{"id":4517,"date":"2017-06-05T00:00:00","date_gmt":"2017-06-04T16:00:00","guid":{"rendered":"\/\/www.afterroberto.com\/?guid=05df34b3da2d617303bb92bd2d57e0da"},"modified":"2018-08-21T12:18:25","modified_gmt":"2018-08-21T04:18:25","slug":"%e5%85%92%e8%a8%80%e8%87%aa%e5%be%97%ef%bc%9a%e7%ba%8c%e8%ab%87%e9%98%b2%e8%a1%9b%e6%80%a7%e9%86%ab%e7%99%82","status":"publish","type":"post","link":"\/\/www.afterroberto.com\/%e5%85%92%e8%a8%80%e8%87%aa%e5%be%97%ef%bc%9a%e7%ba%8c%e8%ab%87%e9%98%b2%e8%a1%9b%e6%80%a7%e9%86%ab%e7%99%82\/","title":{"rendered":"\u5152\u8a00\u81ea\u5f97\uff1a\u7e8c\u8ac7\u9632\u885b\u6027\u91ab\u7642"},"content":{"rendered":"

\u3010\u660e\u5831\u5c08\u8a0a\u3011\u6211\u5011\u6559\u5c0e\u91ab\u5b78\u751f\uff0c\u5c07\u4f86\u7562\u696d\u884c\u91ab\u4e00\u5b9a\u8981\u8b39\u5b88\u91ab\u5b78\u502b\u7406\u7684\u56db\u5927\u539f\u5247\uff0c\u5373\u662f\u884c\u5584\u4e8b\uff08do good\uff09\u3001\u6bcb\u50b7\u5bb3\uff08do no harm\uff09\u3001\u75c5\u4eba\u81ea\u4e3b\uff08autonomy\uff09\uff0c\u4ee5\u53ca\u516c\u5e73\u6b63\u7fa9\uff08justice\uff09\u3002\u91ab\u751f\u6cbb\u75c5\uff0c\u7576\u7136\u662f\u70ba\u4e86\u75c5\u4eba\u597d\uff0cdo good\u4e4b\u5fc3\u6bcb\u5eb8\u7f6e\u7591\u3002\u53ef\u662f\u4e0d\u8ad6\u662f\u958b\u65b9\u65bd\u85e5\u6216\u662f\u52d5\u624b\u8853\u958b\u5200\uff0c\u75c5\u4eba\u6216\u591a\u6216\u5c11\u7e3d\u8981\u5192\u4e00\u9ede\u98a8\u96aa\ufe55\u4e0d\u662f\u85e5\u7269\u7684\u526f\u4f5c\u7528\uff0c\u4fbf\u662f\u624b\u8853\u7684\u4f75\u767c\u75c7\uff0c\u9084\u6709\u56e0\u85e5\u7269\u6216\u8853\u5f8c\u75c5\u4eba\u9ad4\u8cea\u6539\u8b8a\u5f15\u767c\u51fa\u4f86\u7684\u96b1\u75be\u3002\u6240\u4ee5\u91ab\u751f\u5728\u7d66\u75c5\u4eba\u5236\u8a02\u91ab\u7642\u65b9\u6848\u6642\uff0c\u4e00\u5b9a\u8981\u628agood\u548charm\u4ed4\u7d30\u8003\u616e\u6bd4\u8f03\uff0c\u6700\u5f8c\u4e0d\u8ad6\u6c7a\u5b9a\u63a1\u7528\u54ea\u500b\u65b9\u6848\uff0c\u90fd\u4e00\u5b9a\u8981\u4ee5\u75c5\u4eba\u7684\u6700\u4f73\u798f\u7949\uff08best interest\uff09\u70ba\u4f9d\u6b78\u3002<\/p>\n

