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中国医生正在承受的六大重负,你占了几条?

2017-04-19 郑小编 医学干货联盟

为什么中国医生会如此疲惫?

为什么中国医生会如此疲惫?

优质医生不多且集中在大型医院

从宏观来说,中国统计年鉴显示,2013年每***口执业(助理)医生2.04人,已经超过全球中等收入国家的平均水平。按理说中国医生数量已经不算少了,但是由于优质医生不多,而且大部分集中在城市大型医院,结果人们都集中到大型医院看病,大型医院天天爆棚,这里的医生日日辛苦。与此形成鲜明反差的是,基层小医院门厅罗雀。因此,并不是所有中国医生都很劳累,只是大型医院的医生很累,是由于中国医疗市场分配严重不均的结果。

“单位人”身份约束了医生的流动

中国公立医院一家独大,而且目前的人事制度下公立医院通过编制把医生圈养成“单位人”,即使国家出台相关政策鼓励多点执业,仍是上有政策下有对策,以至于医生很难流动,即使知道会累死也没有多少办法。

医院的畸形经济制度是医生过劳的主因

奴隶社会早已成为历史,皮鞭下的劳工管理也已不存在。长期以来,公立医院医生的基本工资所占总收入的比例越来越低,大部分的收入依赖于严重畸形的收入激励机制,让医生自愿或不得不自愿去累死累活才能获得较高的收入。一个典型的事实,比如在省城大型医院一个中级医生的(明的)月收入一般在2~4万元,其中基本工资只有2000~4000元,基本上可以忽略不计,而其绝大部分都是来自奖金(如小组奖、科室奖、院奖、月奖、季度奖等)、加班提成、超时工作提成、收病人住院提成、手术站台费……等一系列名目繁多的收入项目。面对这样的收入结构,有几个医生能不主动去过度劳累?为了不拖累小组、科室和全院的后腿,有几个医生敢不去过度劳累?

大家知道,全球最大的郑州大学附属第一医院,从简单的小病到复杂的大病,大小通吃,以量取胜,“捡到篮里都是菜,甚至和乡镇卫生院抢活干,因为小手术未必效益低”,其目的是通过“薄利多销”来盈利。这里的医生无疑是非常辛苦的,几乎人人天天过度劳累,而且完全是“任劳任怨”。当然收入也是非常可观的。巨大的经济激励机制具有巨大的魔力,劳累根本算不了什么,即使累死了也在所不辞,而且前赴后继,很少有人愿意从这类大型医院调到清闲的基层医院工作。

医生成了公立医院的机械劳动力

众所周知,公立医院年年扩张,病人不断增多,与此同时虽然医务人员的数量也在增加,但其增加的比例却远远落后于病人和病床的增加比例。有些网文或网友认为现在公立医院招人难,或者招不到合格或满意的医生。如果说小医院招不到人还可以理解,但不断扩张的大型医院还说招不到人就根本不是事实了。要知道,每年有多少医科毕业生在拼命地往大型医院挤。其真实的原因是,公立医院基本上靠自己养活和自我发展,不得不以经济效益为核心,严格甚至过分控制人力成本,同时上级行政部门严格控制医院人员编制指标。结果,一方面大型医院医生数量相对严重不足,一方面医科毕业生(包括研究生)找工作很困难。

中国的公立医院在经济上早已是公立的“民营”医院。为了经济效益,大型公立医院事实上已经把医生当成了赚钱的机器,劳动的牲口,工作量上不断加码,以一当十。

中国特色的职称制度

为了牵制每一个医生而形成的当今职称制度,把职称与各种利益捆绑一起,让医生白天忙临床,晚上和节假日在家还得忙着造论文和编课题,而且不干不行,除非改行不想混了。

在教学医院,顶着教授、副教授头衔,干科研搞教学自然无话可说,要命的是,中国的科研体系在医疗领域是一刀切的,科研论文和医生的职称挂钩,职称又和薪资地位挂钩,这样一来就变成了中国数百万医生都得以科学家的标准要求自己,养细胞、喂老鼠。

医学是科学,但医生必须是科学家吗?扯淡而已。事实上,在全世界范围内,大多数医生都不必搞科研创新,只需将既有的医学知识学到位和临床技能训练熟练即可。

违背人性化的管理

医生过度劳累或疲劳,不仅对医生本人害处匪浅,对病人也是危害极大的,因为医生的疲劳显着增加对病人的误诊误治和手术并发症的医疗过失风险。欧美等国早就有明文禁止医生的过度劳累和疲劳工作。反观我国医院及其上级卫生行政部门,不但不禁止,反而大张旗鼓地表扬和奖励医生疲劳工作,违背了基本的职业和道德标准。在经济效益面前,人性化管理沦落为漂亮的口号。

医生在外国是非常受人尊敬而富有的精英群体,而在中国只能和农民工一样,通过超时超负荷劳累才能获得比较高的收入。面对越来越多关于医生过度劳累和累死的事例和报道,笔者只能说:体制牢笼里的医生,请你少受一些利益诱惑,珍惜自己,你的健康和生命关系到你家人的幸福和病人的安危。且行且珍重!

