好英语网美国医生压力过大行医效率低下
The patient, a powerfully built middle-aged restaurant worker, had awakened one morning with a tight pain in his shoulders that traveled down his right arm. At work, he could barely shrug his shoulders or turn his head. "My fingers were so weak," he recalled, "that I couldn't even get a good grip around a glass of water."
这位病人在餐馆工作，是个身材魁梧的中年人。一天早上他被疼醒了，疼痛从肩部放射到右臂。工作时，他几乎无法耸肩或扭头。“我的手指没力气，”他回忆道，“连杯水也抓不牢。”
A senior doctor at a local clinic diagnosed a pinched nerve and prescribed a muscle relaxant. Two weeks later, only more incapacitated, the patient went to another clinic, where a younger doctor made the right diagnosis: A malignant tumor in his chest was pressing against a nerve to his arm.
当地诊所的一位资深医生诊断他是神经受压，为他开了肌肉松弛剂。两周后，无力感更强了，病人去了另一家诊所，得到了一位较年轻医生的确诊：他胸腔里的恶性肿瘤压迫了他手臂上的神经。
"That first doctor couldn't be bothered by what I was trying to say," the patient said. He was now receiving chemotherapy and was hopeful his cancer had been caught early enough, but the near miss still haunted him. "He acted like he just didn't want to be there with me. Or with any patient."
“第一位医生很不耐烦，都不想听听我想要说什么，”这位病人说。他正在接受化疗，希望自己的癌症发现得够早，但那次漏诊依然让他不安，“他表现得好像他不想多搭理我。不想搭理任何病人。”
After reading a study published this week in Archives of Internal Medicine, I've been thinking a lot about this patient's experience. And I've come to two conclusions. First, the older doctor had classic symptoms of burnout.
读完本周发表在《内科学文献》(Archives of Internal Medicine)上的一篇研究后，我对这位病人的遭遇想了很多。我得出了两个结论。首先，这位年长医生有着典型的倦怠症状。
Second, mistakes like his may only become more common.
其次，类似他的这种失误会变得越来越普遍。
Research over the last 10 years has shown that burnout - the particular constellation of emotional exhaustion, detachment and a low sense of accomplishment - is widespread among medical students and doctors-in-training. Nearly half of these aspiring doctors end up becoming burned out over the course of their schooling, quickly losing their sense of empathy for others and succumbing to unprofessional behavior like lying and cheating.
最近10年的调查表明，倦怠——特别是情绪耗竭(emotional exhaustion)、冷漠、成就感低这一系列表现——在医学生和实习医生中普遍存在。这些胸怀抱负的医生中，有近一半在求学过程中陷入倦怠，迅速丧失了对他人的同情心，屈从于说谎与欺骗等有违职业的行为。
Now, in what is the first study of burnout among fully trained doctors from a wide range of specialties, it appears that the young are not the only ones who are vulnerable. Doctors who have been practicing anywhere from a year to several decades are just as susceptible to becoming burned out as students and trainees. And the implications of their burnout -- unlike that of their younger counterparts, who are often under supervision -- may be more devastating and immediate.
如今，研究者对大量不同专业正式医生进行了第一次关于倦怠的调查，结果表明受影响的不仅是年轻一代。与医学生及实习生一样，所有地方的执业医生，从工作一年到几十年的，都可能出现倦怠。而他们发生倦怠产生的影响与受到监管的年轻人不同，往往更具破坏性也更直接。
Analyzing questionnaires sent to more than 7,000 doctors, researchers found that almost half complained of being emotionally exhausted, feeling detached from their patients and work or suffering from a low sense of accomplishment. The researchers then compared the doctors' responses with those of nearly 3,500 people working in other fields and found that even after adjusting for variables like gender, age, number of hours worked and amount of education, the doctors were still more likely to suffer from burnout.
研究人员向超过7000名医生发出了分析问卷，发现近一半抱怨情绪耗竭，对病人和工作环境感觉冷漠，成就感低。研究人员还比较了医生与其他领域的近3500人的反应，发现在调整了如性别、年龄、工作时间和教育程度等变量后，医生依然是更容易发生倦怠的。
"We're not talking about a few individuals who are disorganized or not functioning well under pressure; we're talking about one out of every two doctors who have already survived rigorous training," said Dr. Tait D. Shanafelt, the lead author of the study and a professor of medicine at the Mayo Clinic in Rochester, Minn. "These numbers speak to bigger problems in the larger health care environment."