\u6216\u5927\u5305\u570d\u4e82\u91ab \u6216\u62d2\u6536\u5371\u75be<\/p>\n

\u4e0a\u671f\u548c\u5927\u5bb6\u8ac7\u5230\u7684\u9632\u885b\u6027\u91ab\u7642\uff08defensive medicine\uff09\uff0c\u537b\u80af\u5b9a\u4e0d\u662f\u4ee5\u75c5\u4eba\u7684\u6700\u4f73\u798f\u7949\u70ba\u4f9d\u6b78\uff0c\u800c\u662f\u4ee5\u4fdd\u8b77\u91ab\u751f\uff0c\u8b93\u91ab\u751f\u514d\u65bc\u53d7\u75c5\u4eba\u6295\u8a34\u6216\u544a\u5230\u5b98\u88cf\u70ba\u4e3b\u3002\u600e\u9ebc\u500b\u4fdd\u8b77\u6cd5\uff1f\u539f\u4f86\u9632\u885b\u6027\u91ab\u7642\u5927\u81f4\u53ef\u5206\u70ba\u9032\u53d6\u578b\u548c\u8ff4\u907f\u578b\u5169\u5927\u985e\u3002\u9032\u53d6\u578b\u7684\u9632\u885b\uff0c\u662f\u91ab\u751f\u8981\u75c5\u4eba\u9032\u884c\u5f88\u591a\u4e0d\u5fc5\u8981\u7684\u6aa2\u67e5\uff0c\u6216\u4e0d\u5fc5\u8981\u7684\u6cbb\u7642\uff0c\u7528\u610f\u4e0d\u662f\u70ba\u4e86\u75c5\u4eba\u597d\uff0c\u800c\u662f\u91ab\u751f\u70ba\u4e86\u81ea\u4fdd\u3002\u4f8b\u5982\u75c5\u4eba\u50b7\u98a8\u54b3\u55fd\uff0c\u660e\u77e5\u7d55\u5927\u591a\u6578\u90fd\u662f\u8f15\u5fae\u75c5\u6bd2\u611f\u67d3\uff0c\u904e\u5e7e\u5929\u4fbf\u6703\u4e0d\u85e5\u800c\u7652\uff0c\u9084\u662f\u8981\u91cd\u624b\u8655\u65b9\u6700\u5f37\u6297\u751f\u7d20\uff0c\u518d\u52a0\u7279\u654f\u798f\uff0c\u52d5\u4e0d\u52d5\u9084\u8981\u52a0\u4e0aX\u5149\u96fb\u8166\u6383\u63cf\u6838\u78c1\u5171\u632f\u7b49\u4e00\u5927\u5806\u6aa2\u67e5\uff0c\u6700\u597d\u662f\u5165\u9662\u89c0\u5bdf\uff0c\u7e3d\u4e4b\u300c\u6709\u6bba\u932f\u7121\u653e\u904e\u300d\uff0c\u8981\u662f\u75c5\u4eba\u300c\u842c\u4e00\u300d\u4e0d\u55ae\u55ae\u662f\u50b7\u98a8\uff0c\u9084\u6709\u5176\u4ed6\u66f4\u56b4\u91cd\u7684\u611f\u67d3\uff0c\u90a3\u672b\u6700\u7cbe\u5bc6\u7684\u6aa2\u67e5\u5df2\u505a\u904e\u4e86\uff0c\u6700\u91cd\u7684\u85e5\u4e5f\u7528\u904e\u4e86\uff0c\u5373\u4f7f\u75c5\u4eba\u6b7b\u4e86\u4e5f\u602a\u4e0d\u5230\u91ab\u751f\u982d\u4e0a\u3002<\/p>\n

\u8ff4\u907f\u578b\u9632\u885b\uff0c\u662f\u91ab\u751f\u76e1\u91cf\u907f\u514d\u63a5\u6536\u9ad8\u98a8\u96aa\u7684\u75c5\u4eba\uff0c\u4ee5\u53ca\u70ba\u75c5\u4eba\u9032\u884c\u9ad8\u98a8\u96aa\u7684\u624b\u8853\u3002\u524d\u8005\u6703\u4ee4\u5230\u4e00\u4e9b\u8001\u5f31\u50b7\u6b98\uff0c\u5c24\u5176\u662f\u8eab\u60a3\u591a\u7a2e\u6162\u6027\u75c5\u7684\u4eba\u58eb\uff0c\u5f97\u4e0d\u5230\u9069\u5207\u7684\u6cbb\u7642\u3002\u6709\u4e00\u4f4d\u7576\u666e\u901a\u79d1\u5927\u592b\u7684\u8001\u53cb\u544a\u8a34\u6211\uff0c\u8981\u662f\u6709\u591a\u75c5\u8001\u4eba\u627e\u4ed6\u770b\u75c5\uff0c\u5c24\u5176\u662f\u90a3\u4e9b\u5931\u667a\u53e3\u9f52\u4e0d\u6e05\u7684\uff0c\u5373\u4f7f\u75c5\u5fb5\u8f15\u5fae\uff0c\u4ed6\u90fd\u6703\u7b2c\u4e00\u6642\u9593\u628a\u75c5\u4eba\u8f49\u4ecb\u5230\u516c\u7acb\u91ab\u9662\u6025\u75c7\u5ba4\uff0c\u5c31\u662f\u6015\u770b\u9019\u985e\u75c5\u4eba\u5bb9\u6613\u8d70\u6f0f\u773c\uff0c\u60f9\u4e0a\u9ebb\u7169\u3002\u81f3\u65bc\u9ad8\u98a8\u96aa\u624b\u8853\uff0c\u8a31\u591a\u6642\u662f\u75c5\u4eba\u6700\u5f8c\u6a5f\u6703\ufe55\u4e0d\u505a\u5c31\u5fc5\u6b7b\u7121\u7591\uff0c\u505a\u5247\u662f\u300c\u535a\u4e00\u535a\u300d\uff0c\u96d6\u7136\u5192\u96aa\uff0c\u300c\u535a\u8d0f\u300d\u4e86\u75c5\u4eba\u5927\u6709\u88e8\u76ca\u3002\u8981\u662f\u91ab\u751f\u70ba\u4e86\u81ea\u4fdd\u4e0d\u9858\u5192\u9019\u500b\u96aa\uff0c\u75c5\u4eba\u9023\u9019\u6a5f\u6703\u4e5f\u6c92\u6709\u4e86\u3002<\/p>\n

