Dorothy不在堪萨斯了

我们PROGRAM有一个传统，每年万圣节之前的星期五，要举行constume晚会，我不太喜欢参加晚会，而且周六还要值班，所以打算不去了。从上个星期开始，大家就着手准备constume了，还互相试探，挺好玩的。

星期五上午，我的一个病人是终末期肾病透析，发作了心力衰竭，肺水肿，ICU attending让我打电话给心脏科值班医生会诊。那个医生的脾气是著名的不好，我刚刚把病史说完，那个医生就发作了，说这样的透析病人心脏科还能做什么，这种会诊太愚蠢了blahblah，用词非常难听。然后就粗鲁地挂上了电话。

我挂上电话，看着电脑，过了好一会儿才平静下来。但是那个心脏科医生的话像一种病毒侵染了我的情绪，我的自尊心跌落到了极点。中午的时候我坐在休息室里发呆，一个两年级的住院医生发现了我的异样，说你怎么了，我说没什么，他没有多问，而是说，走，我们去喝咖啡，我摇摇头，他坚持要我和一起去。

走在走廊的时候，住院医生对我说，每个人都有不顺的时候，要学会把一些垃圾放在身后，不要把垃圾堆在心里。我走在他边上眼眶忍不住红了。

周五下午是门诊，看到很晚才结束。

临走的时候，attending问我去不去晚会，我说不去了，明天还要值班，他说so what，你可以去早点回去。看着他微笑的眼睛，不知道为什么，我积蓄了一天的委屈，沮丧，终于毫无保留地倾泻出来，我就把白天的事情跟他说了。他神色严肃地听完，然后慢慢地开导我，跟我说下次应该怎么回答这样粗鲁的医生。他说，以后在真正的世界里，你还会遇到很多这样的爱丝厚，要坚强而又礼貌，在人格上战胜他。attending说，真正的男人，会挑战和自己同年资的人，会质疑权威，但是不会对一个比自己年资低很多的人大喊大叫。

我们说了很久，我我得很不好意思，因为他住得很远，要赶回去换衣服，然后还要赶回来参加化妆晚会。临走的时候，他说，希望晚上会看到你。

我在晚会开始半个小时以后，决定去商店买costume了。

打开晚会的大门，音乐人声鼎沸，大家看见我都很惊喜，我们互相拥抱。看见这些平时努力工作的医生们打扮成各种古怪搞笑的样子，真得很好玩。

我的装束是绿野仙踪的Dorothy，一个被龙卷风吹到了神秘土地的女孩子。我把头发扎成了两个小辫子，提着小篮子和小狗，穿着蓝裙子和红皮鞋。看到一个亚洲女生打扮成美国经典童话的人物，大家都觉得很好玩。忽然一个高高的独眼海盗站在我面前，我看了半天，才发现是下午和我谈话的attending，我不由得惊喜地叫出来。他微笑地说，很高兴你能来，dorothy.

Dorothy不在堪萨斯了，我也不在自己的家乡了，希望我能最终找到自己想要找的东西。

[lullaby_g]

我觉得国内的医生投入产出比应该比美国高 (ZT) ----not really.

[涩郎]

what did you say?

[ddsd]

我觉得国内的医生投入产出比应该比美国高 (ZT)

我自己不是医生，但是认识一些在美国土生土长的医生，也认识国内的资深医生。在风险回报来说，中国的医生是一种管制不高的垄断性行业，美国医生就是管制很高的垄断性行业，回报高之余投入也非常高。

美国的医生，如果不是从事specialist, 做专科，收入也不是很高。不是很高是相对于投入来说，医学院竞争很高，能进医学院的脑子来说，读商学院、法学院一概都没有问题，但是医学院要4年。4年出来要做廉价劳工住院医生3年（还是4年），等到终于能出来赚钱了，30岁。这还不算，一身的学费债，25万美元，都够买房子首期了。

医生里面的general practice，家庭医生类的，才出来的几年，15-20万美元，扣了税，扣了还学费的债，税后跟一个30来岁读了其他研究院就出来工作的相差不大。家庭医生的上限有限，做到50来岁也就比通胀高点而已。

医生里面真正高薪的都是专科，其中以心胸神经科为最，动手术的当然应该。但是投入非常高，除了刚才说的训练以外，额外要多加上6-8年的实习训练，赚钱的时刻又退后了，等到出来单干的时候都30靠后近40了。不仅如此，动手术的不能一直干下去，黄金期只有40-55岁左右，再干下去体力不支，60岁就差不多要从手术台上退下来，你不退我做病人的也不找你。这些专科的手术医生黄金期可以赚50-100万美元一年，但是一辈子就那么10来年能这么赚法，扣除40%的税，我觉得这个薪金是他们该拿的。医生还有一个非常高的开销，malpractice insurance, 给人告了不至于倾家荡产。但是只要给人告了一次得值，他的保险费就可能达到税前收入的1/4。给人告了两次得值，保险公司根本不受保，他的医生生涯就此完蛋。

