今晚Grame给我发来邮件,他把他自己的来看病、手术的详细旅程、手术后的康复等,非常细致地做了表达。他一再告诉我,他从开始被延误手术而带来的痛苦和不方便,然后接受手术,也在手术前感到紧张,到手术后感到比预想地要好很多,又逐渐的康复,一直到现在仅仅是10周时间,他真正感受到手术带给他的成功和喜悦。他写得很直白,很坦诚,我也希望他对我们的工作提出建议。我对他的特别印象是:我每次去看他时,他总在看书。在他的病床旁都是书。他实在太nice!a sheer gentleman! 我也是没有改动一个字,原封不动放入网上。希望能给同样的患者带来手术的信心!——专业成就一切!
一位澳大利亚外籍患者术后家人的来信患者,Grame是一位澳大利亚的男士,非常的优雅。他爱好运动、爱好看书。但这几年他的髋关节出了问题,——股骨头坏死,实在影响他的行走,不要说是运动。对他来说打击很大。他爱人找到了我,采纳了我手术的建议。手术后1个多月,她就常常告诉我,她爱人恢复地实在太好,——到处跑。我能体会到她的心情。我说,您把您真实的看病过程写下来,让更多的患者能理解或感受到:患了关节病(股骨头坏死、强直性脊柱炎引起的髋关节僵直坏死、类风湿性关节炎等),如果保守治疗无效,专业的关节外科医生能用最新的技术,使您脱离痛苦,重新恢复有尊严、有快乐、有幸福的生活。她的来信如下(我没有改动一个字,并告诉她要放到好大夫网上):我老公于今年3月去徐医生那里去就医。去的时候我们并不知道我老公得的是股骨头坏死,因为他右腿根疼痛已经3年多,每次去不同的医院都告诉我们是关节炎、或者有的说是肌肉拉伤,包括泰国的医院也是这么说。但是我老公几乎不能行走,疼痛难忍。于是我们做了一些比较询问的工作,而最终我们去了上海长海医院的徐医生那里。言归正传,当徐医生告诉我们是股骨头坏死的时候,我们真的是心都沉下去了,因为我老公年纪大了还得过心梗,手术难度会比较大。但是通过和徐医生详细的面谈,我们大概知道手术的过程和风险程度,徐医生真的给了我们很大的安全感!手术是4月2号做的。我不得不说我被长海医院徐医生和他的整个科室的认真的态度,对病人的奉献精神震倒了。手术前医生们做了所有必需的检查,以把手术风险降到最低,并对我们做了详细的解释,以让我们对手术过程有充分的了解。麻醉师也对我们做了详细的关于全麻和半麻的优缺点的讲解,以选最好的方案。手术进行了不到1个小时,然后在手术室监护4个小时后,我老公安全地被推出了手术室,回到了病房,一切安然无恙!手术后2个星期,我老公开始用助行器走路,然后开始在家里不用助行器走路,然后居然开始走路上班了,还开助动车!现在居然能搬小家具了!现在距手术只有6个星期!我老公没有再感到右腿疼痛,生活质量比以前好多了!我们实在太感激徐医生,谢谢你了!The Flying FoxIrish Gastro Pub225 Hong Feng Road,Jinqiao Pudong,Shanghai 201206Tel: + 86 21 5030 9807 Fax:+ 86 21 5030 9817
To: Director ChenFr: Peter BiblerRe: Chinese and American Hospital and Surgery – Similarities and DifferencesDate: Dec 2014This memorandum introduces significant features of hospital procedures, costs, and services, comparing both U.S. and Chinese hospitals. NOTE: Its scope is limited to that of patients undergoing orthopedic surgery and the services provided the surgeon, attending physicians, and nursing staff. It does not address general hospital procedures.I. Costs: Currently, the average cost of a total hip arthroplasty or hip replacement (“THR”) in Shanghai is $15,000. This amount includes:1) the initial consultation (anywhere from $4-$30) with the surgeon who examines the patient to assess her mobility, range of motion, pain level, etc;2) an X-ray ($10) or an MRI bone scan ($30), if necessary, as prescribed by the surgeon;3) further consultation ($4-$30) after the surgeon gathers all the medical reports;4) hospitalization (price may vary by length of stay and services required);5) the hip implant(price may vary depending on type selected);6) medicine, medical supplies, tests before and after surgery, nursing care, etc.As a Chinese citizen contributing more than 10 years into the social insurance program in Shanghai, social insurance covered approximately $5570 of the total cost.In the U.S., the cost of surgery is pretty high. One consultation with a physician is about $100. but the average is $2550 for an MRI[1] and $2400 for a CT[2] scan of the pelvis area. the cost of a THR varies widely by location, hospital and availability of insurance among other factors. In 2011, there were 645,000 total knee replacements and 307,000 total hip replacements in the U.S. Those totals are both up about 30% from 2006, according to the latest data from the American Academy of Orthopedic Surgeons. According to an informal study published in the Washington Post, more than 100 U.S. hospitals, both ranked and unranked, were contacted and asked what the total cost (including hospital and doctor fees for the surgeon, anesthesiologist, physician assistants, etc.) for a THR would be for an uninsured senior. Prices ranged from just over $11,000 to more than $125,000.[3] According to one Blue Cross Blue Shield office, one of the largest insurance providers, THR costs on average about $39,000.