\u7f8e\u570b\u56db\u5206\u4e00\u91ab\u7642\u4f7f\u8cbb\u88ab\u6d6a\u8cbb<\/p>\n

\u91ab\u7642\u8a34\u8a1f\u6108\u591a\u7684\u5730\u65b9\uff0c\u9632\u885b\u6027\u91ab\u7642\u6108\u6d41\u884c\uff0c\u7f8e\u570b\u662f\u91ab\u7642\u8a34\u8a1f\u6700\u591a\u7684\u570b\u5bb6\uff0c\u6240\u4ee5\u5728\u9019\u65b9\u9762\u662f\u9996\u5c48\u4e00\u6307\u3002\u66fe\u6709\u7814\u7a76\u986f\u793a\uff0c\u5728\u8cd3\u5915\u6cd5\u5c3c\u4e9e\u5dde\uff0c\u767e\u5206\u4e4b\u4e5d\u5341\u4ee5\u4e0a\u7684\u91ab\u751f\u66fe\u70ba\u4e86\u81ea\u4fdd\u800c\u8981\u75c5\u4eba\u63a5\u53d7\u591a\u9918\u7684\u9020\u5f71\u548c\u5176\u4ed6\u8a3a\u65b7\u6aa2\u9a57\uff1b\u767e\u5206\u4e4b\u56db\u5341\u4e8c\u7684\u91ab\u751f\u66fe\u70ba\u4e86\u540c\u6a23\u539f\u56e0\u62d2\u7d55\u70ba\u75c5\u4eba\u9032\u884c\u9ad8\u98a8\u96aa\u624b\u8853\uff0c\u4ee5\u53ca\u63a5\u6536\u75c5\u60c5\u8907\u96dc\u7684\u75c5\u4eba\u3002\u6839\u64da\u7f8e\u570b\u4e00\u5bb6\u898f\u6a21\u9f90\u5927\u7684\u91ab\u7642\u96c6\u57182010\u5e74\u7684\u7d71\u8a08\uff0c73%\u81f392%\u7684\u79c1\u5bb6\u91ab\u751f\u627f\u8a8d\u5f9e\u4e8b\u9632\u885b\u6027\u91ab\u7642\uff0c\u516c\u71df\u91ab\u7642\u88cf\u7684\u6578\u5b57\u5247\u662f48%\u3002<\/p>\n

\u9632\u885b\u6027\u91ab\u7642\u5e36\u4f86\u56b4\u91cd\u7684\u7d93\u6fdf\u640d\u5931\uff0c\u5728\u7f8e\u570b\uff0c\u6709\u7d71\u8a08\u6307\u6bcf\u56db\u5143\u7684\u91ab\u7642\u4f7f\u8cbb\uff0c\u5176\u4e2d\u4fbf\u6709\u4e00\u5143\u662f\u6d6a\u8cbb\u5728\u9632\u885b\u6027\u91ab\u7642\u4e0a\u3002\u81f3\u65bc\u75c5\u4eba\u56e0\u9032\u53d6\u578b\u6216\u8ff4\u907f\u578b\u9632\u885b\u6240\u53d7\u7684\u4e0d\u4fbf\u3001\u75db\u82e6\u3001\u751a\u81f3\u4eba\u547d\u640d\u5931\uff0c\u5247\u66f4\u975e\u91d1\u9322\u53ef\u4ee5\u8861\u91cf\u3002<\/p>\n

\u6587\uff1a\u970d\u6cf0\u8f1d\uff08\u5152\u79d1\u5c08\u79d1\u91ab\u751f\uff09<\/p>\n

\/\/www.afterroberto.com\/wp-content\/uploads\/2017\/07\/M70515o.jpg;<\/inline><\/p>\n","protected":false},"excerpt":{"rendered":"

