人物说话 Characters speak

　　

北京协和医院宋红梅： SongGongMei Peking union medical college hospital:

　　

儿科发展当务之急是解决医生流失问题 Pediatric development the urgent task is to solve the doctor erosion problems

　　现在约有1/3医大毕业生难找合适工作，如能吸引他们来儿科工作，是增加儿科医生最快捷有效的方法

Now, about a third YiDa graduates hard to find the right job,Such as to attract them to pediatric work,Is to increase the pediatrician fast and effective method

　　据中国医师协会儿科医师分会统计数据显示，我国0～14岁儿童占总人口的22%，儿科医疗资源及服务却明显不足。儿科医师仅占总医师数的3.7%，儿科床位数仅占总床位数的6.4%。每1万名儿童仅有2.6名儿科医师，按1∶1000的比例估算，儿科专业医师缺口逾20万人。儿科医生紧缺的同时，儿童药品匮乏问题也在困扰我国儿童医疗的发展。

According to the Chinese medical doctor association pediatricians branch statistics,Our country 0 ~ 14 years old children, accounting for 22% of the population,Pediatric medical resources and services is obviously insufficient.Pediatricians accounted for only 3.7% of the total number of doctors,Pediatric bedspace accounted for only 6.4% of the total bedspace.Every 10000 children only 2.6 pediatrician,According to the proportion of 1:1000 estimate,Pediatric professional doctor gap of more than 200000 people.Pediatric doctor shortage at the same time,Children's drug shortage in our country with the development of children's health.

　　当前儿童医疗为何出现“缺医少药”的局面？该如何解决这样的难题？近日，北京协和医院儿科主任宋红梅，接受了中国青年报记者专访。

The children's health why appear"Lack of medical treatment"situation?How to solve this problem?recently,Beijing union medical college hospital, director of the department of pediatrics SongGongMei,Accept the China youth daily reporter interview.

　　

儿科医生流失是阻碍儿科发展的主要问题 Pediatricians loss is the main problem in the development of pediatrics

　　中国青年报：为什么儿科医生有这么大的缺口？

The China youth daily:Why pediatricians have such a big gap?

　　宋红梅：最大原因是儿科医生流失严重，医学院校毕业生也不愿做儿科，造成目前严重短缺。

SongGongMei:The biggest reason is a pediatrician erosion is serious,Medical colleges and universities graduates to do pediatric,Cause serious shortage at present.

　　中国青年报：儿科医生因为什么流失？

The China youth daily:Pediatrician because what loss?

　　宋红梅：首先是儿科医生的待遇比较低。儿童病种相对单纯，辅助检查少、用药量比较小；儿科收费也比较低，过去没考虑到儿科医护工作的特殊性，仅按照较成人收费相对减少的原则定价，而且几十年没变；再有儿科需要的医生护士较多，人力成本高。所以如果医院按照科室经济收入来进行绩效考核的话，儿科的奖金肯定低于其他科室。

SongGongMei:The first is a pediatrician treatment is low.Children's disease relatively simple,Auxiliary check less/Considered relatively small;Pediatric fee is low,The past didn't consider the particularity of pediatric medical work,Only according to a principle of charging adults relative reduce price,And dozens of years did not change;Another pediatric need more doctors and nurses,Human cost high.So if the hospital department in accordance with the economic income for performance appraisal words,Pediatric bonus must be lower than other departments.

　　其次是儿科医生和护士的工作压力非常大。现在大部分孩子是独生子女，家长对孩子百般呵护，也对医生和护士的工作有更高要求。比如，给成年人输液一针没成可以再来，而小孩血管较细，本来就不好扎，如果一针没扎好，小孩哭闹不配合会给护士很大压力，家长再不理解护士就更难做好。儿科医护人员的流失，无疑又加大了现有医护人员的工作量和压力，使他们感到身心疲惫，就更容易流失，形成恶性循环。

The second is pediatric doctors and nurses working pressure is very big.Now most of the children are only children,The parents to the child care in every possible way,Also for doctors and nurses work have higher requirements.Such as,Give adults infusion a needle not to come again,And the child blood vessels is fine,Was not firm,If a needle didn't tie well,The child crying not fit to nurse a big pressure,Parents don't understand the nurse is more difficult to do.The loss of pediatric medical staff,It also increases the existing medical staff workload and pressure,Make them feel exhaustion of body and mind,It is easy to lose more,Form a vicious circle.