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  2. [GetPortalCommentsPageByObjectIdResponse(id=1526902, encodeId=de0c15269022f, content=<a href='/topic/show?id=894221e3566' target=_blank style='color:#2F92EE;'>#中国医生#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=21735, encryptionId=894221e3566, topicName=中国医生)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=45f511780919, createdName=nakerunner, createdTime=Fri Apr 21 12:59:00 CST 2017, time=2017-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=189003, encodeId=91b6189003fb, content=问题是有了,解决方法在哪在哪体制制度不变,大多数医生还是老状态, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K6hq2LmWPOViahibFAUK6qIgYDYRCuDHfj1nJkb5WHIZEj8BwULbciboiblfEG1rA78tX3E0Hp7iaCAg3/0, createdBy=f37b2049644, createdName=virya, createdTime=Thu Apr 20 08:08:14 CST 2017, time=2017-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=188992, encodeId=2f16188992ed, content=签到学习了很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/1103841572/A3E53E62691178E2F18D7B999FD22131/100, createdBy=f44d2003846, createdName=Chongyang Zhang, createdTime=Thu Apr 20 07:35:06 CST 2017, time=2017-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=188983, encodeId=956518898300, content=戳中要害, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Pw2csslt7CukWiabqiblnQAXaDEiaxhu025c3P0XshccTrbvGWBjKvnHIxbK3vqa80P7WGIFuicCFet97TicrNKpgB3TdabxP1vMh/0, createdBy=28851960965, createdName=榄枷檬, createdTime=Thu Apr 20 07:17:38 CST 2017, time=2017-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=188981, encodeId=d06f188981e5, content=所以医生们 好好善待自己吧, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLBkyaelI9ia3n9SbuKmBdaY0PqCOzd0nhRUstroXmUmXZ5EBTmibtLEvCCIpyHAqxQXGfZz49ibrwjkg/0, createdBy=39781652829, createdName=雾夜芭蕾, createdTime=Thu Apr 20 07:13:56 CST 2017, time=2017-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=188979, encodeId=e7631889e998, content=都占了怎么办?, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRkia1DP5MpwEgtXo1XhXA11xD6MWKxunAZFXKSNic0fWHUQx83oNHPlRMxxIctM83QKeCLkJpMibibiaC/0, createdBy=7e581734408, createdName=深海的鱼, createdTime=Thu Apr 20 07:03:51 CST 2017, time=2017-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=188970, encodeId=e5f41889e032, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Thu Apr 20 05:59:34 CST 2017, time=2017-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=188936, encodeId=47a218893678, content=都有, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d8732047543, createdName=wen2009, createdTime=Thu Apr 20 00:20:12 CST 2017, time=2017-04-20, status=1, ipAttribution=)]
    2017-04-20 virya

    问题是有了,解决方法在哪在哪体制制度不变,大多数医生还是老状态

    0

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    2017-04-20 Chongyang Zhang

    签到学习了很多

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1526902, encodeId=de0c15269022f, content=<a href='/topic/show?id=894221e3566' target=_blank style='color:#2F92EE;'>#中国医生#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=21735, encryptionId=894221e3566, topicName=中国医生)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=45f511780919, createdName=nakerunner, createdTime=Fri Apr 21 12:59:00 CST 2017, time=2017-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=189003, encodeId=91b6189003fb, content=问题是有了,解决方法在哪在哪体制制度不变,大多数医生还是老状态, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K6hq2LmWPOViahibFAUK6qIgYDYRCuDHfj1nJkb5WHIZEj8BwULbciboiblfEG1rA78tX3E0Hp7iaCAg3/0, createdBy=f37b2049644, createdName=virya, createdTime=Thu Apr 20 08:08:14 CST 2017, time=2017-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=188992, encodeId=2f16188992ed, content=签到学习了很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/1103841572/A3E53E62691178E2F18D7B999FD22131/100, createdBy=f44d2003846, createdName=Chongyang Zhang, createdTime=Thu Apr 20 07:35:06 CST 2017, time=2017-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=188983, encodeId=956518898300, content=戳中要害, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Pw2csslt7CukWiabqiblnQAXaDEiaxhu025c3P0XshccTrbvGWBjKvnHIxbK3vqa80P7WGIFuicCFet97TicrNKpgB3TdabxP1vMh/0, createdBy=28851960965, createdName=榄枷檬, createdTime=Thu Apr 20 07:17:38 CST 2017, time=2017-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=188981, encodeId=d06f188981e5, content=所以医生们 好好善待自己吧, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLBkyaelI9ia3n9SbuKmBdaY0PqCOzd0nhRUstroXmUmXZ5EBTmibtLEvCCIpyHAqxQXGfZz49ibrwjkg/0, createdBy=39781652829, createdName=雾夜芭蕾, createdTime=Thu Apr 20 07:13:56 CST 2017, time=2017-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=188979, encodeId=e7631889e998, content=都占了怎么办?, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRkia1DP5MpwEgtXo1XhXA11xD6MWKxunAZFXKSNic0fWHUQx83oNHPlRMxxIctM83QKeCLkJpMibibiaC/0, createdBy=7e581734408, createdName=深海的鱼, createdTime=Thu Apr 20 07:03:51 CST 2017, time=2017-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=188970, encodeId=e5f41889e032, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Thu Apr 20 05:59:34 CST 2017, time=2017-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=188936, encodeId=47a218893678, content=都有, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d8732047543, createdName=wen2009, createdTime=Thu Apr 20 00:20:12 CST 2017, time=2017-04-20, status=1, ipAttribution=)]
    2017-04-20 榄枷檬

