Artu Gwende is a double professor at Harvard Medical School and School of Public Health, the youngest health policy adviser in the White House, and the only doctor on Time magazine's 20 10 list of "100 most influential people". Gwende is good at telling stories around her with careful observation and vivid brushstrokes. These stories reveal the mystery of the medical industry for us and help us understand what doctors think and how doctors do it.
By the end of 20 18, the four books published by Ge Wende, such as Doctor's Cultivation, Doctor's Diligence, List Revolution and Best Farewell, all had versions of "Listen to this book every day". What is particularly worth mentioning here is the book "The Practice of Doctors". Doctor's Cultivation and Doctor's Diligence were published for five years. In the book "The Cultivation of Doctors", Gwender recorded how he grew from a novice doctor to a skilled doctor. In the doctor's diligence, as a skilled doctor, Gwender is still constantly looking for ways to improve. It can be said that the content change from "cultivation" to "diligence" also reflects the spiritual development process of Ge Wende himself as a doctor from seeking "benevolence" to seeking "benevolence".
Ok, let's go straight to explore another medical industry brought by Gwende. Let's look at the core characteristics of doctor's "benevolence" from three angles: diligence, correctness and innovation.
first part
First of all, let's look at the first characteristic that doctors should have to be "diligent", diligence. Does diligence make doctors take the hospital as their home, take less rest and work more? That's not what I meant. Diligence here means that even in details, doctors should continue to be careful.
For example. Polio, also known as polio, is a highly contagious disease with very serious consequences. Now the disease has disappeared in most countries, but occasionally it will resurface in some corner of the world.
Gwende told us about the polio epidemic in Karnataka, southern India in 2003. Karnataka is poor, the local immunity is poor, and children are completely immune to polio. So once a child gets sick, polio can easily spread from there to the whole of India. In order to avoid this situation, the World Health Organization plans to vaccinate 4.2 million children door-to-door with more than 40,000 people, 2,000 vehicles and 1.8 million incubators to ensure that polio will not be prevalent.
From these figures, you will know that this is obviously a big project. But even for such a big project, the details should be implemented in the end. For example, they should work out a detailed plan, and then convey it layer by layer, and allocate materials and medical staff in place. Vaccinators must go to more than 500 villages with poor traffic conditions in person to persuade those illiterate and wary villagers to vaccinate their children. As for many details in this process, such as how to send the vaccine to various places, where to find a car to send the vaccine, how to solve the problem of cold storage of the vaccine, and how to determine the number of people vaccinated in each area, every detail must be put in place.
Besides, do you know how long it will take them to finish this task? Only three days. It's incredible to vaccinate 4.2 million children in three days. But they did it. We don't know how hard they worked, but we can imagine that they must have been on the road for three days, thirsty for explanation and working day and night. They can accomplish this arduous task through the extreme diligence that Gwende said.
However, the "mopping up" of polio led by the World Health Organization is somewhat different from the daily work of doctors. The "Great Sacrifice Sweep" is soul-stirring, and those who participated in it can also be inspired by their dedication and heroism. But more often, doctors actually can't get these mental stimuli. In every laboratory with lights on late at night, in front of every comatose patient's bed, in every bloody rescue scene, doctors are actually doing the same work as yesterday, the day before yesterday, a year ago, or even ten years ago. In this case of continuous lack of stimulation, doctors will also feel bored and slack. In this case, Gwende's "diligence" is also a good medicine to solve the problem.
Yes, you heard me right. Even if medicine is so developed now, it is often not the cutting-edge medical discoveries but the details that ultimately determine whether patients can recover as soon as possible. Small things like "washing your hands".
You might say, isn't it just washing your hands? What can't I do? Children in kindergarten know to wash their hands before and after meals. But what I want to tell you is that it's not that simple. At that time, an Austrian doctor asked doctors and nurses to wash their hands and disinfect before entering the operating room. As a result, such a small regulation has reduced the maternal mortality rate caused by puerperal fever from 20% to 1%. Because of the importance of hand washing and disinfection, doctors and nurses who have not washed their hands are absolutely not allowed to enter the operating room now.
But what if you don't go into the operating room, but only into the outpatient clinic and ward? The result may surprise you. In clinics and wards, less than13 medical staff can actually wash their hands according to regulations. Doctors also have their reasons: "I have been examining patients all day, treating wounds and writing medical records, and I have no time to wash my hands!" " If I wash my hands according to the regulations, I don't have to do anything else! "The doctor doesn't know the harm of not washing your hands? Definitely not. They know better than anyone that many patients in the hospital are infected with deadly bacteria because they don't wash their hands. But they just feel that they have no time or need to wash their hands.