　　第三是儿科的学科地位低。儿科在很多医院不受重视，人们总是一语双关地说“小儿科”。年轻医生更看重职业发展前景，他们看到其他科室医生的风光，对比儿科耗时耗力又不赚钱的现实，难免思变。

The third is the subject status of pediatric low.Department of pediatrics in many hospitals ignored,People always said shattered"pediatrics".Young doctor think more of career development prospect,They see other department doctor scenery,Contrast pediatric sweated and not the reality of the money,Unavoidably think change.

　　中国青年报：有不少人反映，身边的综合医院和基层医院没有儿科，小孩看病很不方便。

The China youth daily:There are many people reflect,Side of the general hospital and grass-roots hospital no department of pediatrics,The child is not convenient to see a doctor.

　　宋红梅：确实前些年有一些综合医院，因为收入低等原因取消了儿科，有的是全部取消，有的是取消病房保留门诊。由于专业人士和群众一直反映儿童看病难问题，现在卫生行政管理部门要求二级以上综合医院都要恢复儿科，这更凸显了目前儿科医生短缺的问题。因为床位、设备等硬件好重建，但医生从哪儿来呢？儿科发展的关键，还是人的问题。

SongGongMei:Indeed there are some general hospital in previous years,Because of the low income reason cancelled pediatric,Have a plenty of the abolition of all,Have a plenty of cancel ward keep outpatient service.Due to the professionals and the masses always reflect children see a doctor difficult problem,Now health administrative department for more than 2 comprehensive hospital pediatric recovery,The more prominent the current shortage of pediatricians.Because the bed/Equipment and other hardware good reconstruction,But the doctor come from where?The key to the development of pediatrics,Or the problem.

　　现在很多时候，孩子一生病，家长就带着去儿童医院，这导致了基层医院儿科“吃不饱”，儿童医院又“人满为患”。所以必须加强基层医院的儿科建设，建立完善的分级转诊制度，使儿童常见病在基层医院甚至社区医院就能得到诊治，这样也能使三甲级的儿童医院或大型综合医院的儿科，能集中精力处理疑难危重患者。另外要培训基层医师识别疑难重症疾病的能力，同时向公众宣传和普及相关医学知识，使疑难重症患者能够正确及时地得到转诊，既节省了医疗资源，又能缓解儿童看病难的问题。

Now a lot of time,A sick child,Parents took to the children's hospital,This led to the grass-roots hospital department of pediatrics"Do not have enough to eat",Children's hospital and"packed".Therefore we must strengthen the construction of grass-roots hospital department of pediatrics,Establishing a perfect classification referral system,Make children common diseases in basic-level hospitals and community hospitals can get treatment,It also can make the three serie a children's hospital or large general hospital of the pediatric,Can concentrate on handling difficult critically ill patients.In addition to training base physician identification difficult severe the ability of the disease,At the same time to publicize and popularize related medical knowledge,Make difficult in severe cases can correctly and timely get referral,Not only save the medical resources,And can alleviate children see a doctor difficult question.

　　

首要问题是提高儿科医生的待遇 The primary problem is to improve the pediatric doctor's treatment

　　中国青年报：儿科医生的培养有什么困难？

The China youth daily:Pediatric doctor training what difficulties?

　　宋红梅：儿科被称为“哑巴科学”，小孩很难说清楚自己的病痛，儿科医生的经验判断非常重要，所以儿科医生的培养需要更多的时间和经验积累。儿科医生的培养主要是毕业后教育，国外一名医学毕业生在儿科经过3年住院医师培养后，可以做普通的儿科医生，如果要想做儿童心脏、肾病等亚专科的儿科医生，还要再经过3年培训。目前我国大部分地区都基本完善了普通儿科住院医师的培养，但对于亚专科医师的培养才刚刚开始，有待于建立更系统的培训体系。

SongGongMei:Pediatric called"Mute science",The child is hard to say his sickness,Pediatricians experience judgment is very important,So pediatric doctor training needs more time and experience.Pediatric doctor training is mainly education after graduation,A foreign medical graduates in pediatric after 3 years resident after training,Can do ordinary pediatrician,If you want to do the children's heart/Kidney disease and the specialized subject of the pediatric doctor,Again after 3 years training.At present in most regions of China are basic perfected the common pediatric resident training,But for the specialist training has just begun,To build a more system training system.

