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星屑醫生 | 2nd Mar 2007, 01:31 AM | 像我這樣一個醫生

平均分: 10.00 | 評分人數: 2

某討論區轉貼了我的那篇這社會, 不容因盲腸炎而死(現已改了版)先在此謝過那轉貼的朋友,他一心希望多些人關注事件,這是我的期望。我從頭到尾看了一遍那裡的留言,其實也沒甚麼,大部份人提出的意見都是同意香港現行公營醫療的不足之處,希望公營醫療能做得好些。

這正是我拿事件出來討論的目的。至於某些針對一兩個字眼的 comment, 諸如照超聲波和 CT 究竟有多必要,有多準確,和有多叫做無可推諉,我倒不大理會。總之3天就死得人的盲腸炎,我不傾向相信肚子裡真的甚麼也照不出來,而且我說這個,其實只想說給大家知道實際的情況和做法,某大學醫院對所有懷疑盲腸炎的病人,一律會先看幾項資料,包括臨床觸診,白血球數,有沒有發燒等等,然後就會盡快安排在一天裡照超聲波或電腦掃瞄。而我老爸那次在孖人房醫院,也是連忙推了去做電腦掃瞄才開刀。教科書確實會教說緊急開腹手術 laparotomy 可能比任何造影更清楚(哈,那裡竟有人答嘴以為laparotomy 是腹腔鏡,實質腹腔鏡是laparoscopy, 相差了幾個字),但這確實不是大學醫院的一貫做法,一本通書不能看到老。

總之理念是,多一個資料,總是好的。做超聲波花得了幾多資源?極其量是那當值的放射科醫生放遲15分鐘工吧了。人命攸關,連做個超聲波也吝嗇,你期待真的有人打算幫那女孩開肚來看?

而結果是:甚麼也沒有做,和,那女孩子死了。

不容因盲腸炎而死,這說法不是我發明的,那是我在某大醫院工作的時候,在那裡的普遍說法。有說我這是壓低別人抬高自己,現在我也不會再為這些 comment 有太大反應了。實在我自己不是外科專科醫生,如何能壓低別的外科醫生?壓低了又有甚麼好處?難道你不去某醫院做手術,就來找我這個普通科醫生做嗎?

我卻是以我在大學醫院的經驗來和外圍醫院 peripheral hospital 的做法相比較。自出道以來一直都不明白,也常想問:為甚麼同為醫生,在大學醫院各部門一些較為嚴謹而視為 routine 理所當然的做法,在外圍醫院卻覺得是完全無理的苛求。

而且竟然連出聲問也不可以。真的是白色巨塔?

我今天去老人院看一個老人,他90歲,肚痛入某外圍醫院十天 ,昨天出院,才發現雙腳水腫上膝,這情況卻在入院前是沒有的。我看看出院記錄 discharge summary,只在 diagnosis 一欄寫著急性胰臟炎,有甚麼跟進建議沒有寫,連出院藥也沒有寫,而我一向認知給病人版本的出院記錄都會寫好這些資料的。家人說,入院其間已自掏腰包去私家醫院照了掃瞄,而掃瞄報告說根本沒有跡象顯示有急性胰臟炎~ 沒有這個病,而那 discharge summary 卻還照寫如儀。

(當然急性胰臟炎要看在院期間的酵素amylase,我自無這方面的資料)  

我常常覺得看不過眼,真的是我太過敏感了?我又不應出聲嗎?

真的是白色巨塔?

實質我針對的,從來都不是個別醫護人員,有時是個別醫院部門,有時是中央醫院和外圍醫院的行政方針,有時則是整體醫療政策。現在富者可以得到較佳醫療,已成為這社會不容否認的事實。而其他人的唯一依靠:公營醫療卻因為過於繁忙,再加上官僚主義,山頭主義和資源分配不均等原因,質素就變得每況逾下。如果問題出於政策,為何你你我我還不應該出聲說?又如現在財爺有剩錢派糖,這些剩得下來的錢從哪裡來?是不是有部份來自勒緊了醫療社福的褲頭?那麼又何不想想,就放些回公營醫療或社福裡?


末了的話:

留言的朋友,你又來了。‘U call yourself a dr ???‘ 又一個好名字。一個醫生叫得做醫生,必要在Medical council 宣誓註冊。而且行先的不是醫術,不是知識,卻是醫心。


[31] Re:
mirage :
Some rumors to share :1. The girl clinically was not so bad when presented in A/E (Ist time and re-admitted).2. No CBC result obtained before she deteriorated3. Only the HO/1st call MO saw the girl before she had shock, the 2nd call MO haven;t seen it as the 1st call MO didn;t find anything wrong.4. We may wait for autopsy result. My be she isn't died of septic shock.

