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First, Do No Harm.--(2)爾愛其洋,我愛其理。
2010/09/02 03:48:30瀏覽3900|回應8|推薦29
First, Do No Harm. (1) --- 哲人已遠,典型常在。
First, Do No Harm. (2) --- 爾愛其洋,我愛其理。
First, Do No Harm. (3) --- 寧無寸功,勿貽尺害。

Hippocrates 被尊為臨床醫學的鼻祖,是因為他最早。最早開辦醫院,(其運作已基本上與今日大同小異),最早開辦生徒傳習所,(也就是醫學院),最早編寫講義(也就是教科書),和最早制定行規(醫師法)。

他的教科書叫做Hippocratic Corpus,這個拉丁字 Corpus意為“體”、“本體、主體”,中文一般譯作希氏醫書。

First, Do No Harm 是Hippocrates最常被引用的一句。雖然文獻考證指向,這部書該是集體創作,歷代增補集成,假托祖師爺是借光,并非他親筆。但黃帝的指南車、嫘祖的養蠶,到底誰發明?考據都出現爭議。顧頡剛古史辯說大禹是條蟲,錢穆考證孫子兵法孫武就是孫臏,所以是同一本,然后長沙馬王堆墓出土,孫武兵法和孫臏兵法兩本都赫然在列。道教號稱黃老,但與黃帝和李耳都是高攀,基督教舊約的摩西五經咬定是摩西寫的,但寫寫寫,寫到最后出現他過世和死后的情節!。。。。日本人說大和民族氏出天照大神,而天皇萬世一系,實則彩色氣球,不堪一考,。。如果推說這些是遠古,一切從寬,模糊處理,那么就近代舉例:Harvard校園里有一尊坐像(In front of University Hall),銅像號稱是創校(Founder)的Mr. John Harvard,這像卻成了有名的「三謊銅像(The Statue of Three Lies)」:第一,Mr. John Harvard不是創校人,他捐地捐書有功,但創校無份,第二,受雇雕塑的法國藝術家1884年塑本像,因為不識兩百多年前作古的哈佛本尊真顏,只好隨便找了個帥哥照貓畫虎湊數,第三,銅像底座鏤刻創校時間1638也是錯的。......。哈佛銅像是假的,但據傳摸到他的皮鞋可以考運亨通金榜題名,所以四方游客到此一游,都要跳起來“摸一個”,尤其是那些剛收到准考證的,像祭孔之后搶拔智慧毛,銅像的鞋頭被摸得賊亮,說明游客才不管三個或300個謊話!

對嘴假唱是假的,百鳥還朝是真的,托祖借光容或是假的,字字珠璣總是真的。Hippocrates雖號稱是西醫的鼻祖,但這個尊號其實有條件,他的醫學生平是初代臨床的雛形,時間和扁鵲淳于意近,但比華佗張仲景早。他最大的成就是建立了一個即使2000年后來檢討都毫不落伍的系統,一個不卑不亢的行醫心態與內造思想。這個思想體系,有的望文生義翻譯成是醫德,有的截取他醫師誓詞的片紙隻字大跑野馬(例如看維基寫評論的王爾德),我認為不妨翻譯成「行規」:

首先,無論中西,行醫這一行都是危險的行當,社會地位都不高。韓愈【師說】:「巫醫百工之人,士大夫恥之」,很能說明郎中的下九流地位。生病是痛苦的事,也是倒霉的事,請醫生好比進當鋪,滿肚子野火還要跟大朝奉砍價,既看不起又離不開。流血冒膿呼天搶地,任何擦碰都可以無限放大,雖說本質是服務業,這哪是單純的買賣?發生糾紛是無可避免的事。杜月笙說:政治人物拿我們(白相人/流氓)當夜壺。尿急的時候非我們不可,用完了嫌我們臭。杜的話我聽了心虛,老疑心他也在說醫生和當鋪。

用辯證法對服務業作屬性分析:其買賣雙方必須靠制衡來對價,若對service不滿,就拒付,想賺錢就好好辦事,但看病例外,因為雙方的專業差距太懸殊,聽任一方獨攬,無法制衡,于是東方發展出道德制約(醫德),而西方發展出刑罰制約(訴訟)。對醫生的管控只剩下道德(仁心仁術,良醫良相!)和輿論,說明這事嚴重不對等的無奈,總之,沖突糾紛的關鍵在期望差距過大,醫生只能盡其在我,病人卻指望奇跡康復,醫生只是人,無意裝大,但病患在期待神,匿其怨而友其人、恭維溢美不斷卻心里不平衡,等到水落石出放了炮,當然亂棒伺候,一頓好打, (yichun按:就像守株待兔等部落格貼新文,匿其怨而友其人,等得牙癢癢而莫可奈何,一旦有人喊打立刻起哄。)