美国医生绝对不可能干医药回扣，因为你看他的投入就知道了，一旦被吊销牌照，之前30年生命的投入，加上几十万的学费，全部泡汤，此生可以赚到的几百万马上变成零。我问过一个医生，要多少钱回扣她才觉得值得，她说，就算你给她几千万，还得保证她不坐牢，财产不没收，要不然根本不合算。药厂的销售手段不过事请医生去度假胜地开会啊，打golf这种小恩小惠，现金交易医生根本不敢接受。红包更加不敢接了。

国内的资深医生，现在的收入绝对能跟美国的同行看齐，主要是靠医药仪器回扣，回扣在国内是合法的，整个科室都有回扣指标。大至通心脏支架，小至关节置换，拍X光片，全部有回扣，要是癌症药，那个回扣就非常可观了，就算平常的药，医院的价格都是外面的几十倍，而且你不买不行，你在医院住能不吊医院的盐水吗？红包都是其次了，资深医生动手术的几千一万的也不比美国同行多，而且中国的手术费也比较便宜，但是回扣才是真正的聚少成多丰厚利润。美国的医生与药行是两个分开的行业，中国就合并起来了，所以医生连药剂师那份也赚了，还能影响病人专门吃贵药，回扣红包一律不上税，不赚死才怪。

中国才进行的不好说，其实资深、有高级职称的到底一年有多少我也不知道，但是有侧面的数据。我以前有个老邻居，总之20年前还是挺穷的一个医生，现在当然职称高了很多，唯一的女儿在美国，为了搞绿卡在中国人的公司干，钱当然没多少。但是老爸能帮女儿在办绿卡的时候现金在南加买房，花费接近上百万。美国的医生能拿出一百万现金出来买房的也不是大部分。

只要中国的医疗制度不改变，我觉得全世界回报最稳当的医生肯定在中国。

[远方的河]

人能够真正快乐的办法，就是学会苦中作乐。因为人人都是带着苦难在生活。

like this word: 爱丝厚,haha

[Angelboy]

It sounds like the communication problem existed although quality of patient care was unlikely affected.

Few years ago, patients died due to communication and accountability problems in the world’s top one children hospital. The hospital paid huge money to victims families. The state health department stepped in and conducted full review of hospital license. Hospital policy was then changed including that an ombudsman was appointed, this person would take complaints from medical residents if senior doctors brush off their calls for advice. They put in writing a code that is sometimes honored in the breach: Residents must never be criticized for asking a senior doctor for help, only for failing to ask.

[Bali]

I am in finance. A colleague of mine used to get tough time from some arrogant New York brokers and according to her, it was because of her thick Chinese accent. The a***h**** always questioned who she was. One day she got so upset and replied "my name is Fu, FU". That was like the best line for the week.

[黃金時代]

盡量讓自己開心吧,愛死吼太多了,他們的責任就是讓人難受的,所以,不要在意也不要理會,其實這樣的人是很可憐,他們非常的不快樂的活著,并且讓別人也不快樂,多么可悲啊.
很為你慶幸你有一個這么好的Attending.

cheer up!!
happy holloween!

[冰天雪地一萝卜]

I started my job as the Branch Accountant after 3 months I landed in Canada, the language problem was never that serious to me. I was so nervous in talking with local people on the phone esp. the people from states. Some of them were very nice to me, slow and clear, but some of them, vague and with strong accent, and always on speaker. So you can imagine how tough it is for me to have the conference call with those American guys.

I cried as you did when they yelled at me, but now I really don't care when people's yelling at me, cause I know if I become Firmer and Stronger, they will stop yelling and be "polite".

Don't be sad, you are such a smartie. :-)

[冰天雪地一萝卜]

Be firm and be strong!

[落花飘零]

I understand the consult might not be necessarry, but

1, he is talking to an intern, she must have discussed the case with her attending before she had the gut to page him. he doesn't have the courage to yell at my attending, instead he yelled at me, who he is sure would not stand up for herself. this is so lame.
2. even there is not much he can do, it's still a cardiology case, nothing wrong to involve him, all he needs to do is to stop sometime in later afternoon, review the chart and leave some quick note. it's so unprofessional and unnecessarry to snap out.
3.he makes me understand what kind of physician i want to be, and what kind of physician i don't want to be. my attending told me, he was removed from board memeber last year because he screwed with other doc , i am not surprised.

thank you wuximm, for leaving message here everytime i get frustrated.

[wuximm]

It only happens in teaching programs that a specialist gets upset for referals. In the real world, they will thank you for every referal, that is how they get business. It is true though that there is nothing a cardiologist can offer for a ESRD, CHF, pulmonary edema patient. He should have come and leave a quick note stating he can't add on anything to benefit pt for legal reason. He should have not yelled at you. I am glad you went to the party.