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美國醫生效率低下的原因和壓力有關

  The patient,a powerfully built middle-aged restaurant worker,had awakened one morning with a tight pain in his shoulders that traveled down his right arm.At work,he could barely shrug his shoulders or turn his head."My fingers were so weak,"he recalled,"that I couldn't even get a good grip around a glass of water."

  這位病人在餐館工作,是個身材魁梧的中年人。一天早上他被疼醒了,疼痛從肩部放射到右臂。工作時,他幾乎無法聳肩或扭頭。“我的手指沒力氣,”他回憶道,“連杯水也抓不牢。”

  美國醫生效率低下的原因

  A senior doctor at a local clinic diagnosed a pinched nerve and prescribed a muscle relaxant.Two weeks later,only more incapacitated,the patient went to another clinic,where a younger doctor made the right diagnosis:A malignant tumor in his chest was pressing against a nerve to his arm.

  當地診所的一位資深醫生診斷他是神經受壓,為他開了肌肉松弛劑。兩周后,無力感更強了,病人去了另一家診所,得到了一位較年輕醫生的確診:他胸腔里的惡性腫瘤壓迫了他手臂上的神經。

  "That first doctor couldn't be bothered by what I was trying to say,"the patient said.He was now receiving chemotherapy and was hopeful his cancer had been caught early enough,but the near miss still haunted him."He acted like he just didn't want to be there with me.Or with any patient."

  “第一位醫生很不耐煩,都不想聽聽我想要說什么,”這位病人說。他正在接受化療,希望自己的癌癥發現得夠早,但那次漏診依然讓他不安,“他表現得好像他不想多搭理我。不想搭理任何病人。”

  After reading a study published this week in Archives of Internal Medicine,I've been thinking a lot about this patient's experience.And I've come to two conclusions.First,the older doctor had classic symptoms of burnout.

  讀完本周發表在《內科學文獻》(Archives of Internal Medicine)上的一篇研究后,我對這位病人的遭遇想了很多。我得出了兩個結論。首先,這位年長醫生有著典型的倦怠癥狀。

  Second,mistakes like his may only become more common.

  其次,類似他的這種失誤會變得越來越普遍。

  Research over the last 10 years has shown that burnout-the particular constellation of emotional exhaustion,detachment and a low sense of accomplishment-is widespread among medical students and doctors-in-training.Nearly half of these aspiring doctors end up becoming burned out over the course of their schooling,quickly losing their sense of empathy for others and succumbing to unprofessional behavior like lying and cheating.

  最近10年的調查表明,倦怠——特別是情緒耗竭(emotional exhaustion)、冷漠、成就感低這一系列表現——在醫學生和實習醫生中普遍存在。這些胸懷抱負的醫生中,有近一半在求學過程中陷入倦怠,迅速喪失了對他人的同情心,屈從于說謊與欺騙等有違職業的行為。

  Now,in what is the first study of burnout among fully trained doctors from a wide range of specialties,it appears that the young are not the only ones who are vulnerable.Doctors who have been practicing anywhere from a year to several decades are just as susceptible to becoming burned out as students and trainees.And the implications of their burnout--unlike that of their younger counterparts,who are often under supervision--may be more devastating and immediate. 紐約時報中英文網 http://www.244129.buzz

  如今,研究者對大量不同專業正式醫生進行了第一次關于倦怠的調查,結果表明受影響的不僅是年輕一代。與醫學生及實習生一樣,所有地方的執業醫生,從工作一年到幾十年的,都可能出現倦怠。而他們發生倦怠產生的影響與受到監管的年輕人不同,往往更具破壞性也更直接。

  Analyzing questionnaires sent to more than 7,000 doctors,researchers found that almost half complained of being emotionally exhausted,feeling detached from their patients and work or suffering from a low sense of accomplishment.The researchers then compared the doctors'responses with those of nearly 3,500 people working in other fields and found that even after adjusting for variables like gender,age,number of hours worked and amount of education,the doctors were still more likely to suffer from burnout.

  研究人員向超過7000名醫生發出了分析問卷,發現近一半抱怨情緒耗竭,對病人和工作環境感覺冷漠,成就感低。研究人員還比較了醫生與其他領域的近3500人的反應,發現在調整了如性別、年齡、工作時間和教育程度等變量后,醫生依然是更容易發生倦怠的。

  "We're not talking about a few individuals who are disorganized or not functioning well under pressure;we're talking about one out of every two doctors who have already survived rigorous training,"said Dr.Tait D.Shanafelt,the lead author of the study and a professor of medicine at the Mayo Clinic in Rochester,Minn."These numbers speak to bigger problems in the larger health care environment."

