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過度醫療讓人貧病交加

Overtreatment Is Taking a Harmful Toll
過度醫療讓人貧病交加

When it comes to medical care, many patients and doctors believe more is better.

說到醫療,許多患者和醫生都相信,多就是好的。

But an epidemic of overtreatment - too many scans, too many blood tests, too many procedures - is costing the nation's health care system at least $210 billion a year, according to the Institute of Medicine, and taking a human toll in pain, emotional suffering, severe complications and even death.

然而,過度醫療已經成為一場流行病。過多的掃描,過多的血液化驗,過多的檢查……據美國國家醫學院(Institute of Medicine)公布的數據,美國醫療保健系統每年至少為此支付2100億美元的巨額開支。此外,病人也要承受身心兩方面的折磨,面臨嚴重的并發癥甚至是死亡的威脅。
 

"What people are not realizing is that sometimes the test poses harm," said Shannon Brownlee, acting director of the health policy program at the New America Foundation and the author of "Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer."

“人們沒有意識到的是,有時候,檢查反而會帶來傷害,”新美國基金會(New America Foundation)健康政策項目代理主管香農·布朗利(Shannon Brownlee)表示。他著有《過度醫療:為什么太多的藥物會讓我們貧病交加》(Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer)一書。

"Sometimes the test leads you down a path, a therapeutic cascade, where you start to tumble downstream to more and more testing, and more and more invasive testing, and possibly even treatment for things that should be left well enough alone."

“有時候,檢查會將你帶上一條治療的不歸路。一失足成千古恨,你會面對越來越多、越來越具有侵入性的檢查,甚至會對那些原本不作理會反而更好的癥狀大動干戈。”

Have you experienced too much medicine? As part of The New York Times's online series The Agenda, I asked readers to share their stories. More than 1,000 responded, with examples big and small.

你經歷過過度醫療嗎?作為《紐約時報》網絡系列報道“議程”(The Agenda)的一部分,我請讀者分享他們自己的故事。超過1000人作出響應,舉出的例子有大有小。

Some complained that when they switch doctors they are required to undergo duplicate blood work, scans or other tests that their previous doctor had only recently ordered. Others told of being caught in a unending maze of testing and specialists who seem to forget the patient's original complaint. I heard from doctors and nurses, too - health professionals frustrated by a system that encourages these excesses.

一些讀者抱怨,轉診的時候,他們總是被要求進行重復的血液化驗、掃描及其它檢查,雖然之前的醫生剛剛開過這些檢查。另外一些人提及,他們身陷迷宮般沒完沒了的檢查之中,以至于??漆t生似乎忘了病人到底是為了什么來看病的。我也聽取了醫生和護士的看法。醫療體系對此種過度治療實踐的鼓勵令這些專業人士也深感沮喪。

Terrence Power of Breckenridge, Colo., said that after his wife, Diane, learned she had Wegener's disease, an uncommon autoimmune disorder, the couple found it difficult to refuse testing recommended by a trusted doctor. The doctor insisted on office visits every three weeks, even when she was feeling well. He frequently ordered blood tests and X-rays, and repeatedly referred her to specialists for even minor complaints. Even when tests came back negative, more were ordered, and she was hospitalized as a precaution when she developed a cold. During one six-month period, she had 25 doctor visits. The couple was spending about $30,000 a year out of pocket for her care.

科羅拉多州布雷肯里奇的特倫斯·鮑爾(Terrence Power)說,自從他的妻子黛安娜(Diane)被診斷為韋格納氏癥(Wegener's Disease)——一種罕見的自體免疫疾病——以來,這對夫婦便發現,很難拒絕一位深受他們信任的醫生推薦的檢查。這位醫生堅持要他們每三個星期復診一次,就算黛安娜感覺并無不適也不例外。他經常要求抽血化驗和X光掃描,反復推薦她轉診至??漆t生處,即便黛安娜主訴的癥狀十分輕微。就算是返回的檢查結果顯示陰性,還會有更多的檢查隨之而來。連她得一場小感冒,都會被要求住院治療以防萬一。有段時間,她在六個月里看了25次門診。為治療黛安娜的病,這對夫婦光是自付醫療費部分就花了三萬美元。

"He was convincing enough that we felt we needed to have it done," said Ms. Power, 60, who recalls being sedated before an endoscopy procedure, one of the last tests she allowed her doctor to perform. "When they were getting ready to knock me out I was thinking, 'Why am I doing this?' But we felt like the doctor knew what to do and we trusted him."

