People often say that the standard of a good doctor is "benevolence and benevolence". It can be said that this book is to tell us how a doctor can change from "benevolence" to "benevolence". More importantly, these core qualities that doctors need for diligence are also applicable to other fields besides medicine. So no matter what industry you are in, understanding these characteristics will help you become a better self.

The author, 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 in Time Magazine's list of "1 Most Influential People" in 21. Gwende is good at telling stories around him with careful observation and vivid brushwork. These stories reveal the mystery of the medical industry for us, and help us understand what doctors think and what doctors do.

By the end of 218, four books published by Ge Wende, Doctor's Cultivation, Doctor's Diligence, List Revolution and Best Farewell, all have versions of "Listening 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 five years before and after. In the book Doctor's Cultivation, Gwende recorded how he grew from a novice doctor to a skilled doctor. In The Doctor's Diligence, as a skilled doctor, Gwende is still searching for ways to improve continuously. 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".

well, let's talk about it without further ado, and go straight to another medical industry exploration brought to us by Gwende. Let's take a look at the core characteristics contained in the doctor's "benevolence" from three angles: diligence, correctness and innovation.

the first part

let's first look at the first characteristic that a doctor should have to be diligent. Does diligence make doctors regard the hospital as home, take less rest and work more? That's not what I meant. Diligence here means that even in the details, doctors should continue to be serious and meticulous.

give an example. Polio, also known as polio, is a highly contagious disease with very serious consequences. Now this disease has disappeared in most countries, but occasionally, it will resurface in a corner of the world.

Gwende told us about a polio epidemic in Karnataka in southern India in 23. Karnataka is very poor, the local immunization is very poor, and children are not immune to polio at all. So once a child gets sick, polio can easily spread from there to all over India. In order to avoid this situation, the World Health Organization plans to vaccinate 4.2 million children door to door with more than 4, people, 2, vehicles and 18, incubators, so as to ensure that polio will not become popular.

from these figures, you will know that this is obviously a big project. But even such a big project has to be implemented in the details in the end. For example, they have to work out a detailed plan, and then convey it layer by layer, and allocate materials and medical personnel in place. Vaccinators have to go to more than 5 villages with bad traffic conditions in person to persuade those villagers who are illiterate and wary of vaccines to vaccinate their children. As for a lot of details in this process, such as how to deliver vaccines to various places, where to find a car to deliver vaccines, how to solve the problem of cold storage of vaccines, and how to determine the number of people to be vaccinated in each area, we must put them in place in every detail.

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 what kind of efforts they have made, but it is conceivable that they must have been on the road for three days, thirsty to explain and working day and night. They can accomplish this arduous task by the kind of extreme diligence that Gwende said.

But the "sweeping" of polio led by the World Health Organization is somewhat different from the daily work of doctors. The "big sweep" is thrilling enough, and those who participate in this sweep can also be encouraged by their dedication and heroic spirit. But more often, doctors actually can't get these spiritual stimuli. In every laboratory with lights on late at night, in front of every unconscious patient's bed, and in every bloody rescue scene, doctors actually do 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 with the development of medicine, 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 be done? All 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 2% to 1%. Because of the sufficient understanding of the importance of hand washing and disinfection, doctors and nurses who have not washed their hands now are never allowed to enter the operating room.

but what if you don't go into the operating room, but only in the outpatient department and ward? The result may surprise you very much. In clinics and wards, less than one-third of medical staff can really wash their hands according to the regulations. Doctors also have their reasons: "I have been examining patients, treating wounds and writing medical records all day long, so there is no time to wash my hands!" If I wash my hands according to the rules, I don't have to do anything else! " Don't doctors know the dangers of not washing their 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 the infection in the hospital. The hospital of this department in China is generally called "Hospital Infection Department", 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 their best to find ways. In Gwende's hospital, the staff worked hard on the details. For example, install more hand sinks, supply more convenient hand-washing gel, and publish 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 don't care much about the opinions instilled in them by others. Therefore, the hospital organized doctors, nurses and even patients to discuss how to solve the problem of infection in the hospital. This situation is completely different. In this way, everyone feels that their opinions have been taken seriously, and they begin to become very active. 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 treating patients. A year after the reform, the infection rate of a deadly bacterium in this hospital finally dropped to zero.