謝謝你的分享, 看得我的心砰砰跳.


[引用] | 作者 星屑醫生 | 9th Mar 2007 19:33 PM | [舉報垃圾留言]

[30]

Some rumors to share :
1. The girl clinically was not so bad when presented in A/E (Ist time and re-admitted).
2. No CBC result obtained before she deteriorated
3. Only the HO/1st call MO saw the girl before she had shock, the 2nd call MO haven;t seen it as the 1st call MO didn;t find anything wrong.
4. We may wait for autopsy result. My be she isn't died of septic shock.


[引用] | 作者 mirage | 9th Mar 2007 18:58 PM | [舉報垃圾留言]

[29]

初次到訪, 這兒的文章很有意思呢!

先祝你傷了的腰快點康復.

本來我對公共醫療體系也頗有信心的, 覺得問題只是等得久一點而已, 會死人的急症還是能及時得到醫治的. 但看罷這個案後開始對急症室失去信心了...

大概, 是病人太多資源太少的問題吧? 也有太多人濫用急症室(網上的消息說有發燒和看牙醫後流牙血也call 白車, 雖然不能確定消息真偽, 但也顯示出濫用情況去到哪個程度...), 所以就算當初有心的醫生護士也慢慢的被磨練到鐵石心腸, 想不到這次會出人命罷了...


[引用] | 作者 yan | 6th Mar 2007 15:44 PM | [舉報垃圾留言]

[28]

連續看了數篇文章,很想留言,但不知從何入手,久久不能下筆,在我來說,是比較少見的。
最後,我祇能說:「在這裡,我看見一個有血有肉的好醫生!」


[引用] | 作者 鬍鬚人 | 6th Mar 2007 14:48 PM | [舉報垃圾留言]

[27]

醫生......
我朋友昨天因為坐車時下體出血,她有了
七個月b b,是他們夫婦的第一胎,當然
比較緊張,由途人幫助叫車去到九龍區某
醫院,結果是照了超聲波,只說沒事,便
踢了她出院,沒解釋什麼都沒,最後還要
被醫生就[我係醫生,我話得無野就無野啦
唔好以為自己大左肚緊張就大晒先得架]
p.s 我朋友兩夫婦都是香港人,所以應該
不存在岐視,只是那個醫生的態度嘛~
我們也知他忙,但問一下也很正常吧~
結果朋友的家人還是擔心便送她到私家醫院,
那兒的醫生說,要詳細驗,但初步估計是胎盤
移位,要留醫。


[引用] | 作者 雪の御小さい魔女 | 4th Mar 2007 12:51 PM | [舉報垃圾留言]

[26] Re: 詆譭同業
敢言 :
果邊某個醫生直情離譜到人身攻擊, 詆譭同業
原帖由 xxxx 於 2007-3-2 12:56 PM 發表

Those with medical knowledge should know whether it is 抹黑or not after visiting the blog.
I strongly encourage you to submit your idea to major surgery journals or HK college of surgery to promote the idea of routine USG & CT abdomen to those with abdominal pain.
To me, the recent medical joke I've heard is a stupid GP tried to arrange a USG, but not hospital admission, for his father who had features of appenditis. And yet he blamed the hospital for his father's suffering. I begin to understand why someone had to leave after 4 years of specialist training.

哈, 這我倒不打緊. 上年有人對我說批評的話, 我也有信心動搖過, 但那時我有問過一些老細級的, 還有同事呀, 同學呀等等的意見, 他們都在公營架構行內, 對我上年的事瞭若指掌, 也看遍我那時的紀錄. 他們都表示對我的支持和肯定.
一句stupid 也沒甚麼. 我確也有stupid 的表現. 事後有得著最緊要.


[引用] | 作者 星屑醫生 | 3rd Mar 2007 18:55 PM | [舉報垃圾留言]

[25] 自私自利的人,是個人的,與制度無關
自在 :

請不要客氣,這是心底裡真誠的話
說實在,也有認識仍在公營醫院工作,但敢言及不怕強權,為公義永不言棄的醫生
是的,他們個人是會受到好大壓力,或責備,但是,他們的貢獻,不是你我表面能表達的,貢獻是不能抹煞的
自私自利的人,是個人的,與制度無關,只是借口吧
我永遠支持你

自私自利的人,是個人的,與制度無關,只是借口吧


[引用] | 作者 敢言 | 3rd Mar 2007 17:58 PM | [舉報垃圾留言]

[24] 詆譭同業

果邊某個醫生直情離譜到人身攻擊, 詆譭同業

原帖由 xxxx 於 2007-3-2 12:56 PM 發表

Those with medical knowledge should know whether it is 抹黑or not after visiting the blog.

