原文: 41 Secrets Your Doctor Would Never Share

Those free medication samples may not be the best -- or safest.

                                                      By Cynthia Dermody & Patricia Curtis

If You Only Knew ...

Reader's Digest offered two dozen doctors a chance to tell it like it really is, and general practitioners, surgeons, shrinks, pediatricians, and other specialists took the challenge. Some wanted to be anonymous; some didn't care. But all of them revealed funny, frightening, and downright shocking things that can help you be a better, smarter patient.

We're Impatient

• I am utterly tired of being your mother. Every time I see you, I have to say the obligatory "You need to lose some weight." But you swear you "don't eat anything" or "the weight just doesn't come off," and the subject is dropped. Then you come in here complaining about your knees hurting, your back is killing you, your feet ache, and you can't breathe when you walk up half a flight of stairs. So I'm supposed to hold your hand and talk you into backing away from that box of Twinkies. Boy, do I get tired of repeating the stuff most patients just don't listen to.

--Cardiologist, Brooklyn, New York

                                     

                                                                        PHOTOGRAPHED BY DAN WINTERS

"Hospitals want physicians to send patients home faster, so some doctors are given bonuses for getting their patients out of the hospital quickly."

• I was told in school to put a patient in a gown when he isn't listening or cooperating. It casts him in a position of subservience.

--Chiropractor, Atlanta

Thank you for bringing in a sample of your (stool, urine, etc.) from home. I'll put it in my personal collection of things that really gross me out.

--Douglas Farrago, MD, editor, Placebo Journal

• One of the things that bug me is people who leave their cell phones on. I'm running on a very tight schedule, and I want to spend as much time with patients as I possibly can. Use that time to get the information and the process you need. Please don't answer the cell.

--James Dillard, MD, pain specialist, New York City

stop relying on me to bail them out of their own problems.

--ER physician, Colorado Springs, Colorado

• I wish patients would take more responsibility for their own health and

• So let me get this straight: You want a referral to three specialists, an MRI, the medication you saw on TV, and an extra hour for this visit. Gotcha. Do you want fries with that?

--Douglas Farrago, MD

• I used to have my secretary page me after I had spent five minutes in the room with a difficult or overly chatty patient. Then I'd run out, saying, "Oh, I have an emergency."

--Oncologist, Santa Cruz, California

• Many patients assume that female physicians are nurses or therapists. I can't tell you how often I've introduced myself as Dr. M. and then been called a nurse, therapist, or aide and asked to fetch coffee or perform other similar tasks. I have great respect for our nurses and other ancillary personnel and the work they do, but this doesn't seem to happen to my male colleagues.

--Physical medicine and rehabilitation doctor, Royal Oak, Michigan

• The most unsettling thing for a physician is when the patient doesn't trust you or believe you.

--Obstetrician-gynecologist, New York City

• It really bugs me when people come to the ER for fairly trivial things that could be dealt with at home.

--ER physician, Colorado Springs, Colorado

• Your doctor generally knows more than a website. I have patients with whom I spend enormous amounts of time, explaining things and coming up with a treatment strategy. Then I get e-mails a few days later, saying they were looking at this website that says something completely different and wacky, and they want to do that. To which I want to say (but I don't), "So why don't you get the website to take over your care?"

--James Dillard, MD

• I know that Reader's Digest recommends bringing in a complete list of all your symptoms, but every time you do, it only reinforces my desire to quit this profession.

--Douglas Farrago, MD

Pills, Pills, Pills

• Sometimes it's easier for a doctor to write a prescription for a medicine than to explain why the patient doesn't need it.

--Cardiologist, Bangor, Maine

• Those so-called free medication samples of the newest and most expensive drugs may not be the best or safest.

--Internist, Philadelphia

• Taking psychiatric drugs affects your insurability. If you take Prozac, it may be harder and more expensive for you to get life insurance, health insurance, or long-term-care insurance.

--Daniel Amen, MD, psychiatrist, Newport Beach, California

• Ninety-four percent of doctors take gifts from drug companies, even though research has shown that these gifts bias our clinical decision making.