[4] Healthcare Bluebook.com, an organization that educates consumers on fair prices for medical procedures states that a fair price for a THR is approximately $22,533. This price includes the hospital stay (4 days at $1800/day), the hip implant ($8,000), $2,650 for physician services, and $1,211 for anesthesia.[5] Prices will vary depending on whether a patient has health insurance. And actual out-of-pocket costs will depend on the type of insurance that patient has. Most insurance plans require the patient to pay a deductible before the insurance will cover the medical costs. Deductibles can range anywhere from a few hundred dollars to several thousand. After the deductible is paid, insurance coverage ranges anywhere from 80% to 100% depending on the specific plan. For example, senior citizens would be eligible for government-funded Medicare, which requires only approximately $1,000 as a deductible, but thereafter, all medical procedures are paid in full by Medicare.II. Time/Procedure: Insurance requirements, referrals to specialists, timeline for x-rays, CT scans, blood lab results, etc.Our experience in Shanghai was very smooth, and the whole procedure was fast. The time period between initial consultation and surgery was less than two weeks. Having had the hip condition for several years, the patient had already prepared several reports and X-rays to provide the surgeon at the initial consultation. Generally speaking, it takes a patient fewer than 1-7 days to get the first appointment with the surgeon, depending on the doctor’s prestige and the number of patients waiting to see him. Doctor Xu wei dong is nationally famous for THR, and patients come from all China’s provinces to see him, yet it only requires 7 days on average for an appointment. The X-ray can take place the same day, while an MRI might require an appointment several days later. After the doctor concludes that the patient requires surgery, then the patient waits for the hospital to inform her when to check into the hospital. Our experience was 7 days. Of course, if we had requested a two-person room, we might have waited longer. Overall, the process lasted 2-3 weeks.In the United States, for a non-emergency surgery, time is also determined by the patient’s insurance. If the patient has no insurance or the surgeon is outside that patient’s coverage, the patient will bear all costs and may contact the surgeon directly for appointment. If the patient has Preferred Provider Organization (PPO)[6] insurance and the surgeon is within the covered network, the patient may contact the surgeon directly. If, however, the patient has Health Maintenance Organization (HMO) insurance, the patient is first required to obtain a referral by her primary physician. In this situation, the patient must first make an appointment to meet with her primary care physician and report her problem. Her physician will provide the patient with a list of recommended specialists for her problem, and she then must call to make an appointment with the specialist. Waiting times for non-emergency appointments with doctors and surgeons vary by locality, but in a recent survey of metropolitan areas, patients waited to meet with their primary physician for as long as 66 days in Boston to as quick as 5 days in Dallas. For appointments with an orthopedic surgeon, the average wait ranged from 5 to 18 days. Chinese patients do not have primary care physicians, and in most cases, even for non-emergency care, Chinese patients go directly to the hospital to see a physician or specialist. Thus, waiting periods for initial consultation is a matter of hours, not days or weeks.In the U.S, Physicians and surgeons may be