I strongly encourage you to submit your idea to major surgery journals or HK college of surgery to promote the idea of routine USG & CT abdomen to those with abdominal pain.

To me, the recent medical joke I've heard is a stupid GP tried to arrange a USG, but not hospital admission, for his father who had features of appenditis. And yet he blamed the hospital for his father's suffering. I begin to understand why someone had to leave after 4 years of specialist training.


[引用] | 作者 敢言 | 3rd Mar 2007 17:54 PM | [舉報垃圾留言]

[23] Re: Re: Re: Re: Re: 1st principle of medicine
星屑醫生 :
自在 :星屑醫生 :Startract :U call yourself a dr ?? :1. First principle of medicine is do no harm. A delay in management/cure is harm.2. Imaging does not cure the patient while operation sometimes can. That is why if patient is unstable, should send patient to OT rather then CT suite. CT can find something does not mean u need it.3. For the yougn gal we talked about, no one can make comment on whatever the management appropriate or not if u have not go through all clinical notes and autopsy result. I dono any clinical department make any mistake or not now. Please respect your colleagues. Dont make arragont comments only on your limited experience.

1. I think doctors know this, but how to do it requires knowledge, experience, guidiance and the availability of resources.2. The availability of resources will dictate what sort of management you get. Resources also include what kind of doctors, junior or senior, with the ability or without the ability. You may get a USG, CT or MRI, but all those doctors look at them without a bit of knowledge will do the same harm. You may get a laparotomy by somebody inexperience, same harm to the patient.3. We all know, we don't have a case note. Then nobody can give any comment, right? I think Singsit is just trying to give an idea of what can be done on that patient, he is not saying he himself can do better and being arrogant. I think that's fair. He had missed several appendicitis in the past, and he can still miss an appendicitis in the future, Singsit, right?就是, 我覺得main message 就是要夠緊張, 做得足. 做足了, 沒人會怪. 但仍有空間想想為何做足了仍有問題, 仍有空間想想怎樣叫做做得更足. 放下過於保護自己的態度, 開放地接受新意見, 這才會有進步.
星屑,欣賞你敢言,不怕強權的作風,沒帶半點自私或者你會得罪好多人,但為公義,又何妨?這世界就是出現太多自私自利、只懂保護自己(或所謂保護同行),社會才不進步或者要等這班人,事件降臨身上,才會有醒覺的一天,甚或至死都不會醒覺吧請保留你的熱血,為社會公義出一分力為公義,你我又有何可懼?心底裡支持你的人上我很感動, 多謝你的鼓勵. 我現在自己是自己老細, 說話比較無拘束, 才較能把話說出來.你我見不妥, 還是要出聲.無論政制如是, 醫療也如是.

請不要客氣,這是心底裡真誠的話

說實在,也有認識仍在公營醫院工作,但敢言及不怕強權,為公義永不言棄的醫生

是的,他們個人是會受到好大壓力,或責備,但是,他們的貢獻,不是你我表面能表達的,貢獻是不能抹煞的

自私自利的人,是個人的,與制度無關,只是借口吧

我永遠支持你


[引用] | 作者 自在 | 3rd Mar 2007 17:50 PM | [舉報垃圾留言]

[22] 太多自私自利
自在 :

星屑,欣賞你敢言,不怕強權的作風,沒帶半點自私
或者你會得罪好多人,但為公義,又何妨?
這世界就是出現太多自私自利、只懂保護自己(或所謂保護同行),社會才不進步
或者要等這班人,事件降臨身上,才會有醒覺的一天,甚或至死都不會醒覺吧
請保留你的熱血,為社會公義出一分力
為公義,你我又有何可懼?
心底裡支持你的人上

講起太多自私自利, 在某討論區, 某醫生便是咁 ..自己爸爸就安排 early USG...這死去的女孩放o係到觀察 already a management

原帖由 xxxxx 於 2007-3-2 01:05 PM 發表

It should be a clinical decision.
That means you cannot judge without reading the clinical notes.
But i want to point out that observation in hospital is already a management.

原帖由 xxxx 於 2007-3-2 01:12 PM 發表

If I find that my father has features of appendicitis, I would admit him to private hospital, do some blood tests and arrange an early USG. Because all of my family members have medical insurance coverage .


[引用] | 作者 敢言 | 3rd Mar 2007 17:46 PM | [舉報垃圾留言]

[21] Re: Re: Re: Re: 1st principle of medicine
自在 :
星屑醫生 :Startract :U call yourself a dr ?? :1. First principle of medicine is do no harm. A delay in management/cure is harm.2. Imaging does not cure the patient while operation sometimes can. That is why if patient is unstable, should send patient to OT rather then CT suite. CT can find something does not mean u need it.3. For the yougn gal we talked about, no one can make comment on whatever the management appropriate or not if u have not go through all clinical notes and autopsy result. I dono any clinical department make any mistake or not now. Please respect your colleagues. Dont make arragont comments only on your limited experience.

