{"id":4611,"date":"2017-05-22T00:00:00","date_gmt":"2017-05-21T16:00:00","guid":{"rendered":"\/\/www.afterroberto.com\/?guid=340c4c9514e4876e6020ea01e80d147d"},"modified":"2018-08-21T12:31:26","modified_gmt":"2018-08-21T04:31:26","slug":"%e5%85%92%e8%a8%80%e8%87%aa%e5%be%97%ef%bc%9a%e5%be%9e%e3%80%8c%e9%86%ab%e9%86%ab%e7%9b%b8%e8%a1%9b%e3%80%8d%e5%88%b0%e3%80%8c%e4%ba%ba%e4%ba%ba%e8%87%aa%e5%8d%b1%e3%80%8d","status":"publish","type":"post","link":"\/\/www.afterroberto.com\/%e5%85%92%e8%a8%80%e8%87%aa%e5%be%97%ef%bc%9a%e5%be%9e%e3%80%8c%e9%86%ab%e9%86%ab%e7%9b%b8%e8%a1%9b%e3%80%8d%e5%88%b0%e3%80%8c%e4%ba%ba%e4%ba%ba%e8%87%aa%e5%8d%b1%e3%80%8d\/","title":{"rendered":"\u5152\u8a00\u81ea\u5f97\uff1a\u5f9e\u300c\u91ab\u91ab\u76f8\u885b\u300d\u5230\u300c\u4eba\u4eba\u81ea\u5371\u300d"},"content":{"rendered":"

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\u6c42\u81ea\u4fdd\u3000\u52d5\u8f12\u9a57\u6771\u9a57\u897f<\/p>\n

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\/\/www.afterroberto.com\/wp-content\/uploads\/2017\/07\/M70515g.jpg;<\/inline><\/p>\n","protected":false},"excerpt":{"rendered":"

【明報專訊】最近因為換肝事件和延誤通報風波，輿論對「醫醫相衛」的攻擊甚囂塵上，除了醫院高層向公眾鞠躬，醫管局和食衛局高層也忙着向市民大眾解釋道歉，事情弄到全城沸沸揚揚，看來還未有平息的迹象。在這風波之前，有一段有關醫學界的新聞，市民好像不大注意，但在醫學界卻引起了不少反響。<\/p>\n

判斷出錯＝失德？<\/p>\n

據報章報道，事件是一名吞嚥有困難的病人，給醫生轉介到醫院接受胸肺X光檢查，檢查報告是正常，X光照片沒有顯示任何病變。後來病人證實患了肺癌，癌細胞更已蔓延到身體多處，病人不久之後便過了身。家人向醫務委員會投訴負責X光報告的醫生，指控他失職、忽視了X光片裏的肺癌病變；更因為他的誤導，延誤了進一步的檢驗和治療，最終導致病人因病身故。<\/p>\n

醫務委員會找來專家證人翻看病人的肺X光片。根據專家證人的判斷，X光片顯示病人的肺部有一個模糊不清的影像，單憑這個影像，不足以確定病人肺部是否真的有病變情况，有需要進一步的造影檢查。<\/p>\n

參考了專家證人的意見，醫務委員會聆訊委員判決X光醫生專業失德罪成，給予停牌一個月，緩刑三年的處分。<\/p>\n

醫委會的裁決給傳媒公布天下後，在醫學界引起了震盪：在醫院飯堂或醫生聚會上，都聽到眾議紛紜討論這案件。有醫生認為量刑相對醫生的過失重得不成比例：「停牌是最高刑罰，即使緩刑也是太重。」有X光醫生訴苦：「X光片許多時都有不少模糊不清的陰影，我們要憑判斷決定哪些是真哪些是假，是judgment call，誤判了被判失德極不公平。」有外科醫生打抱不平：「摸病人肚子常有些若有若無模糊不清的mass，有些可能是瘤，有些可能是faeces（即糞便），有些可能什麼都不是，搞錯了是否也是失德？ 是不是每次都要做CT胃鏡腸鏡看清楚？要是什麼也看不到，把病人白白折騰是否也是失德？」<\/p>\n

求自保　動輒驗東驗西<\/p>\n

在醫委會工作多年，我當然曉得每次紀律聆訊，委員都會參考多方面的資料，作多角度考慮，經詳細深入討論後才作出判決。單憑傳媒報道批評它的裁決，未必公允。當然我也理解醫生同事的感覺和不安情緒，以及這不安情緒可能帶來的不良後果：防衛性醫療（defensive medicine）。<\/p>\n

防衛性醫療要保護的不是病人而是醫生。就以診斷造影為例，病人久咳不癒需要檢查，醫生依程序先做胸肺X光檢驗，按道理應該有需要才作進一步的檢驗。要是醫生為了自保，不管三七二十一也為病人處方電腦掃描、核磁共振等這些解像度高，但昂貴，甚至有潛在副作用的檢驗。自費病人固然要支付高昂的醫藥費，公立醫院病人也因為服務供不應求，輪候時間更長，因排長龍延誤診治的人更多，害苦了的還是病人。<\/p>\n

根據維基百科資料，由於醫療訴訟氾濫，美國93%的醫生承認自己正在從事防衛性治療。防衛性醫療導致的過度檢驗、過度診斷和過度治療，已經給國民帶來巨大的經濟損失，以及肉體痛苦和人命傷亡，希望香港不會步美國後塵。<\/p>\n

文：霍泰輝（兒科專科醫生）<\/p>\n

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