employed by a hospital, but frequently, they have private offices and clinics (as of 2012, only 8% of orthopedic surgeons were employed by US hospitals). When a US patient visits her primary care physician, her doctor normally has no personal facilities for testing. The doctor will refer the patient to visit a nearby hospital or private lab for MRIs, blood analysis, etc., and these reports will be sent directly to her doctor. Wait times vary widely for non-emergency MRI and CT scans, but the average is $2550 for an MRI[7] and $2400 for a CT[8] scan of the pelvis area. Blood laboratory analyses normally do not require appointments and results are sent directly to the patient’s doctor. In my personal experience, I would visit a local laboratory the same day I saw my doctor, but waited a month to meet with him to discuss the results. Orthopedic surgeons who have clinics may have their own imagine technology, but even they normally refer patients elsewhere for blood analysis.For example, my younger brother required surgery after he injured his knee at work. He contacted the surgeon’s private office directly, and the surgeon’s physician assistant scheduled an MRI test within the week. The MRI was $2800. His knee surgery did not require any implant; nevertheless, the total cost was approximately $10,000. This was an outpatient surgery at the surgeon’s clinic; no hospital stay was required. The entire process from the first call to the surgeon to surgery took a little more than 2 months. Fortunately, his insurance covered 100% of all costs with no deductible. Of course, the time of his case is not through his primary physician. If add the time of appointment with primary physician(averagely 7-14 days) and the recommendation to the surgeon(7-14days), the whole process might take almost 3 months.III. Quality of ServiceIt is difficult to generalize about the quality of service for medical care in the United States, given the diversity of facilities available (public and private hospitals, public and private clinics, private offices of physicians or specialists) as well as the diversity of communities (metropolitan, urban, rural) which generate challenges unique to each. Generally, patients report that they experience friendlier and more efficient non-emergency services in small, private clinics or doctors’ offices than in hospitals, and in private hospitals than public hospitals. And to compare and contrast the quality of health and hospital services with their Chinese counterparts would undoubtedly lead to unfair comparisons and spurious conclusions. Nonetheless, some comparisons may be useful.Changhai hospital is one of the best large-scale hospital in shanghai area. It consists of 57 departments, 535 physicians and surgeons, 2100 beds for hospitalization. In 2013,the hospital welcomed above 3,000,000 patients, completed 46900 surgeries. There is no such hospital of the similar capacity.Changhai Hospital in Shanghai offers 2-person rooms, 3-persons, and 6-person rooms. Given our urgent timeframe, we stayed in the 6-person room. While it is inevitable that a 6-person room is not nearly as comfortable as a smaller room, the larger rooms do have the advantage of providing the patients and their families with a small community for communication and support which helps to reduce stress in anticipation of surgery.The services provided by Changhai’s doctors, nurses and hospital staff were high-quality. Every morning, patients’ temperatures are recorded. If a test is ordered (e.g. a blood test), a nurse will perform the test in the early morning. After breakfast, a team of nurses led by the head nurse