1月18日,《健康报》和近日中央电视台都几次报道了天津第三中心医院(以下简称“天津三院”)实行“病人选择医生”一事,引起社会广泛关注,此项改革大大调动了该院职工的积极性,明显地提高了服务质量,受到了广大患者的好评。不但使该院走出了困境,也给改革裹足不前的其他医疗单位带来了希望,受到了启示。笔者读后受益匪浅,拟谈几点学习体会。 1 自主选择医生,是还病人择医权,贯彻医疗机构改革要“以病人为中心”的重要内容 多年来,患病就医,病人只有选择医院的权利,而没有选择医生的权利。病人一经把自己交给了医院,由谁诊治,只能听候医院安排;怎样诊治,只能听候医生处置。这似乎是天经地义的事。问其原因就在于医患之间存在着对医学知识的不对称性、患者对医疗需求的不可替代性,由此便产生了医疗机构与医生对医疗技术的垄断性等原因所致。正因为如此,医疗服务通常都是在医生的指导或诱导下进行。这样,病人选择医生的权利便被剥夺了。其实,这是医疗机构独占的一种特殊职业权利。笔者认为,长期以来医疗机构实行技术垄断就是靠这种特殊职业权利机制支撑的,医患之间这种不平等的人际关系就是源于这种特殊职业权利机制。这样一种机制必然使医务人员少有压力,医疗机构也缺乏活力。 On January 18, the “Health News” and CCTV recently reported on several occasions that the Third Central Hospital in Tianjin (hereinafter referred to as “Tianjin Sanyuan”) implemented the “patient selection of doctors” issue, which has aroused widespread concern in the society and greatly spurred the reform. The enthusiasm of the hospital staff significantly improved the quality of service and was well received by the majority of patients. Not only did the hospital get out of its predicament, but it also brought hope to other health care units that were deterred from reforms and was inspired. After reading the article, I benefited a lot and I would like to talk about some learning experiences. 1 Self-selecting doctors is an option for patients to choose the right to choose a doctor, and to implement the reform of medical institutions to be patient-centered. For many years, the doctor had been ill and had the right to choose a hospital instead of a doctor. Once the patient has given himself to the hospital, he will only be able to attend hospitals for treatment; he will only be allowed to dispose of the patient. This seems to be a matter of righteousness and righteousness. The reason for this is that there is an asymmetry in medical knowledge between doctors and patients, and the irreplaceability of patients’ medical needs, which has resulted in medical institutions and doctors’ monopoly on medical technology. Because of this, medical services are usually conducted under the guidance or induction of doctors. In this way, the patient’s right to choose a doctor is denied. In fact, this is a special occupational right monopolized by medical institutions. The author believes that the long-term implementation of technical monopolies in medical institutions is supported by this special professional rights mechanism. This unequal interpersonal relationship between doctors and patients is derived from this special occupational rights mechanism. Such a mechanism will inevitably put pressure on medical personnel and the lack of vitality of medical institutions.