好英语网过度医疗让人贫病交加
When it comes to medical care, many patients and doctors believe more is better.
说到医疗，许多患者和医生都相信，多就是好的。
But an epidemic of overtreatment - too many scans, too many blood tests, too many procedures - is costing the nation's health care system at least $210 billion a year, according to the Institute of Medicine, and taking a human toll in pain, emotional suffering, severe complications and even death.
然而，过度医疗已经成为一场流行病。过多的扫描，过多的血液化验，过多的检查……据美国国家医学院(Institute of Medicine)公布的数据，美国医疗保健系统每年至少为此支付2100亿美元的巨额开支。此外，病人也要承受身心两方面的折磨，面临严重的并发症甚至是死亡的威胁。
"What people are not realizing is that sometimes the test poses harm," said Shannon Brownlee, acting director of the health policy program at the New America Foundation and the author of "Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer."
“人们没有意识到的是，有时候，检查反而会带来伤害，”新美国基金会(New America Foundation)健康政策项目代理主管香农·布朗利(Shannon Brownlee)表示。他著有《过度医疗：为什么太多的药物会让我们贫病交加》(Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer)一书。
"Sometimes the test leads you down a path, a therapeutic cascade, where you start to tumble downstream to more and more testing, and more and more invasive testing, and possibly even treatment for things that should be left well enough alone."
“有时候，检查会将你带上一条治疗的不归路。一失足成千古恨，你会面对越来越多、越来越具有侵入性的检查，甚至会对那些原本不作理会反而更好的症状大动干戈。”
Have you experienced too much medicine? As part of The New York Times's online series The Agenda, I asked readers to share their stories. More than 1,000 responded, with examples big and small.
你经历过过度医疗吗？作为《纽约时报》网络系列报道“议程”(The Agenda)的一部分，我请读者分享他们自己的故事。超过1000人作出响应，举出的例子有大有小。
Some complained that when they switch doctors they are required to undergo duplicate blood work, scans or other tests that their previous doctor had only recently ordered. Others told of being caught in a unending maze of testing and specialists who seem to forget the patient's original complaint. I heard from doctors and nurses, too - health professionals frustrated by a system that encourages these excesses.
一些读者抱怨，转诊的时候，他们总是被要求进行重复的血液化验、扫描及其它检查，虽然之前的医生刚刚开过这些检查。另外一些人提及，他们身陷迷宫般没完没了的检查之中，以至于专科医生似乎忘了病人到底是为了什么来看病的。我也听取了医生和护士的看法。医疗体系对此种过度治疗实践的鼓励令这些专业人士也深感沮丧。
Terrence Power of Breckenridge, Colo., said that after his wife, Diane, learned she had Wegener's disease, an uncommon autoimmune disorder, the couple found it difficult to refuse testing recommended by a trusted doctor. The doctor insisted on office visits every three weeks, even when she was feeling well. He frequently ordered blood tests and X-rays, and repeatedly referred her to specialists for even minor complaints. Even when tests came back negative, more were ordered, and she was hospitalized as a precaution when she developed a cold. During one six-month period, she had 25 doctor visits. The couple was spending about $30,000 a year out of pocket for her care.
科罗拉多州布雷肯里奇的特伦斯·鲍尔(Terrence Power)说，自从他的妻子黛安娜(Diane)被诊断为韦格纳氏症(Wegener's Disease)——一种罕见的自体免疫疾病——以来，这对夫妇便发现，很难拒绝一位深受他们信任的医生推荐的检查。这位医生坚持要他们每三个星期复诊一次，就算黛安娜感觉并无不适也不例外。他经常要求抽血化验和X光扫描，反复推荐她转诊至专科医生处，即便黛安娜主诉的症状十分轻微。就算是返回的检查结果显示阴性，还会有更多的检查随之而来。连她得一场小感冒，都会被要求住院治疗以防万一。有段时间，她在六个月里看了25次门诊。为治疗黛安娜的病，这对夫妇光是自付医疗费部分就花了三万美元。
"He was convincing enough that we felt we needed to have it done," said Ms. Power, 60, who recalls being sedated before an endoscopy procedure, one of the last tests she allowed her doctor to perform. "When they were getting ready to knock me out I was thinking, 'Why am I doing this?' But we felt like the doctor knew what to do and we trusted him."