1. I think doctors know this, but how to do it requires knowledge, experience, guidiance and the availability of resources.2. The availability of resources will dictate what sort of management you get. Resources also include what kind of doctors, junior or senior, with the ability or without the ability. You may get a USG, CT or MRI, but all those doctors look at them without a bit of knowledge will do the same harm. You may get a laparotomy by somebody inexperience, same harm to the patient.3. We all know, we don't have a case note. Then nobody can give any comment, right? I think Singsit is just trying to give an idea of what can be done on that patient, he is not saying he himself can do better and being arrogant. I think that's fair. He had missed several appendicitis in the past, and he can still miss an appendicitis in the future, Singsit, right?
就是, 我覺得main message 就是要夠緊張, 做得足. 做足了, 沒人會怪. 但仍有空間想想為何做足了仍有問題, 仍有空間想想怎樣叫做做得更足. 放下過於保護自己的態度, 開放地接受新意見, 這才會有進步.

星屑,欣賞你敢言,不怕強權的作風,沒帶半點自私
或者你會得罪好多人,但為公義,又何妨?
這世界就是出現太多自私自利、只懂保護自己(或所謂保護同行),社會才不進步
或者要等這班人,事件降臨身上,才會有醒覺的一天,甚或至死都不會醒覺吧
請保留你的熱血,為社會公義出一分力
為公義,你我又有何可懼?
心底裡支持你的人上


我很感動, 多謝你的鼓勵. 我現在自己是自己老細, 說話比較無拘束, 才較能把話說出來.
你我見不妥, 還是要出聲.無論政制如是, 醫療也如是.


[引用] | 作者 星屑醫生 | 3rd Mar 2007 17:37 PM | [舉報垃圾留言]

[20] Re: Re: Re: 1st principle of medicine
星屑醫生 :
Startract :U call yourself a dr ?? :1. First principle of medicine is do no harm. A delay in management/cure is harm.2. Imaging does not cure the patient while operation sometimes can. That is why if patient is unstable, should send patient to OT rather then CT suite. CT can find something does not mean u need it.3. For the yougn gal we talked about, no one can make comment on whatever the management appropriate or not if u have not go through all clinical notes and autopsy result. I dono any clinical department make any mistake or not now. Please respect your colleagues. Dont make arragont comments only on your limited experience.

1. I think doctors know this, but how to do it requires knowledge, experience, guidiance and the availability of resources.2. The availability of resources will dictate what sort of management you get. Resources also include what kind of doctors, junior or senior, with the ability or without the ability. You may get a USG, CT or MRI, but all those doctors look at them without a bit of knowledge will do the same harm. You may get a laparotomy by somebody inexperience, same harm to the patient.3. We all know, we don't have a case note. Then nobody can give any comment, right? I think Singsit is just trying to give an idea of what can be done on that patient, he is not saying he himself can do better and being arrogant. I think that's fair. He had missed several appendicitis in the past, and he can still miss an appendicitis in the future, Singsit, right?

就是, 我覺得main message 就是要夠緊張, 做得足. 做足了, 沒人會怪. 但仍有空間想想為何做足了仍有問題, 仍有空間想想怎樣叫做做得更足. 放下過於保護自己的態度, 開放地接受新意見, 這才會有進步.

星屑,欣賞你敢言,不怕強權的作風,沒帶半點自私

或者你會得罪好多人,但為公義,又何妨?

這世界就是出現太多自私自利、只懂保護自己(或所謂保護同行),社會才不進步

或者要等這班人,事件降臨身上,才會有醒覺的一天,甚或至死都不會醒覺吧

請保留你的熱血,為社會公義出一分力

為公義,你我又有何可懼?

心底裡支持你的人上


[引用] | 作者 自在 | 3rd Mar 2007 14:20 PM | [舉報垃圾留言]

[19] Re: Re: 1st principle of medicine
Startract :
U call yourself a dr ?? :1. First principle of medicine is do no harm. A delay in management/cure is harm.2. Imaging does not cure the patient while operation sometimes can. That is why if patient is unstable, should send patient to OT rather then CT suite. CT can find something does not mean u need it.3. For the yougn gal we talked about, no one can make comment on whatever the management appropriate or not if u have not go through all clinical notes and autopsy result. I dono any clinical department make any mistake or not now. Please respect your colleagues. Dont make arragont comments only on your limited experience.