visits all rooms, checks each patient, and receives a summary report from the night nurses. Soon after, the surgeon and his attending physicians conduct their rounds to follow up with their patients. This provided patients and the doctors an opportunity to learn of patient’s status (fever, blood pressure, pain, etc.). It is as the situation in U.S. What is different is that the surgeon and his team also conduct rounds at the end of the day. Sometimes our surgeon Doctor Xu had a whole day of surgeries, after he finished, even it was already 7 or 8pm, he still came to the room to see all his patients. We were so touched by that.Each patient has a lead nurse responsible for the patient’s care during the hospital stay, and doctors from surgeon’s team to consult with during the day. After business hours, a night doctor and nurse are always available should a patient need care. Personally, we found the hospital staff always courteous and professional at all hours of the day and night.We found Changhai Hospital’s medical staff system to be a little different from other Shanghai hospitals. Patients are not encouraged to hire personal caretakers (e.g. you cannot hire one in daytime). Instead, all patients share several medical workers assigned to that floor. For the most part, we found this more practical (and similar to US hospital services) than other Shanghai hospitals where you can hire your own medical worker. Whenever the patient has a need, she can ring the bell, and a medical worker will appear. We did not experience any inconvenience, and in fact, benefited from reduced cost of hiring a personal caretaker.During our stay at Changhai Hospital, we received excellent service, and the doctors and nurses were always kind and gracious as well as professional even under such a demanding environment.A. Communication – Content and ConsistencyIn non-emergency U.S. cases, orthopedic surgeons meet with their patients 1-2 times prior to surgery. The initial consultation could be anywhere from 10 minutes to more than an hour. Subsequent appointments would be made to discuss the results of laboratory and imaging reports. The surgeons often will provide a pamphlet (a sample is attached) so the patient knows what to expect before, during and after the surgery and how to prepare.Given the overwhelming number of patients the Chinese surgeon faces during the patient intake process, such one-on-one consultation is near impossible. Patients and their families usually squeeze into the office giving the examined patient no privacy or time to ask the doctor questions. Cases vary of course, and doctors in their own discretion may attend to the patient’s questions regardless of the queue. In a hospital setting, the situation is inevitably quicker: blood tests, X-rays, CT scans, etc. are usually performed over the course of 24 hours. Surgeons naturally have little time to explain the results and patients have even less time to absorb the information and to formulate questions.To help manage the expectations of the patient, it may be useful to provide the patient and her family a simple pamphlet after the initial doctor’s visit or upon admittance to the hospital. This pamphlet can explain the pre-surgery preparation and necessary testing as well as what to expect on the day of surgery: anesthesia, pain and pain management. Thus, in the stage while the patients and their family signed the papers, they can easily ask questions about whatever they are eager to know. The more they know about the surgery, the more they get psychosocially prepared, the less risk it would be for the hospital if a risk happened.The patient