“他总是信心满满，让我们觉得检查不做不行，”60岁的鲍尔太太说。她回忆起一次内窥镜检查前被镇静催眠的经历。那是她接受医生建议做的最后几项检查之一。“就在他们快把我放倒的时候，我想，‘我为什么要做这个啊？’但我们总觉得，那位医生知道自己在做什么，我们信任他。”
After several years of physical suffering and near financial ruin from the medical costs, the couple began questioning the treatment after consulting with other patients in online support groups. Mr. Power spoke with his own primary care doctor, who advised him to find a new specialist to oversee Ms. Power's care. "It's a really hard thing to determine when they've crossed the line," Mr. Power said. "You think she's getting the best care in the world, but after a while you start to wonder, what is the objective? He seemed caring, but he didn't really consider my wife's time and the suffering she was going through having all these tests done."
经受了数年肉体折磨，为了治病几乎散尽家财后，这对夫妇与网络互助小组的病友们交换了意见，开始对治疗产生怀疑。鲍尔先生与他的家庭医生谈了一次话。后者一直建议他找一位新的专科医生负责鲍尔太太的治疗。“要判断他们是否违规逾矩，这真的很难，”鲍尔先生说：“你觉得她在接受着世界上最好的治疗，但一转念，便又疑惑不解：这到底是为了什么？他看起来是为我们好，但他实际上并没有考虑到我太太为接受这些检查所付出的时间和经受的痛苦。”
Under the new doctor's care, the regular testing stopped and Ms. Power was finally able to achieve remission. Now she sees the doctor only four or five times a year.
换了位新医生之后，常规检查被终止了，鲍尔太太终于可以摆脱身上的枷锁。现在，她一年只需复诊四到五次。
Sometimes the toll of too much medicine is brief, but emotional. Kara Riehman, 43, of Atlanta was vacationing in California when she lost a struggle with an ironing board in her hotel room and ended up with a black eye.
有时候，过度医疗对身体的影响是一过性的，但却会带来心理阴影。43岁的亚特兰大人卡拉·里厄曼(Kara Riehman)之前在加州度假。收起旅馆房间里的熨衣板时，她失了手，结果把自己砸了个乌眼青。
As the bruising peaked around 10 days, she called her doctor to make sure everything looked normal. But instead of seeing her, the doctor, through a conversation with the nurse, ordered a CT scan. She had no symptoms other than a bruised eye, but the doctor never spoke with her or examined her. The scan came back with an ambiguous finding, and the nurse told her it could be a tumor. She was then given an M.R.I. and for two weeks while she waited for the results, she worried she had brain cancer. The nurse called to tell her the M.R.I. was fine.
瘀青过了十天仍肿胀不消，她于是给医生打了个电话，确保一切正常。然而，医生和她的主管护士简单交谈之后，没和她见面就安排了一次CT扫描。除了眼部瘀青，她没有任何其他症状，但医生根本没有跟她说过一句话，也不对她进行检查。返回的扫描结果有一处模糊难以确定，护士对她说，保不准这是个肿瘤。于是，她又被要求进行了一次核磁共振成像扫描(M.R.I.)。在等待结果的那两个星期里，她担心自己真的患上了脑癌。然后，护士打电话过来，告诉她核磁共振成像扫描结果一切正常。
"It was really terrible," she said. "It was only two weeks, but there is a lot of cancer in my family. I never actually talked to my doctor through this whole thing."
“这太恐怖了，”她说道，“虽然只不过两周时间，但我家族里有很多癌症患者。整个过程中，我事实上没有跟医生进行过交流。”
The total cost to her insurance company was about $7,000. "It did change how I think about interacting with the medical system," Ms. Riehman said. "It made me much more of a questioning consumer."
