全身插管仍被需求转院，这些癌症病人在辗转和仓惶中逝去
<img src="https://mmbiz.qpic.cn/mmbiz_jpg/JFpaScNWP4etWQeRYaJFZURcZSiaWGZ3EDuChxhiaR7GnqdkSqdBYekboct1HKibbIZv0icMfkwbu21gI1x6eP2bVA/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"><p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;">▲</span> </span><span style="color: black;"><span style="color: black;">照片</span><span style="color: black;">源自</span>：视觉中国</span></span></p><span style="color: black;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"> 编者按</span></strong></span></p><span style="color: black;"><span style="color: black;"><span style="color: black;">刚才</span>经历转院之痛的小战在母亲病逝后做了一个调查，“不分男女老幼，不分<span style="color: black;">严重</span><span style="color: black;">轻松</span>，哪怕是下了病危<span style="color: black;">通告</span>的病人，住院时间、<span style="color: black;">花费</span>一到，<span style="color: black;">大夫</span><span style="color: black;">亦</span>毫不留情地往外赶人。这让<span style="color: black;">非常多</span><span style="color: black;">病人</span>痛苦不堪，为了节省<span style="color: black;">花费</span>，为了不与医院<span style="color: black;">出现</span>矛盾冲突，只能<span style="color: black;">持续</span>地挨个转院。更有甚者，<span style="color: black;">有些</span><span style="color: black;">病人</span>死在转院途中，<span style="color: black;">或</span>折腾了几家医院后耗尽元神。”<span style="color: black;">医疗保险</span>作出这些限制，初衷是<span style="color: black;">保证</span>病人权利、防止过度医疗，<span style="color: black;">同期</span>更<span style="color: black;">有效</span>地利用<span style="color: black;">医疗保险</span>资金。卫健委的考核，是出于<span style="color: black;">加强</span>三甲医院资源利用率、更<span style="color: black;">有效</span>地治疗病人。正是<span style="color: black;">因为</span><span style="color: black;">迄今</span>尚不完善的临终关怀体系，像小战母亲<span style="color: black;">这般</span>的癌症终末期病人，仍然被迫变为三甲医院的</span><strong style="color: blue;"><span style="color: black;">“候鸟病人”，在辗转和仓皇中<span style="color: black;">逝去</span>。</span></strong></span>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">1</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">垂死之人，怎么还能让她转院？</strong></span></p><span style="color: black;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;">得知母亲被<span style="color: black;">需求</span>转院时，小战虽早有预期，但仍然感到错愕。</p>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">那是2020年8月25日，小战的母亲入住这家医院的第15天。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">小战在东北<span style="color: black;">成长</span>，大学毕业后来到广州工作、结婚生子。如今她是广州一家<span style="color: black;">机构</span>的高管，与丈夫、<span style="color: black;">孩儿</span>还有父母<span style="color: black;">一块</span>住在CBD珠江新城。为了给父母更好的医疗<span style="color: black;">保证</span>，她还把<span style="color: black;">她们</span>的<span style="color: black;">医疗保险</span>迁了过来。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">今年61岁的母亲是个爱说笑、爱交际的人，一向身体健康。2020年4月，她总说腰痛、胃不舒服，于是吃了些胃病的药，但没效果。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">5月初，母亲被一家三甲医院确诊胰腺癌晚期。哪怕是在一线城市广州，这<span style="color: black;">亦</span>是一家顶级医院，在<span style="color: black;">各样</span>全国范围的医院排行榜上，常年盘踞在前十，医院床位非常紧缺。小战发动自己的社会关系，几天后就让母亲住进了肿瘤科病房，<span style="color: black;">起始</span>化疗。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">化疗多次后，到8月初，<span style="color: black;">大夫</span><span style="color: black;">通知</span>，化疗已耐药，<span style="color: black;">无</span>其他有效治疗<span style="color: black;">方法</span>，只能进行支持性治疗，大概还有一两个月的时间，<span style="color: black;">意见</span>转院。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">小战并不想<span style="color: black;">没</span><span style="color: black;">道理</span>地占据顶级的医疗资源——<span style="color: black;">这儿</span>床位太紧缺，<span style="color: black;">乃至</span>出院当天办了手续还没离开，下一个<span style="color: black;">病人</span>就站在旁边等床位了。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">她想找个医院，能<span style="color: black;">保准</span>营养针、腹水处理和止痛，让母亲舒适、安心地度过余下的日子，最好离家近点。<span style="color: black;">不外</span>，她担心母亲这种<span style="color: black;">状况</span>，<span style="color: black;">非常多</span>大医院都不会收。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">她和家人向当时的主治<span style="color: black;">大夫</span>寻求<span style="color: black;">意见</span>。<span style="color: black;">大夫</span><span style="color: black;">意见</span>她去另一家医院，这家医院近年才被发展为三级综合医院，床位充足。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">这家医院的床位果然充裕。8月10日刚入院时，小战问主治<span style="color: black;">大夫</span>，母亲的病已到晚期，能否<span style="color: black;">始终</span>住下去。主治<span style="color: black;">大夫</span>回复说<span style="color: black;">能够</span>，“但可能中间要转一下，去外面（其他医院）住个十来天，<span style="color: black;">而后</span>再回来”。