--Internist, Rochester, Minnesota

Bills, Bills, Bills

• Doctors respond to market forces. If the reimbursement system is fee-for-service, that results in more services. If you build a new CT scan, someone will use it, even though having a procedure you don't need is never a good thing.

--Family physician, Washington, D.C.

--Douglas Farrago, MD

• I really do know why you're bringing your husband and three kids, all of

whom are also sick, with you today. No, they are not getting free care.

• Doctors get paid each time they visit their patients in the hospital, so if you're there for seven days rather than five, they can bill for seven visits. The hospital often gets paid only for the diagnosis code, whether you're in there for two days or ten.

--Evan S. Levine, MD

• Twenty years ago, when I started my practice, my ear, nose, and throat procedures financially supported my facial plastic surgery practice. Today, my cosmetic practice is the only thing that allows me to continue to do ear, nose, and throat procedures, which barely cover my overhead.

--Ear, nose, throat, and facial plastic surgeon, Dallas/Fort Worth

Free Advice

• Avoid Friday afternoon surgery. The day after surgery is when most problems happen. If the next day is Saturday, you're flying by yourself without a safety net, because the units are understaffed and ERs are overwhelmed because doctors' offices are closed.

--Heart surgeon, New York City

• In many hospitals, the length of the white coat is related to the length of training. Medical students wear the shortest coats.

--Pediatrician, Baltimore

• Often the biggest names, the department chairmen, are not the best clinicians, because they spend most of their time being administrators. They no longer primarily focus on taking care of patients.

--Heart surgeon, New York City

The Darker Side

• It saddens me that my lifelong enjoyment and enthusiasm for medicine has all but died. I have watched reimbursement shrink, while overhead has more than doubled. I've been forced to take on more patients. I work 12- to 14-hour days and come in on weekends. It's still the most amazing job in the world, but I am exhausted all the time.

--Vance Harris, MD, family physician, Redding, California

• In many ways, doctors are held to an unrealistic standard. We are never, ever allowed to make a mistake. I don't know anybody who can live that way.

--James Dillard, MD

• Not a day goes by when I don't think about the potential for being sued. It makes me give patients a lot of unnecessary tests that are potentially harmful, just so I don't miss an injury or problem that comes back to haunt me in the form of a lawsuit.

--ER physician, Colorado Springs, Colorado

• Doctors often make patients wait while they listen to sales pitches from drug reps.

--Cardiologist, Bangor, Maine

• It's pretty common for doctors to talk about their patients and make judgments, particularly about their appearance.

--Family physician, Washington, D.C.

• Everyone thinks all doctors know one another. But when we refer you to specialists, we often have no idea who those people are. Generally, we only know that they accept your insurance plan.

--Pediatrician, Hartsdale, New York

• In most branches of medicine, we deal more commonly with old people. So we become much more enthusiastic when a young person comes along. We have more in common with and are more attracted to him or her. Doctors have a limited amount of time, so the younger and more attractive you are, the more likely you are to get more of our time.

--Family physician, Washington, D.C.

• Plan for a time when the bulk of your medical care will come from less committed doctors willing to work for much lower wages. Plan for a very impersonal and rushed visit during which the true nature of your problems will probably never be addressed and issues just under the surface will never be uncovered.

• At least a third of what doctors decide is fairly arbitrary.

--Heart surgeon, New York City

• Doctors are only interested in whether they are inconvenienced -- most don't care if you have to wait for them.

--Family physician, Washington, D.C.

The Sensitive Side

• When a parent asks me what the cause of her child's fever could be, I just say it's probably a virus. If I told the truth and ran through the long list of all the other possible causes, including cancer, you'd never stop crying. It's just too overwhelming.

--Pediatrician, Hartsdale, New York

• Most of us haven't been to see our own physicians in five years.

--Physical medicine specialist, Royal Oak, Michigan

• When a doctor tells you to lose 15 to 20 pounds, what he really means is you need to lose 50.

--Tamara Merritt, DO, family physician, Brewster, Washington

• If a sick patient comes to me with a really sad story and asks for a discount, I take care of him or her for no charge.