“他總是信心滿滿,讓我們覺得檢查不做不行,”60歲的鮑爾太太說。她回憶起一次內窺鏡檢查前被鎮靜催眠的經歷。那是她接受醫生建議做的最后幾項檢查之一。“就在他們快把我放倒的時候,我想,‘我為什么要做這個???’但我們總覺得,那位醫生知道自己在做什么,我們信任他。”

After several years of physical suffering and near financial ruin from the medical costs, the couple began questioning the treatment after consulting with other patients in online support groups. Mr. Power spoke with his own primary care doctor, who advised him to find a new specialist to oversee Ms. Power's care. "It's a really hard thing to determine when they've crossed the line," Mr. Power said. "You think she's getting the best care in the world, but after a while you start to wonder, what is the objective? He seemed caring, but he didn't really consider my wife's time and the suffering she was going through having all these tests done."

經受了數年肉體折磨,為了治病幾乎散盡家財后,這對夫婦與網絡互助小組的病友們交換了意見,開始對治療產生懷疑。鮑爾先生與他的家庭醫生談了一次話。后者一直建議他找一位新的??漆t生負責鮑爾太太的治療。“要判斷他們是否違規逾矩,這真的很難,”鮑爾先生說:“你覺得她在接受著世界上最好的治療,但一轉念,便又疑惑不解:這到底是為了什么?他看起來是為我們好,但他實際上并沒有考慮到我太太為接受這些檢查所付出的時間和經受的痛苦。”

Under the new doctor's care, the regular testing stopped and Ms. Power was finally able to achieve remission. Now she sees the doctor only four or five times a year.

換了位新醫生之后,常規檢查被終止了,鮑爾太太終于可以擺脫身上的枷鎖?,F在,她一年只需復診四到五次。

Sometimes the toll of too much medicine is brief, but emotional. Kara Riehman, 43, of Atlanta was vacationing in California when she lost a struggle with an ironing board in her hotel room and ended up with a black eye.

有時候,過度醫療對身體的影響是一過性的,但卻會帶來心理陰影。43歲的亞特蘭大人卡拉·里厄曼(Kara Riehman)之前在加州度假。收起旅館房間里的熨衣板時,她失了手,結果把自己砸了個烏眼青。

As the bruising peaked around 10 days, she called her doctor to make sure everything looked normal. But instead of seeing her, the doctor, through a conversation with the nurse, ordered a CT scan. She had no symptoms other than a bruised eye, but the doctor never spoke with her or examined her. The scan came back with an ambiguous finding, and the nurse told her it could be a tumor. She was then given an M.R.I. and for two weeks while she waited for the results, she worried she had brain cancer. The nurse called to tell her the M.R.I. was fine.

瘀青過了十天仍腫脹不消,她于是給醫生打了個電話,確保一切正常。然而,醫生和她的主管護士簡單交談之后,沒和她見面就安排了一次CT掃描。除了眼部瘀青,她沒有任何其他癥狀,但醫生根本沒有跟她說過一句話,也不對她進行檢查。返回的掃描結果有一處模糊難以確定,護士對她說,保不準這是個腫瘤。于是,她又被要求進行了一次核磁共振成像掃描(M.R.I.)。在等待結果的那兩個星期里,她擔心自己真的患上了腦癌。然后,護士打電話過來,告訴她核磁共振成像掃描結果一切正常。

"It was really terrible," she said. "It was only two weeks, but there is a lot of cancer in my family. I never actually talked to my doctor through this whole thing."

“這太恐怖了,”她說道,“雖然只不過兩周時間,但我家族里有很多癌癥患者。整個過程中,我事實上沒有跟醫生進行過交流。”

The total cost to her insurance company was about $7,000. "It did change how I think about interacting with the medical system," Ms. Riehman said. "It made me much more of a questioning consumer."