　　中国青年报：改变儿科医生缺口大的现状，需要恢复儿科系吗？

The China youth daily:Change the present situation of the pediatrician gap is so big,Need to restore the pediatric department?

　　宋红梅：首先，恢复儿科系解决不了根本问题，不解决人才流失问题，培养再多的人也留不住；再者，即使恢复了儿科系，5年以后才能有儿科专业毕业生，成为合格的儿科医生还得3年，远水解不了近渴；第三，几乎所有国家的儿科医生培养都是毕业后教育。我认为，过早地把医学生限制在儿科领域不利于儿科学的长期发展，因为，儿童病相对单纯，一些前沿的药物也没办法首先在儿童身上应用，儿童病的检查诊断和治疗手段还是参考成人。这样的情况下，医学生光学习儿科的知识，不去接触其他学科，对儿科的长远发展不利。

SongGongMei:First of all,Restore pediatric department can not solve the fundamental problem,The brain drain problem is solved,Training and many people can't stop;moreover,Even if returned to pediatric department,Five years later to have pediatric graduates,Become a qualified pediatricians have to 3 years,Far hydrolyze not close thirsty;The third,Almost all countries of the pediatric doctor training is education after graduation.I think,Early to medical students in the department of pediatrics field restrictions against paediatric long-term development,because,Children's disease relatively simple,Some advanced drug didn't also the way the first child in application,Children's disease inspection diagnosis and treatment of adult means or reference.Such circumstances,Medical study play a pediatric knowledge,Don't go to contact other subjects,For the long-term development of pediatric adverse.

　　中国青年报：那您觉得应该怎么办？

The China youth daily:Do you think we should do?

　　宋红梅：国家需要出台强有力的措施，留住并吸引更多人从事儿科事业。我觉得首要问题是提高儿科医生的待遇，让儿科医生拥有与目前高强度、高压力的工作相匹配的收入，只有这样才能吸引更多医生来从事儿科工作。

SongGongMei:The country needs to come strong measures,To keep and attract more people in pediatric career.I think the primary problem is to improve the pediatric doctor's treatment,Let the pediatrician at present with high strength/High pressure job matching income,Only in this way can attract more doctors to work in pediatric.

　　现在大概有1/3的医学毕业生难以找到合适的工作，要能吸引他们来儿科工作，是增加儿科医生最快捷有效的方法。但这需要国家和地方政府出台切实可行的激励措施，比如，到社区医院做儿科医生能否有1.5倍于内科医生的工资？能否拓宽他们的进修、晋升渠道？国家需要为儿科医生提供足够的经济保障和良好的职业发展前景。

Now about a third of the medical graduates is difficult to find a suitable job,To be able to attract them to pediatric work,Is to increase the pediatrician fast and effective method.But this need to state and local governments issued feasible measures for the motivation,Such as,To the community hospital for pediatric doctor if there is 1.5 times the physician salary?Can broaden their study/Promotion channels?Countries need for pediatricians provide enough economic security and good career development prospect.

　　

儿童药品的开发、临床试验等需要国家政策支持 Children's drug development/Clinical trials need to be national policy support

　　中国青年报：早在2010年，《人民日报》等媒体就曝出我国98%的药品没有儿童剂型。为什么儿童药这么少？

The China youth daily:As early as in 2010,[People's Daily]And other media to expose it in 98% of the drugs are not children dosage form.Why children medicine so little?