Is there any way for the hospital to deal with this problem? You may not think that there is a department in the hospital that is responsible for controlling nosocomial infections. This department is generally called "Hospital Infection Department" in domestic hospitals, that is, "Hospital Infection Management Department". One of the most important duties of the hospital sensory department is to urge medical staff to wash their hands. In order to make doctors and nurses wash their hands well, hospitals are trying to find ways. In Gwende's hospital, the staff worked hard on the details. For example, installing more hand-washing pools, supplying more convenient hand-washing gels, and publishing the hand-washing situation of various departments on the website, but the effect is not obvious.
Later, some hospitals realized that people usually pay more attention to their own opinions and care less about the opinions instilled in them by others. Therefore, hospitals organize doctors, nurses and even patients to discuss how to solve the problem of hospital infection. This situation is completely different. In this way, everyone felt that their opinions were taken seriously and began to become very positive. For example, take the initiative to put the hand-washing gel in the right place, take the initiative to remind colleagues to wash their hands, and consciously put on gloves before seeing a doctor. One year after the reform, the infection rate of a deadly bacterium in this hospital finally dropped to zero.
When people encounter difficulties, they always hope to have a solution once and for all, and hope that all problems can be solved completely at once. But in medicine, it is really difficult for people to find other ways to wash their hands technically. In the case that medical science is not so easy to make revolutionary progress, in order to help patients better, doctors must do more details, wash their hands more diligently, have a more kind attitude, ask detailed questions and so on. This is like a rocket. If you want to finally launch successfully, you must tighten every seemingly insignificant screw.
In fact, not only doctors, but everyone who does things has the difference between diligence and laziness, carefulness and carelessness. For example, in Japan, it takes 50 years to study how to make a good bowl of rice, and there are also "sushi gods" who spend their lives studying how to make a good bowl of sushi. The core feature of the "artisan spirit" that we often mention now is the diligence and intention that Gwende said here.
Here, I would like to introduce the first characteristic that doctors need to be diligent, diligence. We can see that the diligence of doctors plays an important role in the final medical results, whether in public health events such as mass vaccination or in seemingly insignificant details such as hand washing.
the second part
Let's look at the second trait that doctors need to be diligent. The Chinese translation is "integrity" and the English word is "doing right". Actually, it is more appropriate to translate it as "doing the right thing". So how to define the word "correct"? 1+ 1=2 is mathematically correct, which is definitely indisputable. But not everything in this world is black and white. In those gray areas where different people have different opinions, doctors need to make correct choices and judgments.
In Gwender's view, the first judgment that doctors need to face is related to morality. When you hear this, you may say, I don't know what moral correctness is. But for doctors, moral judgment is sometimes not so easy. Let me give you some examples.
If you are a doctor, will you let a third person join you when you examine a patient's private parts? Don't think this question is puzzling. Some doctors feel that they must find a third person to avoid trouble in the future; Some doctors feel that they have a clear conscience and it is completely unnecessary; Other doctors are easygoing, and they do whatever the patients say. For example, if you are a doctor, will you execute prisoners? In this regard, some doctors feel that their duty is to heal the wounded and rescue the dying, and the execution of the death penalty is not in line with their professional ethics; Some doctors think that I haven't sentenced the prisoner to death anyway, so I'd better do it myself and don't let those unprofessional people do it, so as to minimize the pain of the prisoner's death. Let me ask you one more question. If you are a young doctor who has just worked for a few years, and your family is old and young, will you risk going home and quarreling with your family to make up for the medical expenses when you meet those poor patients? Or can we just make up our minds to get out of destruction?
You may also find that in many cases, the boundary of the word "correct" is actually difficult to determine, but doctors must make a "correct" choice between professional ethics and social needs. How to choose a doctor at this time actually depends largely on your own value orientation. This moral "correctness" is actually "having a clear conscience".
After talking about moral correctness, let's talk about the second judgment that doctors often face. This is a big problem. That is, when a doctor encounters a medical dispute, what kind of treatment is correct.
Generally, everyone thinks that it is good to have a good attitude first, apologize to the patient first, and then compensate. But what if the doctor really didn't make a mistake Or did the doctor make a mistake, but he was afraid to tell the truth to the patient for fear of being sued or losing money? You may have said. In that case, let's go to court and file a lawsuit. But is it really the fairest solution to resort to law? In Gwender's view, people's achievements in medical litigation are not satisfactory. Because medical litigation often takes a long time, wastes manpower and financial resources, and constantly disputes over trifles, putting both doctors and patients on opposite sides, patients rarely get substantial help in the end. For example, in the United States, too much medical compensation has been cheated by people who shouldn't get compensation, and only about 1% of patients who should get compensation actually get compensation. The rest of the patients usually can't even hear an apology.
In godwin's view, the medical compensation system in the United States is so bad that it must be reformed. So how to reform? Gwende first talked about the vaccine compensation system in the United States. In the United States, the cost of each vaccine includes a surcharge of 0.75 cents. The government used this money to set up a fund to compensate children damaged by the vaccine. When making compensation, people don't need to spend energy to identify which damages are caused by doctors' mistakes and which are caused by bad luck. As long as the damage meets the type on the "list of vaccine side effects", patients can get compensation.