1. I think doctors know this, but how to do it requires knowledge, experience, guidiance and the availability of resources.
2. The availability of resources will dictate what sort of management you get. Resources also include what kind of doctors, junior or senior, with the ability or without the ability. You may get a USG, CT or MRI, but all those doctors look at them without a bit of knowledge will do the same harm. You may get a laparotomy by somebody inexperience, same harm to the patient.
3. We all know, we don't have a case note. Then nobody can give any comment, right? I think Singsit is just trying to give an idea of what can be done on that patient, he is not saying he himself can do better and being arrogant. I think that's fair. He had missed several appendicitis in the past, and he can still miss an appendicitis in the future, Singsit, right?

就是, 我覺得main message 就是要夠緊張, 做得足. 做足了, 沒人會怪. 但仍有空間想想為何做足了仍有問題, 仍有空間想想怎樣叫做做得更足. 放下過於保護自己的態度, 開放地接受新意見, 這才會有進步.


[引用] | 作者 星屑醫生 | 3rd Mar 2007 12:14 PM | [舉報垃圾留言]

[18] Re:
難過的人 :
醫生, 記得我這個讀者嗎? 有親人懷疑患上血癌那個呢......
醫生, 呢個禮拜以來, 我的心情好像坐過山車般 ── 過年前, 心情曾短暫從谷底回升, 然而才不過數天, 壞消息又傳來, 我的心情瞬間再次回落至谷底, 然後, 經醫生一番解釋, 我又有短暫的relief, 但這一次, 我真的不敢開心得太早, 我怕歷史重演, 我怕會再次一場歡喜一場空, 好不容易才能穩定自己的情緒, 然後, 看到你篇entry, 心裡又再次擔心起來...... 我們遇上的醫生究竟是不是個好醫生? 究竟我該不該相信醫生所說的?
審慎樂觀, 是最適合的態度. 我也不知如何讓你更覺安慰, 唯有幫你祈禱.


[引用] | 作者 星屑醫生 | 3rd Mar 2007 11:58 AM | [舉報垃圾留言]

[17] Re: 1st principle of medicine
U call yourself a dr ?? :
1. First principle of medicine is do no harm. A delay in management/cure is harm.
2. Imaging does not cure the patient while operation sometimes can. That is why if patient is unstable, should send patient to OT rather then CT suite. CT can find something does not mean u need it.
3. For the yougn gal we talked about, no one can make comment on whatever the management appropriate or not if u have not go through all clinical notes and autopsy result. I dono any clinical department make any mistake or not now. Please respect your colleagues. Dont make arragont comments only on your limited experience.

1. I think doctors know this, but how to do it requires knowledge, experience, guidiance and the availability of resources.

2. The availability of resources will dictate what sort of management you get. Resources also include what kind of doctors, junior or senior, with the ability or without the ability. You may get a USG, CT or MRI, but all those doctors look at them without a bit of knowledge will do the same harm. You may get a laparotomy by somebody inexperience, same harm to the patient.

3. We all know, we don't have a case note. Then nobody can give any comment, right? I think Singsit is just trying to give an idea of what can be done on that patient, he is not saying he himself can do better and being arrogant. I think that's fair. He had missed several appendicitis in the past, and he can still miss an appendicitis in the future, Singsit, right?


[引用] | 作者 Startract | 3rd Mar 2007 11:52 AM | [舉報垃圾留言]

[16] Re: 1st principle of medicine
U call yourself a dr ?? :
1. First principle of medicine is do no harm. A delay in management/cure is harm.
2. Imaging does not cure the patient while operation sometimes can. That is why if patient is unstable, should send patient to OT rather then CT suite. CT can find something does not mean u need it.
3. For the yougn gal we talked about, no one can make comment on whatever the management appropriate or not if u have not go through all clinical notes and autopsy result. I dono any clinical department make any mistake or not now. Please respect your colleagues. Dont make arragont comments only on your limited experience.

其實我們理念應該一致的, 又何必針鋒相對.

唉, 算吧. 還是說OT 定CT... 我想我們都一樣覺得, 總要做一些甚麼來找病因. 我根本從沒說過不做OT, 也根本知道append 不純以imaging 定奪. 我覺得那只因用字混淆, 為免混淆, 我已改了字眼.

我才答護士小天使. 這裡有矛盾呀! 當說做imaging, 就有人說, 要是凡肚痛都做, 資源點頂呀.

同時又有人說應做OT, 但想深一層, 凡肚痛都做, 資源不是更頂不順嗎?

所以討論核心不是做OT 定只做CT. 而是, 總要用各樣方法找病因, 也就是對病症要有planning. 特別是當一個人會去到Unstable 以至arrest, 總有原因! 無論這是外科或是內科或更複雜的病因.