Hippocrates其人思想清楚,非常實際,對醫學的行規也恩威并用,剛柔并濟,他的作法,和吾國處理不同。吾國士大夫對「巫醫百工之人」的約制以抽象的醫德來進行,基本上是高高舉起,狠狠打下。但Hippocrates所代表的西方則另走一路,自始低姿勢,低調內斂,給臨床醫學這個是非不斷的行業,創造了長期穩定性。

Hippocratic Corpus從文學上也是典型的希臘式,犀利簡潔。如果替古希臘文學找一個代表字,我選Laconism。像Diogenes,亞歷山大來隆中訪賢,他不假辭色,要他一邊涼快,別擋了陽光,老子曬太陽。如果Diogenes是一針見血,那么Hippocrates是刀切豆腐。下面收錄他最常被引用的名句,我以林南琴譯法試擬如下:

A physician without a knowledge of Astrology has no right to call himself a physician.
不知道占星術,怎么當大夫?

(yichun按:Hippocrates當然知道占星術是胡說八道,但看病本來就是與虎謀皮的事,不入虎穴,焉得虎子?病人既然相信鬼畫符,就假意應酬,換取信任。。。參看西門豹模式

A wise man should consider that health is the greatest of human blessings, and learn how by his own thought to derive benefit from his illnesses.
智者應將健康一事看作造化的恩賜,化危機為轉機。

Cure sometimes, treat often, comfort always.
(我們作醫生)極少能夠治好,多半只是醫治,永遠都要安撫。

Everything in excess is opposed to nature.
物極必反,過猶不及,允當是尚!(再好的事,過量都是禍害。)

Extreme remedies are very appropriate for extreme diseases.
七年之病,需三年之艾。(治重病,要下猛藥)

Healing in a matter of time, but it is sometimes also a matter of opportunity.
藥醫不死病,佛渡有緣人。
謀事在人,成事在天,盡其在我,不可強求。

If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.
潔食適量,四體勤健,則百病不侵。

It is more important to know what sort of person has a disease than to know what sort of disease a person has.
觀人尋病,寧如依病求人?

(這個比較深,我們有空再講。)

沒有下文?反正已經望斷頸,死豬不怕滾水燙)

 
http://strangene.com/landmarks/3lies.htm

《三謊之像》---看鞋頭賊亮

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2014/09/25 18:14 【udn】 購買前先比價!彩色 智慧 老中 生病比價

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烏拉瑰本尊在此
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士農工商
2011/11/20 13:42
那個病人要殺的是好醫生, 因醫生不願繼續開narcotics.  符合您最後那句。

臨床病人林林總總, 總覺老中病人最不尊敬醫者, 尤其是所謂高學歷者,比醫生還懂, 卻又最相信道聽途說,或是網絡消息,廣告之類的。 不看也罷。士農工商,醫生在中國職業中不知排行老幾?

yichun
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行醫從來是危險的行當
2011/08/21 22:17

Man stabs doctor to death after brother dies at hospital

Last updated: 8/18/2011 8:00

Police in the northern province of Thai Binh have pressed murder charges against a man who allegedly fatally stabbed a doctor and injured another after his brother was pronounced dead at a local hospital.

Nguyen Van Dung, 18, is being detained while the police are still investigating his motive for the killing. At around 11 p.m. on Monday (August 15), Dung, his mother and several relatives brought his 20-year-old brother, Nguyen Van Hung, to the Vu Thu District General Hospital.  Hung was reported to be in critical condition. Dr. Pham Duc Giau, 60, and a male nurse were on duty. Dr. Nguyen Ngo Hoan, 30, was assigned to the emergency room to assist Giau.  According to Hoan, who was injured but has been recovering, the patient was rushed to emergency room with his limbs cold, lips turning purple and hardly breathing.“Doctors soon could not measure his blood pressure or feel his pulse,” Hoan said. “His blood circulation had stopped.”........(1)
yichun(meimei3) 於 2011-08-21 22:21 回覆:
According to a nurse on duty, Dung had repeatedly yelled at the doctors, threatening to kill them if they could not save his brother.  The doctors called the police and two police officers and a militiaman were sent to the hospital to keep order.  Hung, however, died after more than one hour of treatment.  After Hung's family was informed of the news, three doctors and a nurse invited Hung's mother and relatives into a room and explained the cause of his death.  Dung suddenly entered the room, pulled a knife, and stabbed Hoan in the stomach. Hoan narrowly escaped death.  When the relatives held Dung, another doctor and a nurse managed to run away. Giau could not escape after Dung struggled out of the relatives’ arms and stabbed Giau in the chest.  Giau died on the spot. Dung fled the scene quickly, according to police.  Dung jumped on a xe om (motorbike taxi) and hid in a rented apartment but was arrested at around 7:30 a.m. on Tuesday.

The police said they are still investigating the conduct of the doctors on duty to see if they were acting slowly after the patient was rushed to the emergency room, which may have led to Dung’s rampage.

