中国医生在外国医院的工作日记（转贴） [复制链接]

It is a sunny day. Usually the sun can bring us good luck and happy mood, but it turned out to be a really busy shift. I arrived at the ER at 08:20 so I could join the morning round at 08:30. Although I don’t think I could get lots of useful medical information from that, it is really a precious channel to know sth happened in this hospital. As a routine, the docs from each department reviewed the pts seen yesterday. Another two thyroid nodule pts received surgical removal in the surgical department, “wow, so many thyroid nodules pts! Any relationship to the water of this region?” Dr. Monton said, he always wants to share his opinions with all of us. “Who knows? We should start an epidemiological survey to confirm it.” Said Dr. Saied, the chief medical officer. Then a shigella pt of Pediatric department. Two C-section of OB-GYN. Also, as a routine, I kept silent from the start to the end of the morning round.

My shift started. I was not as excited as the first time when I could sit in this office. But the truth always let me feel I am fighting that I could never figure out what kind of patient will come here in the coming second. Before I could log on the Internet, the phone rang. I picked it up, “Dr. Dong, a three-year-old girl with severe SOB!” I rush out to the exam room, only saw an anxious mom and a lovely kid with obvious difficulties in breathing and mild cyanosis. “My daughter had an asthma attack yesterday, I brought her here and doc gave her Ventolin (albuterol) and Atrovent (ipratropium). She was fine after the nebulization, but now you can see that...” “Put her on the bed,” I told the nurse, “I need to listen to her lungs”. Feeling pressing and no time to wash my hands, I put my stethoscope on the kid’s chest. (One of my colleagues received a complain report from a pediatric pt’s mother because he forgot to wash his hands before examining the kid) diffuse wheezes, very typical for asthma. “I am going to give your daughter pednisolone—one of the steroids to relieve the asthma attack.” I told the mother. “Are you sure about this medication and the dosage is ok for my kid?” the mom was very agitated,”I am a lawyer who is specialized at medical malpractice cases. You should know that, if …” I interrupted her, “Look! Madam, here is a book of the latest guidelines for management of pediatric diseases, you can check it up by yourself. ” I don’t want to discuss too much about this issue and left the exam room to my office.
The racial discrimination exists everywhere in this hospital. All the docs are classified according to where they came from and where they got their medical education. This is the first time in my life that I realized the English is more important than your medical knowledge and clinical skills.
-To be continued

在ER当然很忙
要是专业医生就比较舒服了
一天只看寥寥几个好久以前预约的病人

什么时候咱们的医疗制度也改革以下

减少工作量，增加收入，严格准入制度，加强培训

不希望家属过多的干预治疗，

可是医疗官司太可怕

就像文章里的那位母亲

国外医生准入是很严格的
能当上医生尤其是specialist的少数
但也不轻松

选择了这行干什么都不容易

高投入以其高风险么...外国就是这样吧....老太太喝茶嘴被烫了都可以要求10万USD的赔偿...

考出去的医学生最后只有5%的能干上临床,一个在美国当心内科大夫的叔叔说不拿出比美国本土人多上几倍的努力,是不可能赚美国人这口饭的
不过当他真当上专科医生后,第一年的收入就可以顶国内10+年了.

the major aim to open this topic is to offer a platform for you guys to discuss in English. so i really hope each of you could talk something in English and the discussion about professinal medicine is especially welcome.

It is like a TRAUMA day today. Although I am exhausted by the explanation to the pediatric patients’ anxious parents, I was really excited and got something like a refreshment when I saw the trauma patient at the ER. He is a 18 year old boy who was struck by a moving heavy truck when he rode a big motorcycle. On first impression, there is fresh bleeding from an open fracture in the left ankle. But I know very well, as a competent ER physician, you should never concentrate too much on those obvious wounds. On the contrary, the silent injury usually is more fatal. Follow the BLS (Basic Life Support) procedure and under the assistance of the nurse, I examine the airway, breathing, circulation, and consciousness. Airway is secure and the vital sign is stable. Two IV access are established simultaneously. NS 500ml IVPB wide open. After the primary survey, we continue to do the secondary survey--- cut off all the clothes of the boy and examine every part of the body. Back pain and pelvic pain are revealed after the examination and the head to toe CT scan is ordered. After the pulmonary contusion, kidney rupture, liver laceration, pelvic fracture and left comminuted trimalleolar open fracture is confirmed. We transfer this patient to the ICU and refer him to the orthopedics, urologist, general surgeon, respiratory internist, ICU physician. We are working like a team because everybody seems devoted very much into the process to save the boy’s life.
This is a big difference between Chinese hospitals and western hospitals. No definition regarding good or bad patient exist here. I remember it is a very prominent characteristic in china’s hospital that lots of physicians would dump the so called “bad patients” who suffered from a very complicated medical problem or multiple chronic diseases because once admitted, it will become very difficult to discharge them. While the average patient in-hospitalization duration in your department is a main indicator to determine the salary of your staff. Really funny! Under this policy, every doctor would choose the easy patient because they will not stay here too long and then you can get a high salary!

agreen the 7 level