現在的「表面」情況卻是等等等等等到unstable, 等等等等到arrest了.

我都沒comment 過人家的做法和managment, 我只是指出, 有時外圍醫院特別是半夜未必有足夠資源: 人手或檢查服務可以 arrange 得到. 這是人所共知的事實. 我提出這點, 你可以嘆氣說: 這是無可奈何的事, 大學醫院和外圍醫院當然不同啦.我也明白. 但無可奈何之後是不是真的無辦法從management 呀, 資源調配呀, 醫生oncall 制度中慢慢改變嗎? 這是難, 但我卻不覺得真是無可能.

At lease, 應該出聲讓人人都知, 而不是臭屎密襟.

最後誠意勸說, 你無謂用 u call yourself dr??? 這個具挑釁性的名字. 可能你不習慣網上討論? 這種挑釁其實無意義, 也不利討論. 心平氣和說不是更好嗎?

我自己駕馭文字能力只算一般, 有時文不達意, 要進一步互動溝通才能澄清. 也歡迎所有覺得給誤會了的人來澄清, 無任歡迎, 我也從不刪留言.

實在你也想香港醫療好, 我也想, 這我從沒懷疑, 就無謂用挑釁性的態度來討論, 這結果只會淡化了真正應討論的焦點.


[引用] | 作者 星屑醫生 | 3rd Mar 2007 11:47 AM | [舉報垃圾留言]

[15] 1st principle of medicine

1. First principle of medicine is do no harm. A delay in management/cure is harm.

2. Imaging does not cure the patient while operation sometimes can. That is why if patient is unstable, should send patient to OT rather then CT suite. CT can find something does not mean u need it.

3. For the yougn gal we talked about, no one can make comment on whatever the management appropriate or not if u have not go through all clinical notes and autopsy result. I dono any clinical department make any mistake or not now. Please respect your colleagues. Dont make arragont comments only on your limited experience.


[引用] | 作者 U call yourself a dr ?? | 3rd Mar 2007 10:47 AM | [舉報垃圾留言]

[14] Re:
護士小天使 :
「教科書確實會教說緊急開腹手術laparotomy 可能比任何造影更清楚」這當然,但一個咁既OT所需的資源與人手是?...「做超聲波花得了幾多資源?極其量是那當值的放射科醫生放遲15分鐘工吧了」如果唔係一個,而係十個廿個?....可以的話我也希望每個病人也得到全餐服務,可是事實卻往往與夢想有分別,希望香港醫療體系快點轉型,如果唔係問題只會越來越大,沒有解決時刻。越係醫院做得耐,越覺得矛盾,一方面又希望病人好,但另一方面又見到太多人濫用政府資源...

多謝你指出這點, 所以有些人答我的話, 其實邏輯是矛盾的. 一面說最清楚的是要做laparotomy, 但那卻是更耗資源的. 另一面卻說個個做USG 或CT 是無可能的事.

而且問題在於有否著緊地找出病因, FINE, 要是覺得Lap 好而資源配合, 就做lap 囉. 要是覺得多個資料不妨, 就做埋imaging 囉.


[引用] | 作者 星屑醫生 | 3rd Mar 2007 09:03 AM | [舉報垃圾留言]

[13]

我覺得好像凡是和政府有關係的機構,出來的總是問題多多。每次有新的政策,感覺好像非但不能解決問題,還要增加更多問題...


[引用] | 作者 夕陽 | 3rd Mar 2007 03:47 AM | [舉報垃圾留言]

[12]

「教科書確實會教說緊急開腹手術laparotomy 可能比任何造影更清楚」這當然,但一個咁既OT所需的資源與人手是?...
「做超聲波花得了幾多資源?極其量是那當值的放射科醫生放遲15分鐘工吧了」如果唔係一個,而係十個廿個?....
可以的話我也希望每個病人也得到全餐服務,可是事實卻往往與夢想有分別,希望香港醫療體系快點轉型,如果唔係問題只會越來越大,沒有解決時刻。
越係醫院做得耐,越覺得矛盾,一方面又希望病人好,但另一方面又見到太多人濫用政府資源...


[引用] | 作者 護士小天使 | 2nd Mar 2007 23:22 PM | [舉報垃圾留言]

[11]

醫生, 記得我這個讀者嗎? 有親人懷疑患上血癌那個呢......

醫生, 呢個禮拜以來, 我的心情好像坐過山車般 ── 過年前, 心情曾短暫從谷底回升, 然而才不過數天, 壞消息又傳來, 我的心情瞬間再次回落至谷底, 然後, 經醫生一番解釋, 我又有短暫的relief, 但這一次, 我真的不敢開心得太早, 我怕歷史重演, 我怕會再次一場歡喜一場空, 好不容易才能穩定自己的情緒, 然後, 看到你篇entry, 心裡又再次擔心起來...... 我們遇上的醫生究竟是不是個好醫生? 究竟我該不該相信醫生所說的?