她的醫療保險公司總共為此支付了大約7000美元。“這件事確實改變了我對與醫療體系打交道的看法,”里厄曼女士說:“它讓我變成了一個更有質疑精神的消費者。”

Jim Donohue, a Brooklyn bank examiner, had to intervene on behalf of his father, now 79, who had a stroke in March 2007. Doctors in Florida put him on several medications, including two antidepressants, and soon after the man began hallucinating and showing signs of dementia. Mr. Donohue began researching the drugs, and learned they were associated with cognitive problems. He persuaded his father's doctors to change the medication, and his father quickly improved. He has since recovered, and has been living on his own for four years.

吉姆·多諾修(Jim Donohue)是紐約布魯克林一家銀行的賬目核查員。他現年79歲的父親2007年3月經歷了一次腦卒中發作,之后,多諾修不得不代表父親插手治療方案的決策。佛羅里達州的醫生給多諾修的父親開了好幾種藥,其中包括兩種抗抑郁藥。服藥沒多久,老人就開始出現幻覺,并表現出癡呆癥的跡象。多諾修對藥物加以調查后發現,它們可能導致認知障礙。多諾修說服醫生改了藥方,結果父親迅速好轉了。復原后的老人一直獨立生活,如今已經有四年時間。

"All the medical professionals seeing him along the way, the hospital, two nursing homes and nobody thought of this," said Mr. Donohue, who said his father never should have been given a diagnosis of depression in the first place. "I don't know if we have too many specialists and every one is trying to practice their specialty, but it should not have happened."

“一直給父親看病的那些醫學專家、醫院和兩家療養院,所有人都沒想到結果會是這樣,”多諾修說。他認為,父親從一開始就不應該被診斷為抑郁癥,他說:“我不知道是不是因為專家太多了,結果每個人都想表現其專業性。但這本來是不應該發生的事。”

When Kathryn Gullo, a teacher in the Los Angeles area, gave birth to twins just 25 weeks into the pregnancy, she was thrust into the intense medical care of the neonatal ward that saved her children's lives. But when her daughter, Grace, was 3 months old she was transferred to a different hospital, where the doctors insisted on subjecting her to a battery of tests for symptoms that other doctors had dismissed as normal for her condition. "We felt like we were being bullied," Ms. Gullo said. "I had enough faith in her previous doctors that it was then easy to say no."

凱瑟琳·古洛(Kathryn Gullo)是洛杉磯地區的一名教師。懷孕25周時,古洛早產了一對雙胞胎。寶寶被送進新生兒重癥監護室,寶寶因此得救。但當她的女兒格雷絲(Grace)三個月大的時候,卻被轉到了另外一家醫院。那里的醫生堅持要給格雷絲做一系列檢查,以確診她的一些在其他醫生眼中純屬正常的癥狀。“我們覺得好像在被脅迫一樣,”古洛女士說,“幸好我對格雷絲之前的醫生有足夠信心,拒絕不算太難。”

The family switched hospitals and their daughter, now 5 and living with mild cerebral palsy and some vision and feeding issues, continues to require specialized care. But recently, when doctors suggested an M.R.I. that would require that their daughter be anesthetized, Ms. Gullo and her partner, Katie Ingram, said they asked two key questions: "What new information will this give us?" and "Will it change what we are doing?" After talking to the doctor, they declined the M.R.I.

古洛一家人轉了院。他們的女兒現在已經長到五歲,有輕度腦癱,視力和進食也有小問題,仍需特別護理。但最近,當醫生建議為格雷絲進行一次需要全身麻醉的核磁共振成像掃描時,古洛女士和她的伴侶凱蒂·英格拉姆(Katie Ingram)問了兩個關鍵的問題:“這會給我們提供什么新的信息?”以及“我們現在的做法會因此而改變嗎?”和醫生談過之后,她們拒絕了核磁共振成像掃描。

"Not every mystery has to be solved, and not every problem has to be addressed," Ms. Gullo said. "That's hard to get your brain around."

“不是所有的謎底都必須揭曉,也不是所有問題都得考慮到,”古洛女士指出:“想明白這一點并不容易。”
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