primarily communicates with the nursing staff and the surgeon’s attending physicians rather than the surgeon himself. This is only natural, but it does present a potential problem: inconsistent information or instructions. For example, the question how many days after surgery can the patient stand and walk. Sometimes the patient was instructed by one of the attending physicians or nurse with the normal guide in most cases. However there might be some special issues that a general rule doesn’t apply to that patient which only known by the surgeon. If the patients got different instructions from attending physicians and nurses from the surgeon, this type of experience made them less confident in the attending physicians and more dependent on the surgeon for basic information (which creates unnecessary demand on the surgeon’s time and energy).To ensure the consistency of information to the patient, in the US, e.g., these days each patient has an electronic file in which doctors and nurses write notes (or hand-written in the past) that include doctor instructions such as when the patient can walk, when to start to eat as well as nurse reports on the patient’s experiences, such as pain or fever, as well as the medicines given. For example, if the patient reported fever or pain in the middle of the night and was treated by the nurse, the attending physician would know of it easily the following morning by reading the report.B. Control of Patient DataAnother aspect pertaining to communication to the patient is the control of patient data. In the US, if a patient is given a blood test, she normally does not receive the results directly. Instead, the doctor receives the report first and explains the results to the patient. In contract, in China, it seems that when the report is ready, it is given to the patient or at the patient’s request. This can cause unnecessary stress for the patient as well as the doctor. In the age of the Internet, patients and their families will try to find information on the Internet to help them interpret the reports without the benefit of a doctor’s experience and personal knowledge of the patient’s case. It would be better if any reports be held until given to the doctor directly since he has the expertise to explain the relevance of the information to patient.IV. ConclusionFrom this surgery and stay in hospital, we saw with our own eyes that the medical service we received from changhai hospital is no less than what we could get from a U.S. hospital. Doctors, nurses, and medical workers all work hard every day with a heart of devotion, professional spirit and excellent skills. We know they are not paid as well as their peers, their working environment is not as good as that of their peers but they have far more patients to take care of. We truly feel that they abide by the oath of Medicine, they deserve more respect and understanding.My wife and I are grateful to you, Dr. Xu, and the staff of Changhai Hospital. This was clearly a complicated surgery. The surgery’s success has and will continue to have a large impact on Meilin and our family. With each day her body heals and her mobility increases, and we look forward to the day when she has fully regained her strength and mobility such that she can walk, run, hike, bike, without limitation.I admit that I was initially apprehensive at Meilin having surgery in China because I assumed the conditions and procedures might not be on par with my experiences in the United States. Happily, I was disabused of my prejudice upon meeting you and Dr. Shu and the Changhai staff. While Changhai Hospital welcomes thousands more