However, although medical disputes are complicated, they are less encountered after all. For doctors, what they usually encounter is how to make the right choice between "continuing treatment" and "giving up patients". This is the third judgment that doctors often have to face.
You may be a little confused. Saving lives is the bounden duty of doctors. Isn't it that doctors will continue to save lives as long as patients have a glimmer of hope? Indeed, in most cases, doctors think so and do the same. And the doctor's persistence has indeed brought many miracles. For example, a long time ago, people used to think that babies born more than two months premature could not survive at all. But later, because of the doctor's perseverance and careful care, most of those babies survived. There are still many patients whose lives are dying, full of tubes, and they have crossed the gate of hell under the full treatment of doctors.
But the professionalism of doctors eager to save lives often brings them accusations. Some people say that doctors are wasting valuable medical resources at all costs In the United States, 1/4 of the medical resources are spent on patients who live less than six months, which could have been used to help more patients with less serious diseases. But this is precisely the difficult choice that doctors have to face. They are not gods, there is no way to accurately judge how long a person can live, and they don't know whether the medical miracle will happen to their patients in the next second.
Many people think that the line between what doctors can and cannot do is simple and clear. But in fact, the most difficult thing for doctors is to understand where the boundary of "enough" is. What is the right thing to do? What's the best way to do it? Nobody told them the answer. Perhaps the simplest rule for doctors is to do your best and not give up easily. At least it will prevent doctors from making the worst mistake, that is, giving up patients who could have been treated.
Ok, let me sum up the second trait that doctors need, to be diligent and do the right thing for you. This requirement is not as simple as it sounds at first glance. In the complicated medical process, doctors should not only have a clear conscience, but also seek a better way to solve medical disputes and make the right choice between saving and not saving. The moral standards of the medical profession are not always correct, and so are the practices of the outside world. Sometimes there is an essential contradiction between showing professional skills, obeying laws and respecting morality, and sometimes there is confusion. Ge Wende said that he once thought that the biggest difficulty for doctors was technology, but after practicing medicine, he found that the most difficult thing for doctors was actually "knowing where the limits of their abilities are and what they can't control." Perhaps most of the time, what doctors can do is just "do their best and resign themselves to fate".
the third part
Next, let's talk about the third characteristic that doctors should have to be diligent, innovation.
When it comes to medical innovation, the first thing you think of may be spotless laboratories, lovely and poor mice, and various cells cultured in bottles. It seems that innovation exists only in the laboratory. But we all ignore the fact that doctors who are busy in the ward all day are also an important force for innovation. Moreover, compared with those laboratory studies that have invested hundreds of millions of dollars, some seemingly insignificant small creations made by doctors in daily medical care can make more direct and significant contributions to the treatment of patients.
Apgar newborn scale, which is still widely used in obstetrics, is a typical representative of this innovation. This scale was invented by an American anesthesiologist named Virginia apgar in 1953. Why did an anesthesiologist do this neonatal grading scale? This is because apgar often anesthetizes pregnant women, and she also likes to see newborns come into this world. However, at that time, many babies who were born in poor health or even a little blue and had abnormal breathing were regarded as "stillbirths" by obstetricians and gynecologists, leaving them to fend for themselves. Apgar thinks this is unreasonable, but as an anesthesiologist, she can't directly challenge the authority of obstetricians and gynecologists. Therefore, she adopted a less direct but more effective method to design this scale.
Apgar scale is surprisingly simple, based on the newborn's body color, breathing, heart rate, limb movement and response to stimulation, and it is very easy to use. But surprisingly, this simple scale has achieved amazing results. It not only makes the newborn's condition get more objective evaluation, but also makes doctors pay more attention to their baby's condition in order to get higher scores. They will take more care of babies who were originally regarded as "stillbirths". After that, almost all hospitals in the world used Apgar scale to evaluate infants. It was soon found that even if the baby's performance at 1 minute after birth was poor, the performance would become very good after 5 minutes through oxygen inhalation and warmth. Therefore, hospitals have set up neonatal intensive care units. Not only that, doctors also found that compared with general anesthesia, local anesthesia, such as spinal anesthesia and epidural anesthesia, gave birth to a higher score of infants. Therefore, the anesthesia mode of maternal delivery has also begun to attract attention.
It is such a seemingly insignificant small area, but it has successfully saved the lives of countless children and brought revolutionary influence to the whole obstetrics. Correspondingly, people invest huge amounts of money in basic scientific research every year, but few achievements can be translated into clinical practice. Ge Wende feels that small innovations in the clinical front line are actually easier to get huge returns than laboratory research such as gene decoding, stem cell therapy and cancer vaccine.