--Surgeon, Dallas/Fort Worth

• Though we don't cry in front of you, we sometimes do cry about your situation at home.

--Pediatrician, Chicago

Shocking Stats

60% of doctors don't follow hand-washing guidelines.

Source: CDC Morbidity and Mortality Weekly Report

96% of doctors agree they should report impaired or incompetent colleagues or those who make serious mistakes, but ...

46% of them admit to having turned a blind eye at least once.

Source: Annals of Internal Medicine

94% of doctors have accepted some kind of freebie from a drug company.

Source: New England Journal of Medicine

44% of doctors admit they're overweight.

Source: Nutrition & Food Science; Minnesota Medicine

58% would give adolescents contraceptives without parental consent.

Source: New England Journal of Medicine

Anatomy of a Doctor's Bill

Just how much of the $100 your doctor charges for taking 30 minutes to investigate your stomach pain goes into his pocket? After paying the bills, he gets less than half. The breakdown, according to Robert Lowes, senior editor at Medical Economics:

$3.50 for malpractice insurance

$3.50 for equipment, repairs, and maintenance

$6 for supplies, including gowns, tongue depressors, and copy paper

$7 for rent and utilities

$11 for office expenses, such as telephones, accounting fees, advertising, medical journals, licenses, and taxes

$28 for secretary, office manager, and medical assistant salaries and benefits

$41 Amount that goes into the doctor's paycheck

Over the course of a year, that adds up to $155,000, the annual salary of the average family physician. That number rose just 3.3% between 2002 and 2006, while expenses increased nearly 25% over the same period.

From Reader's Digest - July 2008

译文: 41个医生绝不会与你分享的小秘密

那些无偿的药物样品也许不是最好的——或者最安全的

Cynthia Dermody和 Patricia Curtis供稿

如果你只知道……

读者文摘为24位医生提供了一次告诉大家真相的机会，包括普通医生、外科医生、精神病医生、儿科医师和其他专家人士也都应邀参加。一部分希望匿名出现，一部分对此毫不介意。但他们都细数了有趣的、令人恐惧的以及触目惊心的事实，助你成为一个更机智、聪明的病人。

我们显得太不耐烦了

·作为你的母亲我已经彻底厌倦了，每次我看到你，我不得不说“你实在是需要减肥了”。但你发誓你已经“没有吃任何东西”或者“体重就是降不下来”，这个话题也就此打住了。然后你过来这里开始抱怨你膝盖受伤了，你的后背又很难受，你脚也疼，甚至当你上楼时才跨了半步就感觉不能呼吸。所以我建议你举起手，让你的后背远离Twinkies的箱子。孩子，我真的已经厌倦了不停地重复说这些病人根本就听不进去的话。

——纽约布鲁克林的心脏病专家

 

DAN WINTERS摄影

 “院方希望医生把病人更快地送回家，所以那些能让病人迅速离开医院的医生是有奖金的。”

·学校里我学到的是如果病人不听话或者不合作，就让他穿上大袍子。这对他反而是有益的。

——亚特兰大的按摩疗法医生

很感谢你把你的（大、小便等）样品从家带过来。我会把他们放在事实上令我讨厌的个人收藏里。

——Placebo杂志的编辑、医学博士Douglas Farrago

·还有一件困扰我的事就是人们总是开着他们的手机。我的时间安排很紧张，我需要和病人尽可能花足够时间沟通。利用那段时间你掌握情况和整个过程。所以请不要在这个时候接电话。

——纽约的一个头痛的专家，医学博士James Dillard

·但愿我的病人能对他们自己的健康负起更多的责任，并不要再依赖我去帮他们解决他们自己的问题。

——科罗拉多斯普林斯市的急救医生

·所以让我来把这个弄清楚：你需要三方面专家的指导，一份核磁共振成像，你在电视上看的药物治疗和一个小时像这样的见面。我把你难住了吧，来份薯条么？

——医学博士Douglas Farrago

·我过去常常在和一位比较难缠或比较健谈的病人在房间里呆了5分钟后让我的秘书叫我一下，然后我就边跑出去边说：“哦，我有个急诊。”