patients than even my local hospital in Chicago, and while conditions are older and there are fewer amenities than found in my Chicago hospital, the quality of care is equal to that of any US hospital. Overall, I found Changhai Hospital staff to be professional, to provide excellent services and care, and we were confident and secure during our stay there. For that, we thank you.If there is anything I can do, or if you would like me to obtain further information about US hospitals and medical services, please do not hesitate to ask me.Sincerely,Peter Bibler [1] http://www.newchoicehealth.com/procedures/pelvic-mri[2] http://www.newchoicehealth.com/procedures/ct-pelvis-scan[3]http://www.washingtonpost.com/blogs/wonkblog/wp/2013/02/12/how-much-does-hip-surgery-cost-somewhere-between-10000-and-125000[4] http://health.costhelper.com/hip-replacement.html[5] https://healthcarebluebook.com/page_ProcedureDetails.aspx?id=28&dataset=MD[6] PPO & HMO are the two primary options for private insurance. HMO is less flexible with fewer options, but premiums are cheaper. Patients may choose doctors and hospitals only within that HMO network for insurance coverage. PPO is more expensive, but provides more flexibility. A patient can choose any doctor, specialist, or hospital without the need for a referral and still have insurance coverage.[7] http://www.newchoicehealth.com/procedures/pelvic-mri[8] http://www.newchoicehealth.com/procedures/ct-pelvis-scan
Peter Bible的妻子在髋关节疼痛了很多年,并且行走非常艰难时,来我们医院就诊、手术、康复。他把求医过程中的所见所闻,用英语和中文,写了:中美医院及手术经历比较——相同与不同,发给了我们医院的管理部门。大家看了很有感触,我们确实仍有一些地方需要改进。我没有改动一个字、一个标点,发给大家看看。原文如下:To: 陈主任Fr: Peter BiblerRe: 中美医院及手术经历比较——相同与不同Date: 2014年12月 这篇文章主要是根据我本人在中美两国的就医体验。从看病程序、医疗费用及医院服务等三个方面对中美两国的医疗进行了一番对比。由于我本人是位在中国生活的美国人,其所经历的是骨科手术,因此文中所提及的手术医生、医生及护士均来自骨科,并不能代表中美两国所有医院所有医生,仅仅是试图以一斑窥全豹而已。1,医疗费用 目前,在中国上海地区做一次全髋置换手术(THR)的费用为15000美元左右。这笔费用包含: 1)初次就诊咨询(根据普通门诊和专家门诊的不同,价格从4美金—30美元不等),初次就诊咨询包括由医生听取病人讲述病情,检查病人的患肢,确认病人的行动能力,运动范围,疼痛程度等。需要指出的是,在中国,病人通过网络和口碑了解医生的专长和水平,因此可以事先选择医生,所以很有可能初次就诊的医生即为最终的手术医生。 2)一次X光片(10美元),如果医生认为需要,病人可能需再拍摄一张关节核磁共振片(30美元)。 3)进一步医疗咨询(价格仍为4-30美元不等),对初诊没有提供所以有效资料的病人,医生在收集齐全部资料后进一步诊断病情,得出是否需要手术以及如何治疗的结论。 4)住院费用(费用根据住院时间,所住的病房标准,以及是否需要聘请专人护理而高低不等)。关节植入假体(平均价格为10000美元,根据所选关节的品牌价格有高有低)。其他药品,医疗器材,术前术后检查,护理费用等。 由于我妻子有参加上海地区城市医疗保险,因此最后我们全部费用中的5570美元得到了报销。在美国,医疗费用是非常高的。一次普通门诊的费用在100美元,一次核磁共振的平均价格为2550美元,一张骨盆CT的价格在2400美元。 全髋置换手术的费用由于地区,医院和参加医疗保险项目的不同而有所变化。例如,2011年整个美国的膝关节置换手术为64.5万台,髋关节置换手术为30.7万台。美国骨科医师协会的数据显示这两个数字比2006年都上升了大约30%。据华盛顿邮报一项公开研究显示,经过对全美超过100所医院的调查显示,全髋置换手术的费用大概从11000美元到125000美元不等。而根据美国最大的医疗保险组织之一《蓝十字蓝盾》的公开数据显示,全美全髋手术的平均价格为39000美元。而另一家专门指导消费者医疗价格的组织健康蓝皮书则显示,在美国,一次价廉物美的全髋手术价格大约应在22533美元左右。这费用应包含四天住院费用(1800美元每天),植入关节(8000美元),医生手术费用(2650美元),和麻醉师费用(1211美元)。 美国的医疗保险报销和中国不同,个人医疗费用最后的实际支出和个人买的医疗保险类型有关。大多数医疗保险都要求投保人先支付免赔额,然后再由保险公司支付你的医疗费用。免赔额从几百美元到几千美元不等。病人支付完免赔额后,保险公司会赔付大概80%-100%的医疗费用。举个例子,老年人一般都适用政府投资的医疗保险,这类保险一般要求的免赔额在1000美元左右,然后所有的医疗费用都将由保险公司直接支付给医院。2,时间程序——医疗保险的要求:专家介绍,X光片、CT拍片,验血报告等 我和妻子在上海看病过程十分顺利,整个程序非常快捷。从初次就诊到动手术,整个过程不超过2周。因为妻子的髋关节患病已有几年,所以我们初次就诊时就准备好了X光片和过去的就诊记录,因此没有第二次就诊,就直接选择了手术方案。从我们自身经历和在医院通过其他病人了解到的情况,一般来说,根据医生的知名程度以及随之而来的病人的多少,第一次预约的时间在(1—7天不等),一般通过网上预约、医院当场预约等方式,也有特别急的案例,可以直接找到医生,请医生加号,这样在医院当场等上半天就可以见到医生。 就我们的经历来说,长海医院的徐卫东医生是髋关节置换方面的权威手术医生,病人从全国慕名。而通过网上预约徐医生的排队时间在1-2周。在中国,在就诊的同一天就可以拍摄X光片,而核磁共振一般情况下需要预约,大概在就诊后一周可以进行,同天拿到结果。我们的经历是在医生告诉我们结论,需要手术解决,我们同意这一决定后,就在助理医生那里进行了登记,然后回家等候医院通知。我们大约在一周内就得到了医院的通知, 当然,我们没有提出必须要住二人病房的要求,由于病人很多,不然可能我们需要等待的时间会更长些。总之,我认为,在中国上海的一流医院,从预约医生直到手术完成,这个寻医问药的过程历时2-3周左右。而在美国,对类似的非紧急手术,等待手术时间的长短很大程度上取决于病人的保险。如果病人没有医疗保险或者手术医生不属于病人医保的覆盖范围,那么病人在自己负担所有医疗费用的同时还必须自己想法联系手术医生,有时不一定能取得预约。如果病人投保了PPO保险,而手术医生在保险范围内,病人可以自行联系医生,相对比较容易取得预约。