    戳中要害

    0

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    2017-04-20 雾夜芭蕾

    所以医生们 好好善待自己吧

    0

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    2017-04-20 深海的鱼

    都占了怎么办?

    0

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    2017-04-20 龙胆草

    学习了,谢谢分享

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1526902, encodeId=de0c15269022f, content=<a href='/topic/show?id=894221e3566' target=_blank style='color:#2F92EE;'>#中国医生#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=21735, encryptionId=894221e3566, topicName=中国医生)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=45f511780919, createdName=nakerunner, createdTime=Fri Apr 21 12:59:00 CST 2017, time=2017-04-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=189003, encodeId=91b6189003fb, content=问题是有了,解决方法在哪在哪体制制度不变,大多数医生还是老状态, beContent=null, objectType=article, channel=null, level=null, likeNumber=106, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K6hq2LmWPOViahibFAUK6qIgYDYRCuDHfj1nJkb5WHIZEj8BwULbciboiblfEG1rA78tX3E0Hp7iaCAg3/0, createdBy=f37b2049644, createdName=virya, createdTime=Thu Apr 20 08:08:14 CST 2017, time=2017-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=188992, encodeId=2f16188992ed, content=签到学习了很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=104, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://q.qlogo.cn/qqapp/1103841572/A3E53E62691178E2F18D7B999FD22131/100, createdBy=f44d2003846, createdName=Chongyang Zhang, createdTime=Thu Apr 20 07:35:06 CST 2017, time=2017-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=188983, encodeId=956518898300, content=戳中要害, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Pw2csslt7CukWiabqiblnQAXaDEiaxhu025c3P0XshccTrbvGWBjKvnHIxbK3vqa80P7WGIFuicCFet97TicrNKpgB3TdabxP1vMh/0, createdBy=28851960965, createdName=榄枷檬, createdTime=Thu Apr 20 07:17:38 CST 2017, time=2017-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=188981, encodeId=d06f188981e5, content=所以医生们 好好善待自己吧, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLBkyaelI9ia3n9SbuKmBdaY0PqCOzd0nhRUstroXmUmXZ5EBTmibtLEvCCIpyHAqxQXGfZz49ibrwjkg/0, createdBy=39781652829, createdName=雾夜芭蕾, createdTime=Thu Apr 20 07:13:56 CST 2017, time=2017-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=188979, encodeId=e7631889e998, content=都占了怎么办?, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRkia1DP5MpwEgtXo1XhXA11xD6MWKxunAZFXKSNic0fWHUQx83oNHPlRMxxIctM83QKeCLkJpMibibiaC/0, createdBy=7e581734408, createdName=深海的鱼, createdTime=Thu Apr 20 07:03:51 CST 2017, time=2017-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=188970, encodeId=e5f41889e032, content=学习了,谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4Nd44v3xHnnictn9UpctwtH62EPQ59TMdI9lnqHMgQ16nH7GmGCfpzicsHgjibYVk6vwSpXrC86gMibRkoaIzf5HwSz7/0, createdBy=78cc1691107, createdName=龙胆草, createdTime=Thu Apr 20 05:59:34 CST 2017, time=2017-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=188936, encodeId=47a218893678, content=都有, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d8732047543, createdName=wen2009, createdTime=Thu Apr 20 00:20:12 CST 2017, time=2017-04-20, status=1, ipAttribution=)]
    2017-04-20 wen2009

    都有

    0

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