“我们在这里所说的，不是一些人面对压力会变得行为涣散，或者没法正常工作；我们要指出的是，每两个已经熬过了严格培训的医生中就有一人出现了这些情绪问题，”泰特·D·沙那非博士(Dr. Tait D. Shanafelt)是本次调查的主要作者，也是明尼苏达州罗切斯特市(Rochester)梅奥医疗中心(Mayo Clinic)的内科教授，他说：“这些数字说明，在越大型的医疗环境中，问题也越大。”
The doctors' burnout appeared to have little to do with hours worked or even the ability to balance personal life with work. Instead, the only factor predictive of a higher risk was practicing a specialty that offered front-line access to care. More than half of the doctors in family medicine, emergency medicine and general internal medicine experienced some form of burnout.
医生的倦怠似乎与工作时间、甚至工作与个人生活的平衡能力无关。相反，唯一预示高风险的因素是提供一线医疗保健专业服务。家庭医生、急诊室医生和普通内科医生中，超过一半经历过某种形式的倦怠。
The study casts a grim light on what it is like to practice medicine in the current health care system. A significant proportion of doctors feel trapped, thwarted by the limited time they are allowed to spend with patients, stymied by the ever-changing rules set by insurers and other payers on what they can prescribe or offer as treatment and frustrated by the fact that any gains in efficiency offered by electronic medical records are so soon offset by numerous, newly devised administrative tasks that must also be completed on the computer.
这项研究为当今医疗保健系统中的行医状况蒙上了一层阴霾。有相当数量的医生感到陷入困境，他们能够给予病人的时间之少令人挫败，保险公司或其他支付者关于他们能够给予什么药物或治疗的条例不断变化在妨碍他们工作，电子医疗记录带来的效率提升很快又被无数新衍生的必须在电脑上完成的行政任务所抵消，这同样让他们感到沮丧。
In this setting, "doctors are losing their inspiration," Dr. Shanafelt said, "and that is a very frightening thing."
在这种情况下，“医生失去了动力。”沙那非博士说，“这是一件非常可怕的事。”
What patients must face in the examining room is no less alarming. Doctors who are suffering from burnout are more prone to errors, less empathetic and more likely to treat patients like diagnoses or objects. They are also more likely to quit practicing altogether, a trend that has serious repercussions in a system already facing a severe doctor shortage as it attempts to expand coverage to 30 million or more currently uninsured Americans.
病人在诊室中的遭遇依然令人忧虑。倦怠的医生更容易出现失误，更没同情心，更倾向于把病人仅当作诊断的对象。他们也更容易放弃执业，这一趋势对已经面临严重医生短缺的医疗系统产生了负面的影响，此系统正试图覆盖超过3000万目前尚无医疗保险的美国人。
"Doctors are coming to this expansion already pretty stretched and stressed out," Dr. Shanafelt noted. "I don't think there is going to be a lot of room to maneuver without some significant structural changes."
“医生们承受了重压，弦已经绷得满满的了，”沙那非博士强调说，“如果没有重大的结构性变化，我不认为还有什么回旋余地。”
Dr. Shanafelt and his colleagues are in the midst of studying the effects of workplace initiatives aimed at providing greater support for doctors while improving efficiency, which they believe is critical for doctors and patients as well as the large health care organizations that aim to serve us all. Without decreasing the total hours worked or the number of patients a doctor must see, a hospital system might, for example, restructure its clinics so that doctors could spend more time with patients and less time on the phone getting authorization from insurers or in front of a computer completing administrative tasks.
沙那非博士及其团队正在研究为医生提供更多支持提高效率的工作举措是否有效，他们相信这对于医生、病人、以及向我们提供服务的大型医疗保健机构来说，都一样非常重要。医院系统或许不能减少医生的工作时间或接诊病人数量，但可以做其他改变，比如对诊所的机制予以调整，从而令医生可以有更多时间与病人接触，而把较少的时间花在打电话获得保险公司授权，或趴在电脑前处理行政任务上。
"If people work in an environment where they believe there is meaning, they will put up with a lot," Dr. Shanafelt observed. "It goes beyond the significant personal consequences for an individual physician. It affects whom patients can see when they are sick, the quality of care they receive and their safety."
“如果人们能在他们觉得有意义的环境中工作，他们会甘愿忍耐。”沙那非博士观察认为：“这个问题远不仅仅是个别医生的遭遇。它会影响到病人生病时看到什么样的医生、接受什么质量的服务，以及他们的安全感。”