如病人参加的是HMO保险,那么病人必须首先预约一位普科医生,向医生报告自己的病情。这位普科医生会根据病人的病情,提供一张自己推荐病人去咨询的专科医生名单。病人可从中选出一位,自行致电预约。对于非紧急情况下的预约普科医生,预约等待时间的长短根据病人所在地区、医生而各有不同。 2014年全美的时间大致从最短德克萨斯州达拉斯的5天到最长波斯顿的66天不等。由普科医生处预约一位骨科医生的平均时间在5天到18天不等。与之相比,大多数中国病人看病不需经过普科医生,他们有病痛时,即使没有紧急情况,他们一般也可以直接前往医院去看一位普科医生或专科医生。这样一来,等待初诊的时间和美国人相比,不是用天或者周来计算,而是用小时计算的。 在美国,普科医生和手术医生可能受雇于医院,但更多情况下,他们有自己私人的办公室和诊所。例如2012年的数据显示,全美仅有8%的骨科医生在医院工作。因为这种原因,当美国人走进医生办公室的时候,病人基本上不能指望那里有任何检测设备。不管是验血,X光片,CT还是核磁共振。医生一般会推荐你附近的医院或私人实验室去做这些必要的检查。病人检查完这些报告会直接寄给医生。当然,非紧急情况下,去这些地方做检查同样需要预约和等待,等待时间长短不一,检查费用价格不菲。验血相对好些,血液检测一般不需要预约,前往实验室就可以直接完成,根据检测内容的不同,报告会在一段时间后直接反馈给医生。我的个人经验是,在芝加哥地区,一次普通的门诊,医生的预约在上午,看完医生后,同一天内直接前往附近的实验室验血。然后大约需等1个月后,可以再次见到我的主治医生,同他讨论我的血液报告的结果。 据我了解,一些拥有私人诊所的骨科手术医生可能会有他们自己的影像学设备,但通常情况下他们会让病人去当地实验室做血液检查。 举个我所经历的例子。我弟弟2013年在工作中弄伤了膝盖,需要手术。由于保险原因,通过熟人介绍,他直接联系了手术医生的私人办公室。医生助理在一周内帮助他预约了核磁共振。这次核磁共振的价格为2800美元。通过医生诊断,他的膝盖不需要置换,只需要微创手术。这次手术属于门诊手术,全过程在骨科医生的诊所完成,不需要住院。尽管这样,这次手术的全部花费仍在1万美元左右。整个治疗过程从第一次电话预约到手术完成用了2个月多一点的时间。幸运的是,他的医疗保险覆盖了100%的费用。这时间是在不通过普科医生预约的情况下完成的,如果加上预约普科医生(平均7天—14天左右),和普科医生转诊手术医生的时间(7天——14天左右),估计整个流程会需要近3个月时间。3,服务质量 事实上很难用一个结论来总结美国医疗机构整体的服务质量,这很多时候取决于医疗机构本身(公立医院和私立医院不同,公立诊所和私立诊所不同,各个医生和手术医生私人办公室不同),同时也和病人所在社区有关(大都市,小城市,郊区,村镇),每个医疗机构的服务质量肯定有所差别。总体来说,美国人的普遍反映是小型私人医生诊所的服务更亲和更快捷,而私人医院比公立医院的服务要更好些。我深知拿我个人体验的某家美国医院和某家中国医院比较很可能会导致不客观的结论,但我仍然做了一些比较,希望这些比较从某种程度上能说明一些问题。 长海医院是上海地区第一流的大型综合医院之一,拥有57个科室,535位可以直接预约的医生,2100个病床。2013年全年医院就诊人数超过300万人,完成手术4.69万次。就病人人数和手术数量来说,美国没有类似医院可以比较。长海医院提供住院病房有2人房,3人房,6人房。考虑到手术的时间,我们选择住进了6人房。虽然6人房不可能像2人房那样舒适,但更大的房间,更多的病人和家属使这个病房如同一个小团体一样,病友以及他们的家人们互相交流,互相支持,大大减少了我们等待手术时的紧张。 虽然病人数量如此巨大,我们在医院感受到服务,无论是医生,护士还是其他医院工作人员都是高质量的。每天清晨,病人的体温都会由护士量好记录,如果有需要完成的血液检查血压测量等,总会有一名护士在早饭前为病人做好这些检查。早饭后,护士们在护士长的带领下开始查房,询问每位病人,从晚班护士那里收取报告,如有新来的病人或需要注意的特殊病人,护士长会向护士们特别介绍,使护士们了解病人要做的手术,需要特别关照的内容等。护士们离开后不久,手术医生和他所领导的团队开始他们清晨的查房,查房的主要内容是跟踪观察手术后的病人,询问他们的情况,回答他们的问题,以及针对他们不同的情况给予医疗意见和调整用药。这样的例行查房使医生了解到病人术后的康复情况(比如是否发烧,血压情况,疼痛程度等)。这一点中国和美国基本相同。 但在中国长海医院,同样的查房每天傍晚,手术医生和他的团队还会再进行一次。有时我们的手术医生徐医生结束他一天的手术已经很晚,即使是晚上7、8点,他仍然会在下班离开医院前来到病房看视他的每一个病人。这点使我们非常感动。 住院期间,每个病人都有负责自己的护士和一位手术医生团队中派出常驻病房的医生。这样有任何问题,我们都可以立刻找到护士,如护士无法处理,比如开处方之类的问题,我们也可以直接找到医生来解决。工作时间结束后,夜班护士以及夜班医生也会在离病房不远处随时待命,病人可以随时打铃呼唤他们。我们住院期间就碰到过半夜疼痛的状况,五分钟内护士为我们找来了夜班医生解决了问题。我个人体会,在医院期间,无论是医院还是护士,无论是工作时间还是非工作时间,我们以及同病房的病人们都感受到专业精神和亲切的服务。 长海医院的护理系统设置和我们听说的其他上海医院有所不同。这里不鼓励病人雇私人护工(例如,白天你不能请护工专门照顾你一个人),相反,整个楼面的病人们共有7个护工。我们一开始非常担心,但实际使用下来发现这种方式十分管用。在长海医院,无论何时白天或夜晚,病人有需要,只要按铃要求护工来,基本上护工都会在一两分钟内出现,在夜里,如果病人没有家属陪伴,也可以每天12美元的价格请医院提供一名护工夜间陪伴病人。因此共用护工没有给我们带来任何不便,事实上,这减少了病人的花费。这种方式其实和美国医院十分接近。 在美国,护工不象中国这么常见,基本上病人所有的需求包括大小便都由护士来完成,在美国病人基本不可能请私人护士。所有病人共用护士。由于病人数量增加,这几年,美国国内也正面临护士紧缺的严峻问题。而中国由于病人数量之多,病人的需求更不可能全部由护士来完成了,因此护工是必不可少的重要一环。在我们住院期间,我们认识了热心友善认真尽职的护工,专业能力强对病人非常耐心的护士,她们中有些已在这家医院的骨科病房工作五年以上,对病人的各种术后症状十分了解。正是她们的工作使医生的专业精到的手术成果得到更好的保障。中国医院的不足之处A 沟通——内容和一致性 在非紧急情况的医疗中,美国的骨科医生常常会在手术前和他们的病人见面1-2次。初诊时检查病人,和病人讨论病情的时间可能从10分钟到1小时。后续的诊疗主要会详细讨论影像学检查结果。如需要手术,手术医生经常会提供一个关于手术内容的小册子给病人,这样病人对手术以及术前准备及术后大致的康复过程以及可能出现的风险会会有一个大致的概念。 由于中国如此之多的病人,美国式的一对一的长时间检查问诊几乎是不可能的。病人们和家属大量的挤入医生的办公室,这给病人提问和医生检查都造成了时间空间上的压力。尽管每个医生不同,但要求一位医生完全无视门外排队的汹涌人流而耐心地花上半小时到一小时只和一个病人讲述病情是不合理的。因此在中国,医院里的所有进程都被加快了。手术医生只能简短地向病人说明需要手术的结果,而病人只有极其短的几分钟时间来消化医生的话,更不要说在医生提供的信息基础上组织好自己的问题来向医生提问了。 我个人感觉,医院可根据病人手术种类的不同,在病人确诊后或决定住院手术后,为病人和病人家属提供一个简单的小册子,对医生来不及说明的手术前的准备(比如血糖血压不能过高,身体不能有其他感染),手术中的麻醉,术后第一天的感觉,预期的疼痛等等做些介绍,以便病人了解。这样在最后阶段手术签字时,病人可以有针对性的提问,同时病人对手术了解的越多,有更多的心理建设,也规避了一部分一旦发生风险,病人由于不理解手术风险,没有心理预期而失去理智的情况。 还有一个小问题是信息的一致性。有时病人首先沟通到的人可能是护士或者是病房医生而非他的手术医生。这时就需要病房医生和护士都能够了解到手术医生对病人的诊断和指导意见。比如关于骨科手术后病人何时能下床的问题,病房医生和护士按照一般惯例来指导病人,而病人的有些特殊情况只有手术医生最了解,如果病人从手术医生那里得到的指示和护士或者病房医生的不同,那么病人或家属就会降低对医院其他人信任,转而更依赖于手术医生。甚至在各种无关紧要小问题上也必须问到手术医生才放心,这大大地浪费了手术医生的时间和精力。 