  “我們在這里所說的,不是一些人面對壓力會變得行為渙散,或者沒法正常工作;我們要指出的是,每兩個已經熬過了嚴格培訓的醫生中就有一人出現了這些情緒問題,”泰特·D·沙那非博士(Dr.Tait D.Shanafelt)是本次調查的主要作者,也是明尼蘇達州羅切斯特市(Rochester)梅奧醫療中心(Mayo Clinic)的內科教授,他說:“這些數字說明,在越大型的醫療環境中,問題也越大。”

  The doctors'burnout appeared to have little to do with hours worked or even the ability to balance personal life with work.Instead,the only factor predictive of a higher risk was practicing a specialty that offered front-line access to care.More than half of the doctors in family medicine,emergency medicine and general internal medicine experienced some form of burnout.

  醫生的倦怠似乎與工作時間、甚至工作與個人生活的平衡能力無關。相反,唯一預示高風險的因素是提供一線醫療保健專業服務。家庭醫生、急診室醫生和普通內科醫生中,超過一半經歷過某種形式的倦怠。

  The study casts a grim light on what it is like to practice medicine in the current health care system.A significant proportion of doctors feel trapped,thwarted by the limited time they are allowed to spend with patients,stymied by the ever-changing rules set by insurers and other payers on what they can prescribe or offer as treatment and frustrated by the fact that any gains in efficiency offered by electronic medical records are so soon offset by numerous,newly devised administrative tasks that must also be completed on the computer.

  這項研究為當今醫療保健系統中的行醫狀況蒙上了一層陰霾。有相當數量的醫生感到陷入困境,他們能夠給予病人的時間之少令人挫敗,保險公司或其他支付者關于他們能夠給予什么藥物或治療的條例不斷變化在妨礙他們工作,電子醫療記錄帶來的效率提升很快又被無數新衍生的必須在電腦上完成的行政任務所抵消,這同樣讓他們感到沮喪。

  In this setting,"doctors are losing their inspiration,"Dr.Shanafelt said,"and that is a very frightening thing."

  在這種情況下,“醫生失去了動力。”沙那非博士說,“這是一件非??膳碌氖?。”

  What patients must face in the examining room is no less alarming.Doctors who are suffering from burnout are more prone to errors,less empathetic and more likely to treat patients like diagnoses or objects.They are also more likely to quit practicing altogether,a trend that has serious repercussions in a system already facing a severe doctor shortage as it attempts to expand coverage to 30 million or more currently uninsured Americans.

  病人在診室中的遭遇依然令人憂慮。倦怠的醫生更容易出現失誤,更沒同情心,更傾向于把病人僅當作診斷的對象。他們也更容易放棄執業,這一趨勢對已經面臨嚴重醫生短缺的醫療系統產生了負面的影響,此系統正試圖覆蓋超過3000萬目前尚無醫療保險的美國人。

  "Doctors are coming to this expansion already pretty stretched and stressed out,"Dr.Shanafelt noted."I don't think there is going to be a lot of room to maneuver without some significant structural changes."

  “醫生們承受了重壓,弦已經繃得滿滿的了,”沙那非博士強調說,“如果沒有重大的結構性變化,我不認為還有什么回旋余地。”

  美國醫生壓力過大為什么會影響效率

  Dr.Shanafelt and his colleagues are in the midst of studying the effects of workplace initiatives aimed at providing greater support for doctors while improving efficiency,which they believe is critical for doctors and patients as well as the large health care organizations that aim to serve us all.Without decreasing the total hours worked or the number of patients a doctor must see,a hospital system might,for example,restructure its clinics so that doctors could spend more time with patients and less time on the phone getting authorization from insurers or in front of a computer completing administrative tasks.

  沙那非博士及其團隊正在研究為醫生提供更多支持提高效率的工作舉措是否有效,他們相信這對于醫生、病人、以及向我們提供服務的大型醫療保健機構來說,都一樣非常重要。醫院系統或許不能減少醫生的工作時間或接診病人數量,但可以做其他改變,比如對診所的機制予以調整,從而令醫生可以有更多時間與病人接觸,而把較少的時間花在打電話獲得保險公司授權,或趴在電腦前處理行政任務上。

  "If people work in an environment where they believe there is meaning,they will put up with a lot,"Dr.Shanafelt observed."It goes beyond the significant personal consequences for an individual physician.It affects whom patients can see when they are sick,the quality of care they receive and their safety."

  “如果人們能在他們覺得有意義的環境中工作,他們會甘愿忍耐。”沙那非博士觀察認為:“這個問題遠不僅僅是個別醫生的遭遇。它會影響到病人生病時看到什么樣的醫生、接受什么質量的服務,以及他們的安全感。”

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