hospitals in China， especially the large ones such as Peking Union Medical College Hospital and Huashan Hospital of Fudan University， are run by the government. Public hospitals in China enjoyed full government funding before 1985.

    中国的大多数医院，尤其是北京协和医院与复旦大学华山医院之类的大医院，都由政府运作。中国的公立医院在1985年前享受政府的全额资金支持。

    After economic reforms， the hospitals now receive very limited financial support from the government， with the result that hospitals must generate income to cover costs. As the main source of hospitals' income is from diagnostics and treatment， there is a financial incentive to over-investigate and over-treat.

    经济改革后，现在的医院收到的政府金融支持十分有限，其结果是医院必须生财有道来抵消其运作成本。而医院的主要收入来自于诊断与治疗，因此存在着过度检查与过度治疗的利益动机。

    To minimise inappropriate conflicts of interest， the Chinese Government passed laws to prevent doctors receiving financial kickbacks from drug companies. Because the standard salary of a doctor is modest， even by Chinese standards， many doctors struggle to balance professional ethics and making ends meet in an economically booming China. Such pressures， coupled with a sense of feeling seriously undervalued by the government and society as a whole， drive many doctors out of medicine into other jobs.

    为使不适当的利益冲突最小化，中国政府通过立法防止医生接受来自医药公司的金融回扣。因为医生的标准工资即使从中国的标准来看也比较少，因此在经济迅速发展的中国环境下，许多医生就必须在职业道德与收支平衡问题面前挣扎。这种压力，加之感觉到自己的服务价值被政府与社会总体严重贬低，迫使许多医生改行易辙另谋生路。

    China's health-system reforms cannot be successful without reforming the social and economic status of doctors. Chinese doctors should be involved more in shaping health policy， by giving voice to their own experiences and constructive ideas about the health system.

    如果忽视医生的社会与经济地位的改革，中国的卫生体制改革是不会成功的。 中国医生应该就自己的经历而畅所欲言、为医疗卫生系统的发展振兴建言献策，更多地加入到卫生政策的制定中来。