在保持信息一致这一问题上,美国医院的做法是每个病人都有一个医生和护士共享的电子文档(过去是手写的),护士们将对病人观察到的情况,疼痛,发烧,给药情况记录在上面,而手术医生则把对这个病人的主要思路,比如何时开始进食,何时下地,写在上面,并根据对病人的观察随时调整。这样,任何一个病房医生和护士就可以在手术医生工作繁忙的时候,通过这个文档也一样能正确指导病人的康复进程了。B 对病人的信息控制 另一个沟通方面的问题和对病人的信息控制有关。在美国,病人验血后一般不会从实验室直接拿到报告。报告只会直接提供给医生,再由医生交给病人,与此同时将报告解释给病人。而在中国医院,似乎只要报告结果一出来,病人就可以拿到,无需通过医生。在网络普及的这个时代,拿到报告还没来得及见到手术医生的病人和家属难免会自己上网寻找相关案例,试图第一时间了解报告上的结果。而缺少专业知识的他们往往会被网上的一些信息误导,张冠李戴,导致病人和家属在不明所以的情况下无谓的担心,或使病人有先入为主的误解,增加了医生事后沟通的压力。我个人认为在这一方面,美国的经验值得学习,任何报告在医生能对病人做出专业解释前不应直接提供给病人。4,结论 经过这次手术,以我们的眼睛观察,用我们的心体会,我们在长海医院中收到服务质量绝不比美国医院的服务差。无论是医生、护士、还是护工都在以崇高的职业精神,优秀的专业技能为病人的康复日复一日地努力工作着。特别是考虑到他们每天经手的病人数量远远超过美国,工作环境工作报酬远远及不上他们的美国同行,我们感到他们无愧于希波克拉底誓言,南丁格尔的称呼,他们理应获得大众更多的尊敬和爱戴。 我的妻子和我非常感谢您,徐医生以及长海医院所有的医生护士。这次手术无疑是一次难度高复杂的手术。手术的成功已经并还将在未来深深改变我妻子和我们全家的生活。随着她每天的康复,我们期待不久她完全恢复健康的那一天,她将可以象正常人一样行走,跑步,踩自行车,旅行,再也不受病腿的限制。而这些,都是因为你们才能发生,我们因此永怀感恩之心。 我必须承认最初了解到我妻子必须在中国进行这么重大的手术时我非常担心。因为在我的想象中,中国医院的条件和专业水准恐怕很难和美国医院相提并论。非常幸运的是,我遇到了您,徐医生和长海医院的所有医护人员,使我能够有机会改变自己的偏见。 尽管长海医院的设施比我所看病的芝加哥医院要老旧,病房条件比那里要简陋,但这里每天却比那里接待数倍数十倍更多的病人,为他们手术,送他们康复出院。当然美国医院能提供专业优良的服务,但我和我妻子在长海医院一样感受到专业,信心和安全。为此,我们感谢您!如果有任何我可以为您做的,或者需要美国医院方面进一步的资料的,任何时候我都愿意为您效劳!您忠实的Peter Bibler
患者ao187发表给您的感谢信疗效:很满意 态度:很满意看病过程:我是安徽省霍邱县潘集镇中心学校的一位患者,13岁时因右患髂骨骨髓炎,先后两次手术,感染累及右髋关节,致使右侧髋关节股骨头缺血性坏死,二十年来,严重影响工作、生活。辗转各地求医,我们安徽的医科大学附属医院,省立医院的骨科教授,看了片子均表示不敢手术,因为病程太长,骨盆畸形严重,骨质也较差,患肢严重缩短,肌肉萎缩,手术后果不可预测,建议我拄拐行走,眼看我的教育生涯即将就此结束,可我才三十多岁,正是人生中的黄金时期,而我的教学,在我们这里,也深受领导的认可,家长的肯定。我不甘心自己平凡的职业历程就此停止,我也不想从此以后与拐杖相伴。也许是机缘巧合,2009年,因父亲患恶性脑瘤在长海医院手术,那段时间我一直在长海医院陪父亲,无意中听人说长海医院的骨科徐教授医术高超,待人和蔼,抱着试试看的想法,拿着片子,去徐教授的办公室找他,去了之后,发现他正在办公室打点滴,门口的护工告诉我,徐教授的工作量特别大,一年几百台手术,带病工作是常事。我当时就深受震动,像他这样的权威专家,如此敬于自己的职业,精于自己的专业,令人敬仰!当时没好意思打扰他,过了几天,在他的门诊,徐教授看了片子,说手术难度很大,可是如果我相信他,手术一定会成功。看着他那份自信,我知道那是源自于精湛技术的支撑,我灰暗的人生瞬间又燃起了光亮。当徐教授得知我当前的家庭困境时,十分同情,让我陪父亲走完最后一程后,再来找他手术,临走时拍拍我的肩,说一定会好的。之后的一年,我处理好了一切事情,于2010年在长海医院由徐教授亲自手术,经过一段时间康复训练,术后恢复的非常好,疼痛消失,功能恢复的也特别理想,双腿也一样长了,目前工作生活一切正常,每当站在讲台上,尽情享受自己的教育时光的时候,我倍感珍惜,我经常和学生们说,不是遇见徐教授,可能我现在已经没有站在讲台上的机会了。真心感谢徐教授,您的儒雅气质,人性关怀,精湛技艺,令每一个患者终身难忘!保重,徐教授!愿您永远安康! ---本胜诚言
患者:病情描述(发病时间、主要症状、就诊医院等): 患者女,35岁,确诊AS已经十几年了,髋关节强直,4月底在长海医院徐教授为我做的左髋关节置换手术。 徐教授好我是山东的小郭。4月29日是您给我做的手术,真的很高兴,现在我术侧恢复的很好,可以爬楼梯,可以逛超市还有乘公交车都没问题了,感觉自己像一个正常人一样。徐教授精湛的医术,高尚的医德让人值得尊敬!借此平台谢谢您!同时也感谢何医生、范医生、还有李医生,谢谢您们! 我真切地告诉所有的与我一样患强直性脊柱炎疾病的病人,如果关节疼痛、影响活动或关节象死的一样不能活动,赶快手术!我们需要生活、我们需要工作、我们要过上关节正常活动的生活!手术对于象徐教授这样的专业关节外科医生,非常有把握。象徐教授,每年要做500台手术,而且每一台手术都是他自己从头做到尾,包括缝合皮肤。他说的,也是这样做的!所有病人都冲着徐教授去做手术,因为他手术量最大、经验最为丰富,而最为重要的是,尽管他是教授、博士生导师,但为了病人,每一个手术都是自己亲自做。不像有的教授把病人忽悠住院后,却没有自己手术,而叫手下的助手手术。手术后,2-3个月就如正常人一样,不再受关节疼痛的折磨,获得正常的关节活动功能,感觉非常地好!今天我父母从山东来上海看我(我住在姐姐家),他们很惊讶,我不再被看出是病人了。上海长海医院骨科徐卫东:谢谢您小郭的鼓励!确实,希望所有的病人,因为关节疼痛、不能活动而影响工作、影响生活、影响家庭的病人,来手术吧!我可以说:“我们行!”祝您从此开始您新的人生,做一份合适的工作、找一位适合的伴侣,----因为您与大家已没有任何不同!
患者:我母亲今年67岁,双腿行走困难,不能下蹲和上下楼梯,患病已有十几年,非常痛苦,最近检查结果两侧髋关节无菌性坏死,需要做两侧的髋关节置换 以前没有治疗过 在网上看到徐教授是髋关节置换的专家,想来您处看病,因为我们是浙江的星期一早上九点左右过来看您的门诊,是否能挂上您的号,能否尽早的入院治疗,我知道徐教授处的病人实在是很多,因为我母亲的病已经拖了很长时间了,以相当严重了,还有就是可以双侧一起置换吗?烦请徐教授尽快答复!谢谢! 化验、检查结果:两侧股骨头变形,密度增高,两侧股骨头缩短,两侧髋关节间隙变窄,两侧髋臼欠光整,密度不均匀。 最后一次就诊的医院:上海长海医院骨科徐卫东:没有问题,请尽快来就诊。谢谢您!欢迎浏览上海关节网,www.jointshanghai.com患者:好的!谢谢您!徐教授!我们会尽快来就诊的!上海长海医院骨科徐卫东:请放心!手术后,您母亲就可以象正常人一样,正常地行走、生活,再没有任何痛苦,做子女的,可能这是最大的孝心啊!患者:徐教授您好!1月4日,下个星期一您是否照常门诊,我们准备过来就诊,我母亲现在走动非常不便,望教授能尽快安排入院治疗。谢谢!上海长海医院骨科徐卫东:那就1月4日来我门诊,看了后直接住院吧!我的电话:13901814702患者:您好!徐教授,电话已经联系了!谢谢您的安排,星期一我们过来看病!上海长海医院骨科徐卫东:好的。到时见,请放心!徐卫东患者:徐教授您好!我母亲1月7日做的左侧髋关节置换,到现在已有4个多月了,置换后的状况非常的好,现在走路都没感觉有什么不适,没有疼痛,真是万分感谢您!只是右髋还没有做,倒是走路感到酸痛的很!想也尽快的前来做手术。准备在7月过来置换右髋节!另外请问一下徐教授,现在做的那个左腿明显长了好多,大概2个腿之间高低有4厘米左右,不知道换了右腿后是不是能够持平呢?上海长海医院骨科徐卫东:很高兴,您母亲恢复得很好。下次,右腿手术后,两条腿的长度会一样等长。谢谢您!患者:看此医生门诊的具体时间: 2010年1月 医生给您做的检查项目、结果及给出的处置方案: 在徐教授处已经做了左侧的髋关节置换,置换后状况非常的好! 您还需要的帮助: 现在准备7月过来徐教授处做右侧的髋关节置换,请教授到时安排一下!谢谢您了!上海长海医院骨科徐卫东:很高兴,您母亲恢复得很好。下次,右腿手术后,两条腿的长度会一样等长。谢谢您!