　　宋红梅：这涉及我国药物科技的发展水平和儿童药品的制作工艺问题。儿童药品实验成本高，企业专门生产儿童药可能没有生产成人药经济效益高，没有动力去研发。所以，儿童药品的开发、临床试验等需要国家政策支持，对药企给予税收、研发补贴等激励。此外，药企也要注意改善儿童药品的口感，成年人得了病成天吃药都觉得没有生活质量，更何况是孩子，特别是一些得慢性病的孩子，如果每天都在担心吃苦药，还有什么快乐可言。

SongGongMei:This involves our country medicine science and technology and the development level of children's drug production process problems.Children's drug experimental high cost,Enterprise specializing in the production of children's medicine may not produce adult medicine high economic benefit,No power to research and development.so,Children's drug development/Clinical trials need to be national policy support,For medicine to give tax/R&d subsidies and incentives.In addition,Medicine to also want to pay attention to improve children's the taste of drugs,Adults all disease take medicine all feel to do not have the quality of life,What is the child,Especially some chronic diseases to the children,If you worry about every day in hard drugs,What is happiness.

　　中国青年报：您在开药时遇到过什么难题吗？

The China youth daily:You have to prescribe medicine what problem?

　　宋红梅：由于儿童药品少，家长给孩子服用成人药在剂量上很难用得准，我们只能让家长尽量买有液体剂型的药品，实在没有，就得把药品用水充分溶解，再计算孩子应该吃多少。这还会造成很大的药品浪费，比如治疗哮喘的吸入药物，一种药每天只用1/3或1/2，剩下的药也不能再用了。

SongGongMei:Because children less drugs,Parents give their children in adult medicine dose is difficult to use a tune,We can only let parents try to buy a liquid dosage form drug,Don't really have,You have to drug water dissolves,Recompute the child how much to eat.It will cause a lot of pharmaceutical waste,Such as the treatment of asthma of inhaled drugs,A kind of medicine every day for a third or half,The rest of the drug also can't use.

　　我碰到无药可用时最头疼。一些药品没有儿童的实验数据，只在说明书上注明“没有儿童用药经验”，甚至还注明“儿童慎用或禁用”。但有些孩子得了病不能用药治疗或没药可用，难以想象会有怎样的后果。

I have no medicine can be used the most headache.Some drugs are not children's experimental data,Only in manual marked"No medicine for children experience",Even indicate"Children with caution or disabled".But some kids got disease cannot medicate or myrrh available,It is hard to imagine how will the consequences.

　　中国青年报：在用一些“慎用药”时，您怎么和家长沟通？

The China youth daily:In some"Drug in"when,How do you and parents communicate?

　　宋红梅：鉴于孩子在家庭中的重要性，儿科的医患沟通就显得更加重要。首先要和家长取得共识，相互信任。其实，不用去说特别高尚的理由，我经常和家长说的是，医生是靠看病吃饭的，没有哪个医生会故意把病人看坏而砸自己的饭碗，用最小的副作用达到最大的治疗效果是每个医生都追求的治疗境界。

SongGongMei:In view of the importance of children in the family,Pediatric doctor-patient communication is more important.First of all to and parents agreed,Mutual trust.In fact,Don't have to say special noble reasons,I often and parents said,The doctor is to rely on to see a doctor,No doctor would deliberately put the patient look bad and hit him his job,With minimal side effects to achieve maximum treatment effect is every doctors are the pursuit of the treatment state.

　　一些慢性病的治疗周期较长，我最担心家长不按医生的方案去做。医生酌情用药，一步步地控制孩子病情，但一些家长自行改变治疗方式，给后面的治疗造成很大的困难。例如，一些家长因为担心激素的副作用，对于风湿病的患儿擅自停用激素药，就会造成病情复发，医生只有增加激素的用量甚至用副作用更大的药物才能再次控制病情，如此反复会对患儿身体造成更大伤害。所以作为医生应该向家长和患儿充分说明、耐心解释，和家长互相理解和信任，毕竟共同的目标是把孩子的病治好。(记者 王聪聪)

Some chronic treatment with a long cycle,I am most worried about parents not to the doctor's plan to do.The doctor discretionary drug,Step by step control a child,But some parents to change the ways of treatment,To the back of the treatment caused great difficulties.Such as,Some parents because worry about the side effects of hormone,For rheumatic patients discontinued hormone medicine without authorization,Can cause disease recurrence,The doctor only increase the amount of hormone even with more side effects of drugs to control their condition again,So again and again will cause more damage with the body.So as a doctor should ask the children and full explanation/Patient explanation,And parents understand each other and trust,After all, the common goal is the child's disease cure.(Reporter WangCongCong)