Taking breast cancer as an example, the US government and private foundations spend nearly $654.38+billion every year to research new treatments for breast cancer. However, few people think that the mortality rate of breast cancer can be reduced by improving the comfort and convenience of mammography 1/3. Because if the X-ray examination of breast is comfortable and convenient enough, it will be easier for women to insist on annual examination, and breast cancer can be found and treated as soon as possible.
Gwende has such an understanding of the great potential value of clinical innovation because he found that in many parts of the world, the best hope to save people's lives is innovation adapted to local conditions, not any biological or genetic research.
For example, after completing surgical training, Gwende once visited India where his ancestral home was located as a visiting doctor. He has a sense of superiority, thinking that he is a first-class trained doctor in the United States and can certainly give guidance to doctors in India. But he soon discovered that when there were no advanced instruments and equipment and patients were crowded in front of him, it was the ugly Indian doctors who were better at saving lives. Here, a doctor created a surgical method to repair gastrointestinal perforation with a cheap second-hand laparoscope. This operation has the advantages of small incision, short operation time, few complications and quick recovery. The exquisiteness of this operation is enough to make well-equipped American doctors stunned.
Also in this hospital, when a child with severe hydrocephalus came to see a doctor, doctors used hemostatic forceps in their hands to grind a hole in the child's skull without the necessary drainage tube and skull drill, and then put the trimmed and disinfected cottage drainage tube in, saving the child's life.
These stories make us sad, but they also let us know that no matter where we are, no matter what the environment, as long as we have the original spirit and strong willingness to try, every doctor may find truly valuable innovations. Doctors should never pin all their hopes on luxurious medical equipment, nor should they attribute their helplessness to environmental embarrassment or the stagnation of medical research. The method of saving lives is not only the result of advanced equipment and laboratories, but also those seemingly ordinary innovations, which should be seized when solving every specific problem.
This is the third quality of doctor's diligence mentioned in this book, innovation. In this part, Gwende emphasizes not the remarkable scientific revolution in the laboratory, but the meticulous innovation and creation of the diagnosis and treatment process by the clinical frontline doctors. Compared with expensive basic research, this seemingly insignificant innovation of clinicians is often easier to get rich returns.
Doctor's Diligence In this book, Gwende tells us that medical skill is not only technology, but also the soul. An experienced doctor does not mean that he is an excellent doctor. A doctor's "progress" from specialty to Excellence depends not on the improvement of specialty and technology, but on the sublimation from "benevolence" to "benevolence". The doctor's "benevolence" needs to include three important qualities: diligence, correctness and innovation. Specifically, "diligence" means being willing to work hard and being persistent, earnest and meticulous in working attitude; "Correctness" includes moral conscience, seeking a better solution to medical disputes and making a correct choice between saving and not saving; And "innovation" emphasizes the down-to-earth and concrete improvement of doctors in daily medical treatment.
At the end of the book, Gwender also raised a question, that is, how can a person become more valuable and different in his own industry? He shared several suggestions, two of which I think are particularly good, which can not only help doctors, but also help you in other industries to make your mark in your peers faster.
One suggestion is to be diligent in statistics. It doesn't matter what the statistics are, as long as you find some points of interest and stick to the statistics, you may get unexpected gains. For example, Gwende has counted how many doctors will leave things like gauze in patients after surgery. Later, according to the statistical results, Gwender and his colleagues designed an automatic monitoring device for gauze.
In my opinion, the purpose of Gwende encouraging people to do statistics is actually to keep people focused and observe their own fields. Long-term concentration and observation often lead people to find some small problems that are often overlooked. For example, Amazon has made a round of reforms to improve the speed of logistics. Once, their packaging process was like this: for example, a customer ordered a book and a bottle of wine, and two sorters went to different categories of shelves to look for it. But if it takes an hour to find books and three hours to find wine, it will take at least three hours to complete the goods. This is too time-consuming.
Then how did they solve this problem later? It is to count a lot of sales data and put those things that customers often buy on the nearest shelf. The sorter can pack the most orders in the shortest time, and the speed is improved at once. You see, innovation doesn't need to be earth-shattering. Even small problems, if you can find and solve them, you can reshape the whole system.
Another piece of advice mentioned by Gwende is to be diligent in writing. Writing is not all a writer's business. There is no need to write a complete article every time. Record what you see and think at work, whether it is writing a few paragraphs on your blog, writing stories or poems, or contributing to academic journals. Writing can make people get out of daily chores and think deeply about their own problems. More importantly, we can share our inner feelings with readers through our own words. No matter how big or small this readership is, we may gain a sense of identity from their affirmation and support, and see a wider world from refutation or criticism. Maybe you have written a lot. You can re-recognize your career and establish a high-dimensional cognition of your career through constant observation and summary, just like Gwende.