——加利福尼亚州圣克鲁斯的肿瘤学家

·很多病人都觉得女医生就是护士或者临床医生。我都没法告诉你我有多少次在介绍我自己是M.医生的时候被认为是护士、临床医生或者助手，并让我去拿杯咖啡或去做一些其他类似这方面的事。我很尊敬我们的护士和助手以及他们所做的工作，但我之前说的那种情况似乎并不会发生在我男同事的身上。

——密歇根皇家橡树的物理治疗和康复医师

·对医生来说最不安的就是病人不信任你。

——纽约的妇产科医生

·有件事很困扰我，那就是人们会因为完全可以在家里就能处理的小事而被送来急诊。

——科罗拉多斯普林斯市的急诊医生

·你的医生比网络还是知道的多一点的。我有一个病人，我花了大量的时间给他解释一些事情，并已经到了治疗的阶段。几天后我收到一封电子邮件，说他们看了一个网站，说了些和我诊断的截然不同并甚至有些荒谬的话，并且他们还打算就照那么做。对此我想说（但我不能）：“为什么你们不直接让网络给你治病呢？”

——医学博士James Dillard

·我知道读者文摘建议能把医院的所有特征都列举出来，但每次你这么做了，就只会坚定我想退出这行的想法。

——医学博士Douglas Farrago

药，药，药

·有时候对医生来说，开一个处方要比向病人解释为什么不需要某种药来的简单。

——缅因州班戈市的心脏病专家

·那些所谓的最新、最贵的药的免费试用品不一定是最好和最安全的。

——费城的内科医师

·服用精神治疗的药物会影响你上的保险。如果你服用三环抗抑郁剂，那你获得人寿保险、健康保险或长期医疗保险时会变得更为困难和支付得更多。

——加利福尼亚新港口海岸的精神病专家、医学博士Daniel Amen

·94%的医生从医药公司获利，即使研究显示这些利益流向了我们的临床决策。

——明尼苏达州罗切斯特的内科医生

账单，账单，账单

·医生对市场力量作出回应。如果偿还体系是服务性收费，那就会导致更多的服务项目出现。即使你不需要检查某些项目但你也做了一次全新的CT扫描，这并不是件好事。

——华盛顿的家庭医生

·我确实清楚今天你为什么带着你丈夫和三个孩子一起过来，而他们也都病了。但是我只能说不，他们不能得到免费的治疗。

——医学博士Douglas Farrago

·医生在医院看一次他的病人都会有钱拿，所以如果你住院7天而不是5天，他们就能得到7次看你的钱。如果你在医院住上2天或10天，医院只需要根据诊断号收钱。

——医学博士Evan S. Levine

·20年前，当我开始实习时，我做的耳鼻喉方面的手术财政上支撑了我在面部整型外科的实习。今天，我的面部化妆经验是唯一能让我继续做耳鼻喉方面手术的事了，这方面的手术勉强应付我的开支。

——达拉斯、福特和沃斯一带的耳鼻喉及面部整型外科医生

一些建议

·尽量避免在周五下午做手术。手术后那天大部分问题都会暴露，如果后面那天是周六，你就失去了保障职能自力更生，因为医院医生都不上班了，所以人手不足，急救力度也弱了。

——纽约的心脏外科医生

·在很多家医院，白大褂的长度是和医生的经验相对应的。实习医生穿的是最短的衣服。

——巴尔的摩的儿科医师

·通常那些大名鼎鼎的人物、部门主管都不是最好的临床医生，因为他们花了大量的时间成为主管。他们将不再重点关注如何照顾病人。

——纽约心脏外科医生

黑暗面

·我很伤心我对医疗事业终身的热爱已经逝去了。当日常的付出超过双倍的时候，我看到过退缩。我被迫治疗更多的病人，我一天工作12至14个小时直到周末才休息。这仍然是世界上最了不起的工作，但我始终疲惫不堪。

——加利福尼亚州Redding的家庭医生、医学博士Vance Harris

·医生用很多方法去坚持一个不切实际的标准。我们从来不这样，任何时候都可以犯点小错。我不知道还有谁也是那样的。

——医学博士James Dillard

·一天下来，我总是在想着会不会有可能被起诉。这让我给病人做很多根本就没有必要甚至有可能有害的测试，只是为了让我不会漏掉任何病症或者那些会回过头来以法律诉讼的形式纠缠我的问题。