[引用] | 作者 難過的人 | 2nd Mar 2007 21:32 PM | [舉報垃圾留言]

[10] Re:
aMy :
I'm not trying to start an argument here, just alternative perspective.
I think it's different in U hospital and peripheral hospital.U hospital got much more resources (not just $, also staff), of course they can afford to do CT/USG for every pt. Even when it may not be indicated.
In peripheral hospital, esp like TMH, I'm not sure if you have worked there, it's so busy for MO/houseman with so many admissions, if they do CT/USG on every case of acute abdomen, their workload will increase a lot... If the pt is septic with acute abdomen esp in young girls, I think it's reasonable to a diagnostic lap (tho I'm no surgeon/gyn, correct me if I'm wrong, but it's what I often see.) I think we have too limited info on the case to make a judgement tho.
Are you sure there's plan of mx on discharge slip? hmm... I remember there're only diagnosis and medications. maybe I remember wrongly...
The problem for discharge slip is that they are prepared by house officers who may not understand the case. And I don't think we diagnose pancreatitis by CT, maybe the amylase is sky high?
A friend of mine just got a discharge slip with dx of pneumonia, but her CXR was clear all along... =P haha!!

你好, 我等這方面的討論向導等了一天, 終於等來了.

你說的話我很同意. peripheral 醫院面對病人數甚至更多, 卻分到較少資源, 是矛盾的. 為何不能改變, 而我們只能無奈接受?

1. 是不是資源錯配?
2. 是不是山頭主義?
3. 是不是on call 制度有問題?
4. 是不是有人太多野做, 有人則太少野做?
5. 是不是有些人人工太高?
6. 其中又有沒有態度相差的問題?

這些是不是100 年後都無法改變的事?

至於照乜照物的問題, 我不再說了. 實在我都不是說要個個照, 唉... 鬼唔知無可能個個照咩... 但acute abdomen 以至於死呀~~~ 真是沒有indication 這麼簡單?

那acute pancreatitis 也是, 一來, 那是人說給我聽, 是那公營醫院醫生建議他們出去某私家醫院照MRI 來看看pancreas 的. 唉, 關我甚麼事? 而且我剛打電話去老人院, 他們說阿伯今天屙黑屎, 又給送去醫院了. 出院才兩天, 又回醫院了.

這裡又有私家醫療和公營醫療無法溝通的問題... 實在香港醫療自己真的病入膏肓才真.


[引用] | 作者 星屑醫生 | 2nd Mar 2007 19:36 PM | [舉報垃圾留言]

[9]

I'm not trying to start an argument here, just alternative perspective.

I think it's different in U hospital and peripheral hospital.
U hospital got much more resources (not just $, also staff), of course they can afford to do CT/USG for every pt. Even when it may not be indicated.

In peripheral hospital, esp like TMH, I'm not sure if you have worked there, it's so busy for MO/houseman with so many admissions, if they do CT/USG on every case of acute abdomen, their workload will increase a lot... If the pt is septic with acute abdomen esp in young girls, I think it's reasonable to a diagnostic lap (tho I'm no surgeon/gyn, correct me if I'm wrong, but it's what I often see.) I think we have too limited info on the case to make a judgement tho.

Are you sure there's plan of mx on discharge slip? hmm... I remember there're only diagnosis and medications. maybe I remember wrongly...

The problem for discharge slip is that they are prepared by house officers who may not understand the case. And I don't think we diagnose pancreatitis by CT, maybe the amylase is sky high?

A friend of mine just got a discharge slip with dx of pneumonia, but her CXR was clear all along... =P haha!!


[引用] | 作者 aMy | 2nd Mar 2007 18:47 PM | [舉報垃圾留言]

[8]

I'm not trying to start an argument here, just alternative perspective.

I think it's different in U hospital and peripheral hospital.
U hospital got much more resources (not just $, also staff), of course they can afford to do CT/USG for every pt. Even when it may not be indicated.

In peripheral hospital, esp like TMH, I'm not sure if you have worked there, it's so busy for MO/houseman with so many admissions, if they do CT/USG on every case of acute abdomen, their workload will increase a lot... If the pt is septic with acute abdomen esp in young girls, I think it's reasonable to a diagnostic lap (tho I'm no surgeon/gyn, correct me if I'm wrong, but it's what I often see.) I think we have too limited info on the case to make a judgement tho.