Tran Quy Tuong, who led a team of officers from the Health Ministry to the Vu Thu District Hospital to investigate the case, told the Tuoi Tre (Youth) newspaper that the officers did not find any wrongdoings by the doctors during their treatment process.  Colonel Tran Xuan Tuyet, chief of the Thai Binh Province Police Department, told Tuoi Tre Dung had demanded that the doctors save his brother immediately and kicked the post with hanging infusion cords.  Giau had required him to get out of the emergency room, Tuyet said.  After Hung was confirmed dead, the doctors prevented Dung from touching the dead body and invited the family to another room, he added.

A forensic test by the Vu Thu District Hospital showed Hung died from reflux syndrome - in which food flows back into the gullet and obstructs the respiratory system.

By Thuc Quyen, Thanh Nien News (The story can be found in the August 19th issue of our print edition, Thanh Nien Weekly)

程小豚
希伯克拉底行醫之道的啟示之1:醫病之間首重溝通
2010/09/10 00:24

希伯克拉底認為醫病之間最重要的是信任,由於病人信賴醫師的專業,因此會認為醫師所做的任何治療或檢查,一定是有必要的。也因此,醫師不該濫用病人對他的信賴而做一些沒有效用的治療。相反地,應該耐心聆聽病人對於病痛的敘述、仔細探問病史、用心做好各項身體檢查、留心病人身體所透露的各種變化與訊息、瞭解病人與家屬的想法和需求,這才是醫病溝通的真諦。


程小豚
希伯克拉底行醫之道的啟示之2:高科技設備的迷思
2010/09/10 00:14

對高科技設備的迷思最主要來自於無知,因為高估了各種檢查的效果,相信高科技是萬能的,因此醫生與病人都喜歡做一些不必要的檢查,例如:抽血、照X光片、電腦斷層或磁振造影等高科技檢查,造成大量醫療資源浪費的狀況。

醫師只關心醫學檢查的數據結果,卻忽略仔細了解病人身體狀況的重要,這種倒果為因的方式,會嚴重誤導醫師的診斷,對病人並無任何助益。因此,希伯克拉底告訴我們:「病人」比「檢查結果」重要、「聆聽病人與仔細做身體檢查」是無法以其他任何「科學」所取代的。


程小豚
希伯克拉底行醫之道的啟示之3:醫師存在的〝意義〞
2010/09/10 00:07

Cure sometimes, treat often, comfort always.」是否可以詮釋為:醫師對病人最大的影響不一定是他的專業技術,而是他的「存在」。有些病人雖然知道自己的病情很嚴重,但卻可以因為醫師對他的關心和照顧,讓病人感到被重視、被關懷,醫師所釋放出的善意與熱忱,讓病人感受到心靈上的撫慰與滿足,而讓疾病好轉或是有起色。所以醫師的存在跟「安慰劑」的效用有異曲同工之妙?!


程小豚
希伯克拉底行醫之道的啟示之4:病人是醫療工作的主體
2010/09/10 00:01

醫病關係是平等的、同行的,並不是上對下的權威關係(例如:老大VS小的之關係),但因為醫病之間專業差距懸殊、權力關係不對等、傳統權威地位不容挑戰的影響,使得醫病之間形成無法跨越的鴻溝,病人也會對醫師產生超乎現實的期待,或是要求醫師做一些其實是沒有必要的用藥或治療。

因此希伯克拉底告訴我們:病人才是醫療工作的中心、要重視醫病之間的溝通與連結、病人的身體與心理兩方面同等重要。


程小豚
希伯克拉底行醫之道的啟示之5:醫師面對生死的身心調適
2010/09/09 23:58

醫學科技再發達,終究還是有極限。醫師每日面臨大量急病的發生與死亡的衝擊,在這樣高壓的工作情境中,醫師如何調適生死議題、如何面對束手無策的挫折感、如何接納自己醫療技術的不足?…

希伯克拉底說:「First, Do No Harm」,醫師最重要的就是絕對不要傷害到病人,但萬一遇到會傷害自己的狀況時,身為濟世救人的醫師該如何自救??

(這個比較深,我們有空再講。)

yichun(meimei3) 於 2010-09-10 00:57 回覆:

別說了,早點睡吧。

Sleeping is man's scond to the best medicine.
再睡早起,百病不侵。


sas
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冲突纠纷
2010/09/06 02:49

但写文例外,因为雙方的専業差距太悬殊,聼任一方独揽,无法制衡。对作家的管控只剩下文德和舆論,说明这事严重不對等的无奈,总之,冲突纠纷的闗健在期望差距濄大,作家只能儘其在我,看客卻指望奇文叠出。

匿其名而跑其座,等得牙癢癢而莫可奈何,一旦有龍蝦挑頭呛声,“铿锵掄棍起舞”,立刻四方响應,揭棍而起。

yichun(meimei3) 於 2010-09-06 06:26 回覆:
掄棍每多屠蝦輩,負心最是熟眼人。