When encountering difficulties, people always hope to have a once-and-for-all solution, and hope to solve all the problems at once. But in medicine, it is really difficult for people to find other ways technically for things like hand washing. In the case that it is not so easy to make revolutionary progress in medicine, in order to help patients better, doctors must do more details, wash their hands more diligently, have a more kind attitude, ask questions in detail and so on. This is like a rocket. If you want to launch it successfully in the end, you must tighten every seemingly insignificant screw.

In fact, not only doctors, but everyone has the difference between being diligent and not diligent, being attentive and not being attentive. For example, in Japan, it takes 5 years to study how to make a bowl of good rice, and there are also "sushi gods" who spend their whole lives studying how to make a good sushi. The core characteristic of the "artisan spirit" that we often mention now is the diligence and intention that Gwende said here.

here, the first trait that doctors need for diligence, diligence, is all for you. 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.

Part II

Let's take a look at the second trait that doctors need to achieve diligence. The Chinese translation is "integrity" and the English word is "doing right". In fact, it is more appropriate to translate it into "doing the right thing". So how to define the word "correct"? 1+1=2 is mathematically correct, which is definitely not controversial. But things in this world are not all black and white. In those gray areas where different people have different opinions, doctors need to make correct choices and judgments.

In Gwende's view, the first kind of judgment that doctors need to face is related to morality. After hearing this, you may have said, I don't know what moral correctness is? But for doctors, it is sometimes not so easy to judge morality. Let me give you some examples.

if you are a doctor, will you ask a third person to join you when you examine the 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 easy-going, and they do what the patients say. For example, if you were a doctor, would you execute the prisoner? 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 didn't sentence the prisoner to death anyway, so it's better to do it myself than to let those unprofessional people do it, so as to minimize the pain of the prisoner's death. Let me ask you another question. If you are a young doctor who has just been working for a few years, and your family is also old and young, when you meet those poor patients, will you risk going home and quarreling with your family to supplement the medical expenses? Or can only be determined to come to from ruin?

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. At this time, how to choose a doctor actually depends on his own value orientation to a great extent. This moral "correctness" actually means "having a clear conscience".

after talking about moral correctness, let's talk about the second kind of judgment that doctors often face, which is a big problem. That is, when doctors encounter medical disputes, what kind of treatment is correct.

generally speaking, 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 the doctor made a mistake, but he was afraid to tell the truth to the patient because he was afraid of being sued or losing money? You may have said it. In that case, let's go to court and file a lawsuit. But is going to court really the fairest solution? In Gwende's view, people's achievements in medical litigation are not satisfactory. Because medical litigation often takes a long time, wastes people and money, wrangling constantly, and puts both doctors and patients on opposite sides, patients rarely get substantive 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 don'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 charge for each vaccine contains a surcharge of .75 cents, and the government used the money to set up a fund to compensate children damaged by vaccines. 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 damages meet the types on the "list of vaccine side effects", patients can get compensation.

However, although medical disputes are complicated, they are seldom encountered. For doctors, what they usually encounter is how to make the right choice between "continuing treatment" and "giving up patients". This is the third kind of judgment that doctors often have to face.

You may be a little confused. It is a doctor's bounden duty to save lives. Isn't it true that doctors should continue to save lives as long as patients have a glimmer of hope? Indeed, in most cases, doctors think so and do so. 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 live at all. But later, because of the doctors' perseverance and careful care, most of those babies survived. There are still many patients who are dying and full of tubes, and they have also crossed the gate of hell under the full treatment of doctors.

But doctors' professionalism, which is 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, a quarter of medical resources are spent on patients with less than six months to live, and the money 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 God, and there is no way to judge exactly 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 boundary between what doctors can and can't do is simple and clear. But in fact, the most difficult thing for doctors is to understand where the boundaries of "enough is enough" are. What is the right thing to do? What is 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 the very least, it will prevent doctors from making the worst mistake, that is, giving up patients who could have been treated.

ok, I'll summarize the second trait that a doctor needs 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 seek 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 principles of the medical profession are not always correct, and so are the practices of the outside world. There are sometimes essential contradictions among exerting professional skills, obeying the law and respecting morality.