她的医疗保险公司总共为此支付了大约7000美元。“这件事确实改变了我对与医疗体系打交道的看法，”里厄曼女士说：“它让我变成了一个更有质疑精神的消费者。”
Jim Donohue, a Brooklyn bank examiner, had to intervene on behalf of his father, now 79, who had a stroke in March 2007. Doctors in Florida put him on several medications, including two antidepressants, and soon after the man began hallucinating and showing signs of dementia. Mr. Donohue began researching the drugs, and learned they were associated with cognitive problems. He persuaded his father's doctors to change the medication, and his father quickly improved. He has since recovered, and has been living on his own for four years.
吉姆·多诺修(Jim Donohue)是纽约布鲁克林一家银行的账目核查员。他现年79岁的父亲2007年3月经历了一次脑卒中发作，之后，多诺修不得不代表父亲插手治疗方案的决策。佛罗里达州的医生给多诺修的父亲开了好几种药，其中包括两种抗抑郁药。服药没多久，老人就开始出现幻觉，并表现出痴呆症的迹象。多诺修对药物加以调查后发现，它们可能导致认知障碍。多诺修说服医生改了药方，结果父亲迅速好转了。复原后的老人一直独立生活，如今已经有四年时间。
"All the medical professionals seeing him along the way, the hospital, two nursing homes and nobody thought of this," said Mr. Donohue, who said his father never should have been given a diagnosis of depression in the first place. "I don't know if we have too many specialists and every one is trying to practice their specialty, but it should not have happened."
“一直给父亲看病的那些医学专家、医院和两家疗养院，所有人都没想到结果会是这样，”多诺修说。他认为，父亲从一开始就不应该被诊断为抑郁症，他说：“我不知道是不是因为专家太多了，结果每个人都想表现其专业性。但这本来是不应该发生的事。”
When Kathryn Gullo, a teacher in the Los Angeles area, gave birth to twins just 25 weeks into the pregnancy, she was thrust into the intense medical care of the neonatal ward that saved her children's lives. But when her daughter, Grace, was 3 months old she was transferred to a different hospital, where the doctors insisted on subjecting her to a battery of tests for symptoms that other doctors had dismissed as normal for her condition. "We felt like we were being bullied," Ms. Gullo said. "I had enough faith in her previous doctors that it was then easy to say no."
凯瑟琳·古洛(Kathryn Gullo)是洛杉矶地区的一名教师。怀孕25周时，古洛早产了一对双胞胎。宝宝被送进新生儿重症监护室，宝宝因此得救。但当她的女儿格雷丝(Grace)三个月大的时候，却被转到了另外一家医院。那里的医生坚持要给格雷丝做一系列检查，以确诊她的一些在其他医生眼中纯属正常的症状。“我们觉得好像在被胁迫一样，”古洛女士说，“幸好我对格雷丝之前的医生有足够信心，拒绝不算太难。”
The family switched hospitals and their daughter, now 5 and living with mild cerebral palsy and some vision and feeding issues, continues to require specialized care. But recently, when doctors suggested an M.R.I. that would require that their daughter be anesthetized, Ms. Gullo and her partner, Katie Ingram, said they asked two key questions: "What new information will this give us?" and "Will it change what we are doing?" After talking to the doctor, they declined the M.R.I.
古洛一家人转了院。他们的女儿现在已经长到五岁，有轻度脑瘫，视力和进食也有小问题，仍需特别护理。但最近，当医生建议为格雷丝进行一次需要全身麻醉的核磁共振成像扫描时，古洛女士和她的伴侣凯蒂·英格拉姆(Katie Ingram)问了两个关键的问题：“这会给我们提供什么新的信息？”以及“我们现在的做法会因此而改变吗？”和医生谈过之后，她们拒绝了核磁共振成像扫描。
"Not every mystery has to be solved, and not every problem has to be addressed," Ms. Gullo said. "That's hard to get your brain around."
“不是所有的谜底都必须揭晓，也不是所有问题都得考虑到，”古洛女士指出：“想明白这一点并不容易。”