在信任缺失的中国医院切身体验看病难

Chinese patients are fed up with their doctors, and doctors are fed up with their patients.

中国的病人已经受够了他们的医生，而医生也受够了他们的病人。

During a two-week stay in a Beijing hospital, here’s what I wrote in my diary: ‘‘One has a curious sense of being in a machine, an irritant, like a grain of sand. … No one has the right to anything, not even medical care. You can only demand, beg or seize.’’

在北京一家医院住院两周期间，我在日记里写下了以下文字：“有一种奇怪的感觉，仿佛身处机器里，仿佛令人生厌，像是一粒沙子……人没有任何权利，就连获得医疗护理的权利也没有。你只能要求、恳求或尽力去抓。”

And people do. ‘‘Kan bing nan,’’ or ‘‘It’s hard to see a doctor,’’ they say about the country’s oversubscribed, underfunded, often corrupt, health system. In frustration, patients may attack their physicians. Bribery is common.

大家确实就在这么做。提到中国的医疗体系需求过多、资金不足，而且经常出现腐败现象时，人们将其概括为“看病难”。一些心怀不满的病人可能会攻击医生。收受贿赂的现象也颇为常见。

Patients’ relatives gather in hospital waiting rooms and corridors, or camp out in wards cooking and tending to the sick, to make up for inadequate nursing. They may stage noisy protests to get the attention of staff members.

病人的亲属聚集在医院的候诊室和走廊里，或者暂住在病房中，做饭并照顾病人，以此弥补医院看护不足的问题。他们可能会故意进行激烈的抗议活动，为的是引起工作人员的关注。

‘‘I think you will find that most doctors are good people,’’ said a doctor at another Beijing hospital. Yet, physicians are unpopular and need advice on ‘‘upholding their rights,’’ according to an article on the website of the Chinese Medical Doctor Association. Common problems: What should a doctor do when bitten by a patient with syphilis? Assaulted by a drunk? Besieged at home for 10 years by a couple angry over their daughter’s unsuccessful operation?

在北京另一家医院工作的一名医生表示，“我想，你会发现大多数医生都是好人。”不过，中国医师协会网站上的一篇文章却显示，医生不受欢迎，需要“维权”方面的建议。常见问题包括：被梅毒携带者咬伤后，医生该怎么办？遭到醉酒者攻击时，该如何应对？被不满女儿手术失败的夫妇围堵家门长达10年时，该做些什么？

China’s medical system is a ‘‘market of distrust,’’ according to Cheris Shun- ching Chan, a sociologist at the University of Hong Kong. An emphasis on profits, a culture of ‘‘gift giving’’ and a lack of professional ethics have produced a difficult atmosphere, she said.

香港大学的社会学研究者陈纯菁(Cheris Shun-ching Chan)称，中国的医疗体系是一个“信任缺失的市场”。她表示，对盈利的重视、“送礼”文化的盛行，以及职业道德的缺乏产生了一种不利的氛围。

‘‘During the Mao period, doctor-patient relationships were relatively harmonious,’’ Ms. Chan said. Money was scarce and resources were few, for all. But after decades of market liberalization as hospitals sought to generate revenue, contributing to treatment shaped by commercial rather than medical concerns, trust is gone. ‘‘The conflict really is between patients and doctors,’’ she said.

陈纯菁说，“在毛泽东时代，医患关系相对融洽。”尽管当时也存在经费和资源匮乏的问题。不过，经过数十年的市场自由化后，随着医院寻求盈利，出于商业而非医疗方面的考虑进行治疗，这种信任已经荡然无存。她表示，“这实际上就是病人与医生之间的矛盾。”

The government says 90 percent of Chinese have some health insurance, but underfinanced state programs leave many patients covering the bulk of their costs themselves. One attempt to overcome the inefficiencies of the system and ensure a physician treats a patient well is to give ‘‘hongbao,’’ or red envelopes — bribes.

政府声称90%的中国人都有某种医疗保险，但资金不足的国家医保导致很多病人需要自己支付大部分的医疗费用。要想克服医疗系统效率低下的问题，确保医生认真治疗，一种办法就是送“红包”——贿赂医务人员。

Such payments are illegal. In 2017 the National Health and Family Planning Commission issued its 13th notice in two decades demanding that patients not give them and physicians not take them, Ms. Chan said.

此类报酬属于非法所得。2017年，国家卫生和计划生育委员会发布通知要求病人不送红包，医生不收红包。陈纯菁表示，这是20年来的第13份相关通知。

Hongbao, typically of 1,000 to 5,000 renminbi per envelope, or $160 to $800, are particularly common before major surgeries, said Ms. Chan, citing a survey she conducted. Of 572 people interviewed in Beijing, Shanghai and Guangzhou, 31 percent said they had offered hongbao, and these were accepted in 80 percent of cases, she said.

陈纯菁称，她所做过的一项调查显示，在重大手术前送红包是一种常见的现象，金额从1000元到5000元不等。她表示，应答者包括北京、上海及广州的572人，其中31%表示，他们送过红包，80%的情况下被对方收下。

‘‘You have to ‘buy’ a doctor’s effort to save the life of a person,’’ she said. ‘‘The main aim is to get the physicians to perform the surgery to the best of their ability. It’s what surgeons are supposed to do, of course.’’

“要想拯救一个人的生命，你得‘收买’医生，”她说。“主要目的是让医生尽力做好手术。当然，医生本来就应该这样做。”

The government recognizes the problems. On April 1, a meeting of the Central Leading Group for Comprehensively Deepening Reforms discussed the need for change in the medical system.

政府承认存在上述问题。4月1日，中央全面深化改革领导小组举行会议，讨论医疗系统改革的必要性。

‘‘We must realize the responsibility of the state to provide medical care, break the system of public hospitals pursuing profit, and build an appropriate salary system that matches the special skills of the medical profession,’’ reported Xinhua, the state news agency. Leaders know more investment is needed.

官方资讯机构新华社报道，“要落实政府办医责任，破除公立医院逐利机制，建立符合医疗行业特点的人事薪酬制度。”看来，领导人知道需要加大投入。

But money may not be enough. A lack of professionalism skews everything, according to a recent report by David Blumenthal and William Hsiao in The New England Journal of Medicine. A century into China’s quest to be a modern state, ‘‘the norms and standards of medical professionalism’’ and ‘‘the independent civic organizations that could promote and enforce them’’ are still missing, they write.

不过，光是加大投资可能还不够。戴维·布鲁门萨尔(David Blumenthal)和萧庆伦(William Hsiao)近期在《新英格兰医学杂志》(The New England Journal of Medicine)发表文章称，职业精神的缺失会扭曲一切。文中写道，中国寻求成为现代国家已有一个世纪的时间，但仍旧缺乏“医学职业精神的规范和标准”，以及“能够推广并加强这些规范和标准的独立民间组织”。

Said Ms. Chan: ‘‘Doctors often joke that they are afraid to sit in offices with their backs to the door in case they’re stabbed.’’ And everyone feels the deficit of humanity.

陈纯菁表示，“医生们经常开玩笑说，他们不敢背对着门坐在办公室里，以防被捅。”大家都能感觉到这当中人性的缺失。