【明報專訊】我們教導醫學生，將來畢業行醫一定要謹守醫學倫理的四大原則，即是行善事（do good）、毋傷害（do no harm）、病人自主（autonomy），以及公平正義（justice）。醫生治病，當然是為了病人好，do good之心毋庸置疑。可是不論是開方施藥或是動手術開刀，病人或多或少總要冒一點風險﹕不是藥物的副作用，便是手術的併發症，還有因藥物或術後病人體質改變引發出來的隱疾。所以醫生在給病人制訂醫療方案時，一定要把good和harm仔細考慮比較，最後不論決定採用哪個方案，都一定要以病人的最佳福祉（best interest）為依歸。<\/p>\n

或大包圍亂醫 或拒收危疾<\/p>\n

上期和大家談到的防衛性醫療（defensive medicine），卻肯定不是以病人的最佳福祉為依歸，而是以保護醫生，讓醫生免於受病人投訴或告到官裏為主。怎麼個保護法？原來防衛性醫療大致可分為進取型和迴避型兩大類。進取型的防衛，是醫生要病人進行很多不必要的檢查，或不必要的治療，用意不是為了病人好，而是醫生為了自保。例如病人傷風咳嗽，明知絕大多數都是輕微病毒感染，過幾天便會不藥而癒，還是要重手處方最強抗生素，再加特敏福，動不動還要加上X光電腦掃描核磁共振等一大堆檢查，最好是入院觀察，總之「有殺錯無放過」，要是病人「萬一」不單單是傷風，還有其他更嚴重的感染，那末最精密的檢查已做過了，最重的藥也用過了，即使病人死了也怪不到醫生頭上。<\/p>\n

迴避型防衛，是醫生盡量避免接收高風險的病人，以及為病人進行高風險的手術。前者會令到一些老弱傷殘，尤其是身患多種慢性病的人士，得不到適切的治療。有一位當普通科大夫的老友告訴我，要是有多病老人找他看病，尤其是那些失智口齒不清的，即使病徵輕微，他都會第一時間把病人轉介到公立醫院急症室，就是怕看這類病人容易走漏眼，惹上麻煩。至於高風險手術，許多時是病人最後機會﹕不做就必死無疑，做則是「博一博」，雖然冒險，「博贏」了病人大有裨益。要是醫生為了自保不願冒這個險，病人連這機會也沒有了。<\/p>\n

美國四分一醫療使費被浪費<\/p>\n

醫療訴訟愈多的地方，防衛性醫療愈流行，美國是醫療訴訟最多的國家，所以在這方面是首屈一指。曾有研究顯示，在賓夕法尼亞州，百分之九十以上的醫生曾為了自保而要病人接受多餘的造影和其他診斷檢驗；百分之四十二的醫生曾為了同樣原因拒絕為病人進行高風險手術，以及接收病情複雜的病人。根據美國一家規模龐大的醫療集團2010年的統計，73%至92%的私家醫生承認從事防衛性醫療，公營醫療裏的數字則是48%。<\/p>\n

防衛性醫療帶來嚴重的經濟損失，在美國，有統計指每四元的醫療使費，其中便有一元是浪費在防衛性醫療上。至於病人因進取型或迴避型防衛所受的不便、痛苦、甚至人命損失，則更非金錢可以衡量。<\/p>\n

文：霍泰輝（兒科專科醫生）<\/p>\n

<\/inline><\/p>\n","protected":false},"author":2,"featured_media":6321,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"rank_math_lock_modified_date":false,"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[3],"tags":[118,1165],"class_list":["post-4517","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-3","tag-118","tag-1165"],"publishpress_future_action":{"enabled":false,"date":"2026-11-16 12:07:52","action":"change-status","newStatus":"draft","terms":[],"taxonomy":"category"},"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"_links":{"self":[{"href":"\/\/www.afterroberto.com\/wp-json\/wp\/v2\/posts\/4517"}],"collection":[{"href":"\/\/www.afterroberto.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"\/\/www.afterroberto.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"\/\/www.afterroberto.com\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"\/\/www.afterroberto.com\/wp-json\/wp\/v2\/comments?post=4517"}],"version-history":[{"count":0,"href":"\/\/www.afterroberto.com\/wp-json\/wp\/v2\/posts\/4517\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"\/\/www.afterroberto.com\/wp-json\/wp\/v2\/media\/6321"}],"wp:attachment":[{"href":"\/\/www.afterroberto.com\/wp-json\/wp\/v2\/media?parent=4517"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"\/\/www.afterroberto.com\/wp-json\/wp\/v2\/categories?post=4517"},{"taxonomy":"post_tag","embeddable":true,"href":"\/\/www.afterroberto.com\/wp-json\/wp\/v2\/tags?post=4517"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}