Are you sure there's plan of mx on discharge slip? hmm... I remember there're only diagnosis and medications. maybe I remember wrongly...

The problem for discharge slip is that they are prepared by house officers who may not understand the case. And I don't think we diagnose pancreatitis by CT, maybe the amylase is sky high?

A friend of mine just got a discharge slip with dx of pneumonia, but her CXR was clear all along... =P haha!!


[引用] | 作者 aMy | 2nd Mar 2007 18:45 PM | [舉報垃圾留言]

[7] Re: Re:
星屑醫生 :
外星人 :看得多, 聽得多這些不負責任醫生所做的事, 令我也開始對這個世界(不只是香港, 我在美國or 加拿大所看/聽到的有時更可怕)的醫療制度都開始失去信心.自己又不是醫生. 但又開始不相信醫生. 那我以後生病了怎算? 難道真的事事google?google 消息過分膨漲, 越讀反而越亂呢. 還是得依賴專業人士, 和自求多福.

專業人仕定係專業收費人仕?上次講嘅2分鐘大集團兒科醫生,轉介咗小孩去同集團嘅皮膚專科醫生,佢話無大問題,但為排除其他可能性建議照張x-ray,然後俾放射科醫生寫意見,本來約好一週後覆診睇報告,點知過咗兩日收到專科護士電話,話報告出咗,專科醫生話建議再轉介骨科醫生,但佢集團無,介紹另一個係中環嘅.份報告要去攞,專科護士6:00收工,最好唔好收工先來. 中環專科醫生當然唔同D,只有2-4點先係診所,其餘時間私家醫院做嘢就貴好多,只有請假陪小孩去....

結果係一句:小孩無事嘅,你唔帶佢去照x-ray就無咁多事啦...


[引用] | 作者 住家男人 | 2nd Mar 2007 15:12 PM | [舉報垃圾留言]

[6] Re:
葉一知 :
有人個名係"you call youself a dr", 就係因為太多人掛dr的名, 其實在做緊官僚, 故危害自己權威的就不是dr..., 不容人質疑..., 難道dr就只能按方執藥!!!

正是!
最慘的是, 其實我人很怕事的, 因此寫評論的時候已盡量對事, 從來沒有提過誰來罵. 讚就有說得清楚一點.

香港公營醫療要是再抱如此官僚的態度, 連一點反對聲音也不能出, 只有越加沉淪.


[引用] | 作者 星屑醫生 | 2nd Mar 2007 12:42 PM | [舉報垃圾留言]

[5]

有人個名係"you call youself a dr", 就係因為太多人掛dr的名, 其實在做緊官僚, 故危害自己權威的就不是dr..., 不容人質疑..., 難道dr就只能按方執藥!!!


[引用] | 作者 葉一知 | 2nd Mar 2007 11:28 AM | [舉報垃圾留言]

[4] Re:
膽小貓 :
星屑醫生,請問肓腸炎是怎樣得到的? 3天便會死亡實在太可怕。

我原本也想寫, 但現在卻卻步了.

唯有link 你去維基, 注意, 那裡資料也是簡化的, 也有不全的地方.
http://en.wikipedia.org/wiki/Appendicitis

也要注意: 維基也提到超聲波和電腦掃瞄的作用. 又要注意, 我link 你去維基不代表我就認同它, 那只算是認識這情況的起步點. ok?
有問題再問我吧.


[引用] | 作者 星屑醫生 | 2nd Mar 2007 09:49 AM | [舉報垃圾留言]

[3] Re:
外星人 :
看得多, 聽得多這些不負責任醫生所做的事, 令我也開始對這個世界(不只是香港, 我在美國or 加拿大所看/聽到的有時更可怕)的醫療制度都開始失去信心.
自己又不是醫生. 但又開始不相信醫生. 那我以後生病了怎算? 難道真的事事google?

google 消息過分膨漲, 越讀反而越亂呢. 還是得依賴專業人士, 和自求多福.


[引用] | 作者 星屑醫生 | 2nd Mar 2007 09:40 AM | [舉報垃圾留言]

[2]

星屑醫生,請問肓腸炎是怎樣得到的? 3天便會死亡實在太可怕。


[引用] | 作者 膽小貓 | 2nd Mar 2007 09:17 AM | [舉報垃圾留言]

[1]

看得多, 聽得多這些不負責任醫生所做的事, 令我也開始對這個世界(不只是香港, 我在美國or 加拿大所看/聽到的有時更可怕)的醫療制度都開始失去信心.

自己又不是醫生. 但又開始不相信醫生. 那我以後生病了怎算? 難道真的事事google?


[引用] | 作者 外星人 | 2nd Mar 2007 03:01 AM | [舉報垃圾留言]