愤怒的“病人”

Barack Obama is not the only politician in the world with a healthcare problem. Many US voters may hate Obamacare, but their pique pales in comparison with the anger of those who will not be voting for China’s new generation of political leaders next month. They are taking up knife and cudgel to vent their spleen directly on doctors, since they cannot do it through the ballot box.

巴拉克·奥巴马(Barack Obama)并非是世界上唯一遭遇医疗问题的政客。许多美国选民可能对“奥巴马医改(Obamacare)感到不满，但与无法在下月投票选举新一代政治领导人的中国人的愤怒相比，他们的不满不值一提。这些中国人拿起刀子和棍棒，直接把怒气发泄到医生身上，因为他们无法通过选票箱表达不满。

In 2010, the last year for which official figures are available, the health ministry says there were 17,000 protests or attacks directed against doctors or hospitals in China. The number of incidents, which continues to rise at a double-digit rate each year, may have more than doubled since 2005, official estimates indicate.

中国卫生部表示，在2010年（可获得官方数据的最近年份），中国发生了1.7万起针对医生或医院的抗议或袭击活动。据官方估计，此类事件自2005年以来增长了一倍多，目前仍在以每年两位数的速度增长。

When China’s political leaders meet on November 8 for the most important Communist party congress in a decade, they will not need to count ballots to gauge the mood of the nation: they can count knife wounds.

当中国政治领导人在11月8日召开十年里最重要的共产党代表大会时，他们将不必计算选票来判断这个国家的情绪：他们可以计算刀伤。

Last last month the death of a woman treated for a sore throat and fever at a hospital in southern China triggered a riot of 2,000 people. Earlier in the month, four staff in the ear, nose and throat department of a private hospital in the southern city of Shenzhen were stabbed by a patient treated for allergic rhinitis.

上个月，中国南方一位妇女在因喉咙痛和发烧入院治疗期间死亡，引发了2000人的骚乱。上月初，中国南部城市深圳的一家民营医院耳鼻喉科的四名工作人员被一位过敏性鼻炎患者刺伤。

In May a nurse was attacked in Nanjing by a woman who claimed that a Caesarean delivery at the same hospital 16 years before had harmed her sex life. And last year a Beijing doctor who had operated on a man with laryngeal cancer

今年5月，南京一名女子闯入一家医院刺伤一名护士。这名女子声称，16年前在这家医院做的剖腹产手术影响了她的性生活。去年，北京一名喉癌患者在病情多次反复后，刺伤了为其做手术的医生。该名男子在2010年曾起诉医院，但在法院审理案件前就开始行凶伤人。

was stabbed by him multiple times when his cancer returned. The man sued the hospital in 2010 but knifed her before the court was able to hear the case.

此类事件并非仅仅是那些被疾病或悲伤折磨的发狂患者的孤立行为。相反，它们反映了中国公众对高昂医疗费用的普遍愤怒。而高昂的医疗费用是由医疗体系腐败导致的，许多患者不得不向医生行贿，仅仅是为了确保能约上医生。

Incidents like these are not just isolated acts perpetrated by those driven crazy by illness or grief. Instead they reflect widespread public anger at the high cost of medical care in China, fuelled by corruption in the medical system where many patients have to pay bribes just to secure a doctor’s appointment.

中国近几年大幅扩大了医疗保险覆盖范围，但根据麦肯锡(McKinsey)新近发布的一份报告，中国医疗支出仅占国内生产总值(GDP)的5%左右，西欧的这一比例为10%-12%，美国为15%-17%，而中国人均医疗支出水平还要低得多。中国每千人口甚至不足两名医生，许多医生的月工资仅有几千元人民币。

China has vastly expanded health insurance coverage in recent years, but according to a new McKinsey report , it still spends only about 5 per cent of gross domestic product on healthcare, compared with 10-12 per cent in western Europe and 15-17 per cent in the US – and far less per capita. There are not even two doctors for every 1,000 people in China – and many of them are paid only a few thousand renminbi per month.

医生们承受着为医院（更不用说为他们自己）创造额外收入的巨大压力，这导致病人怀疑他们在行医时唯利是图。患者对现代医疗的效果有着不合理的高预期，而穷人和富人在医疗方面的差距与其他领域一样明显。患者称，他们对医生没有好感，而许多医生表示，他们最不想让自己孩子做的事情就是学医。

Doctors are under intense pressure to generate extra income for their hospitals – not to mention themselves – leading patients to suspect them of practising mercenary medicine. Patients have unreasonably high expectations of the wonders of modern medicine, and the gap between rich and poor, in healthcare as in everything else, is glaring. Patients say they do not respect doctors – and many doctors say the last thing they want their children to do is study medicine.

李慧娟是中国医师协会(China Association of Medical Doctors)医疗风险控制和管理委员会的一名律师。最近，中国北方一家医院的实习医生王浩被一名自己甚至从未接诊过的17岁患者杀害。李慧娟担任王浩家庭的代理律师。

Li Huijuan is a lawyer who sits on the medical risk control and management committee of the China Association of Medical Doctors. She represents the family of Wang Hao, a trainee doctor at a hospital in northern China, who was killed recently by a 17-year-old whom he had never even treated.

李慧娟表示，凶手因为自己的肺结核和背部疾病屡治不好而感到愤怒，他在附近超市花4.30元人民币（合0.68美元）买了一把水果刀，刺向了身高1.80米的王浩医生，因为他担心这个高个子医生会挡住他的路。

The assailant, who became enraged after repeated hospital visits failed to cure his tuberculosis and back problems, spent Rmb4.30 ($0.68) on a fruit knife at a nearby supermarket, and attacked the 1.8-metre tall Dr Wang because he feared the tall doctor would otherwise block his way, Ms Li said.

李慧娟表示，医患之间的信任度非常低，双方甚至在知道出问题之前就开始搜集诉讼材料：患者录下看病过程的视频，而医生则让患者多花钱做额外的检查，所有这些都是为了在可能的诉讼中维护自己的利益。李慧娟指出，医生遇袭事件大幅上升始于2002年颁布的举证新规。新规要求医院和医生承担证明自己清白的举证责任。

Ms Li says trust between patient and doctor has hit such a low level that both sides start assembling material for litigation even before they know there is a problem: patients video record doctor visits and doctors cover their backs by ordering extra tests that cost patients more money, all to defend themselves in a potential lawsuit. She dates the sharp rise in attacks to new rules of evidence issued in 2002, which require hospitals and doctors to bear the burden of proving their innocence.

人民网(People's Daily Online)在王浩遇袭之后发起的一项调查显示，三分之二的受访者在听说袭击事件后感到“高兴，因为受害者是一名医务工作者，这一结果令人不寒而栗。

A People’s Daily Online poll, taken soon after the attack on Dr Wang, found that a chilling two-thirds of respondents had been “delighted to hear of the attack because the victim was a medical professional.

中国下一代政治领导人很可能希望就此做些什么。如果他们置之不理，那么中国政府将通过一种残酷的方式明白，即便在中国政治中，也有“第三轨道——那就是医疗问题。

China’s next generation of political leaders will probably want to do something about that. If they don’t, Beijing will learn the hard way that, even in China, there is such a thing as a “third rail in politics – and it is called healthcare.