——科罗拉多斯普林斯市的急诊医生

·医生通常会听那些推销药品的介绍而让病人等着。

——缅因州班戈的心脏病专家

·医生谈论他们的病人，并作一些评价，尤其是对他们的穿着打扮议论纷纷是极其普通的。

——华盛顿的家庭医生

·大家都以为所有的医生对彼此都很熟悉，但当我们把你介绍给专家的时候，我们通常都不知道那都是些什么人。总的来说，我们只知道他们能接受你的保险计划。

——纽约Hartsdale的儿科医师

·在医学的大部分分支里，我们和那几个人老打交道。所以在一个新的病人来的时候我们会更为热情。我们更喜欢他（或者她），和他们也更有共同语言。医生的时间是有限的，所以你越年轻，越有吸引力，你就越有可能占用我们更多的时间。

——华盛顿的家庭医生

·一个不尽职的医生，他工作是为了更低的收入，当他给你做大量的药物治疗的时候，你需要做一个时间上的计划。当你的问题的实质很可能并没有被查出来，而是被表面现象所覆盖并不会被发现的话你就需要计划好一次客观而又迅速的看医生。

——医学博士Vance Harris

·至少三分之一的医生所作的决定相当武断。

——纽约的心脏外科医生

·医生只关心那些是否对他们造成不便的事——大部分都不会关心你是不是在等着他们。

——华盛顿的家庭医生

敏感边缘

·当一位家长问我她孩子发烧的原因可能是什么时，我只是说可能是病毒引起的。如果我告诉她真相并列举一个长长的单子包括所有其他可能的原因，包括癌症，那你一定会很伤心。这也太让人无法接受了。

——一位纽约州哈茨代尔的儿科医师

·我们中绝大多数在五年内都不曾看过我们的私人医生。

——密歇根皇家橡树的医药学专家

·当医生告诉你需要减15至20磅的时候，他实际上是说你需要减50磅。

——一位华盛顿布鲁斯特的正骨疗法家庭医生Tamara Merritt

·如果一个病人来找我，并告诉我一个确实很动容的故事然后要求能有优惠，我会免费照顾他或她。

——达拉斯、福特和沃斯一带的一位外科医生

·虽然我们不会在你面前哭，但我们回到家后确实会为你的处境哭泣。

——一位芝加哥的儿科医生

令人震惊的统计数据

60%的医生并不遵守洗手的规定。

资料来源：CDC(即Centers for Disease Control：全美位于亚特兰大的疾病控制中心)患病和死亡率周报

96%的医生觉得他们应该指出他们同事中不太合格的或者能力不强的或者那些犯了严重错误的，但是……

他们中46%承认他们至少一次对此视而不见。

资料来源：内科学纪事

94%的医生曾接受来自医药公司的一些免费赠品。

资料来源：新英格兰医学杂志

44%的医生承认他们超重。

资料来源：营养和食品科学；明尼苏达医学网

58%的医生未经父母同意给青少年避孕用具。

资料来源：新英格兰医学杂志

一张医生所开账单的解析

你看胃疼看了30分钟，花了100美元，这里头到底有多少进了医生的口袋？在付完这笔帐后，他其实得到的不到一半。这是由医学经济的高级编辑Robert Lowes提供的明细：

3.5美元支付医疗事故保险

3.5美元是设备的维修和保养

6美元是他所提供的东西，其中包括长袍、压舌头的压板和复印纸张

7美元是租金和水电费

11美元是用来支付办公费用的，像电话、核算费、广告、医学杂志、营业执照以及税

28美元用来支付秘书、办公管理人员以及医疗助理的薪水和福利的

41美元就是医生的薪水了

在一年间，那就已经涨到了155,000美元，是一位家庭医生的平均年薪。那个数据在2002年至2006年间涨幅仅为3.3%，而在同段时期内开支的涨幅接近25%。

摘自2008年7月的读者文摘