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">小战当时想：母亲还能下地走动、自主<span style="color: black;">摄食</span>，十来天后再转一次院应该<span style="color: black;">亦</span><span style="color: black;">不碍事</span>，于是她同意了。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">15天过去了，主治<span style="color: black;">大夫</span>口头<span style="color: black;">通告</span><span style="color: black;">必要</span>转院时，小战还是有些错愕。这是<span style="color: black;">由于</span>，<span style="color: black;">此时</span>母亲已完全<span style="color: black;">没</span>法<span style="color: black;">摄食</span>、<span style="color: black;">没</span>法下地，插着胃管、尿管、腹水导管，精神状态极差。就在几天前，主治<span style="color: black;">大夫</span>还下达了《病重<span style="color: black;">通告</span>》。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">“随时都有生命危险的人，怎么还能让她转院？”她想。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">2</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">惶恐中捱过最后的时光</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">主治<span style="color: black;">大夫</span><span style="color: black;">需求</span>转院的理由是：母亲是<span style="color: black;">医疗保险</span>身份，住院已有15天，<span style="color: black;">医疗保险</span><span style="color: black;">花费</span>超额，需转去外院治疗。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">小战<span style="color: black;">起始</span>上网搜索，还问了许多亲友。她<span style="color: black;">发掘</span>，<strong style="color: blue;">癌症晚期病人住院十来天后被要求转院的<span style="color: black;">状况</span>，在全国各地多家医院都频繁<span style="color: black;">出现</span>，并且已<span style="color: black;">连续</span><span style="color: black;">数年</span></strong>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">“不分男女老幼，不分<span style="color: black;">严重</span><span style="color: black;">轻松</span>，哪怕是下了病危<span style="color: black;">通告</span>的病人，住院时间、<span style="color: black;">花费</span>一到，<span style="color: black;">大夫</span><span style="color: black;">亦</span>毫不留情地往外赶人。这让<span style="color: black;">非常多</span><span style="color: black;">病人</span>痛苦不堪，为了节省<span style="color: black;">花费</span>，为了不与医院<span style="color: black;">出现</span>矛盾冲突，只能<span style="color: black;">持续</span>地挨个转院。更有甚者，<span style="color: black;">有些</span><span style="color: black;">病人</span>死在转院途中，<span style="color: black;">或</span>折腾了几家医院后耗尽元神。”</span></strong><span style="color: black;">她<span style="color: black;">这般</span>总结搜集到的信息。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">让她疑惑的是，她咨询得知，<span style="color: black;">医疗保险</span>局、卫健委均<span style="color: black;">没</span><span style="color: black;">关联</span><span style="color: black;">发帖</span>，<span style="color: black;">关联</span>官员公开<span style="color: black;">暗示</span>说<span style="color: black;">这般</span>操作是违规<span style="color: black;">行径</span>，医院<span style="color: black;">亦</span>不承认有这个政策。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">不外</span>她听说，<span style="color: black;">有些</span>医院会有“通融”之举：有的让病人办出院手续，但人不动，<span style="color: black;">次日</span>再办一次入院手续；有的让病人转为自费身份继续住一段时间，再改回<span style="color: black;">医疗保险</span>身份；还有让病人去同院其他科室住一段时间再转回来。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">她<span style="color: black;">期盼</span>母亲能<span style="color: black;">尽可能</span>少折腾，提出自费住院<span style="color: black;">1星期</span>，再转<span style="color: black;">医疗保险</span>住院。当时，主治<span style="color: black;">大夫</span>同意<span style="color: black;">帮助</span>与<span style="color: black;">专家</span>沟通。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">同日，护士撤走了心电监护仪，护理记录上的理由是<strong style="color: blue;">“撤病重”</strong>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">8月26日，主治<span style="color: black;">大夫</span>来回复：科室<span style="color: black;">专家</span>不同意自费，<span style="color: black;">由于</span>“<span style="color: black;">医疗保险</span>身份入院的病人转为自费属于违规操作”。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">小战当即去找科室<span style="color: black;">专家</span>面谈。<span style="color: black;">专家</span><span style="color: black;">保持</span><span style="color: black;">需求</span>转院，<span style="color: black;">意见</span>去一家二甲民营医院。经过小战一再争取，<span style="color: black;">专家</span>同意“等观察几天再说”。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">其间，主治<span style="color: black;">大夫</span>对小战提了<span style="color: black;">有些</span><span style="color: black;">意见</span>。<span style="color: black;">例如</span>，要不就回家住一天，<span style="color: black;">而后</span>再来。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">小战<span style="color: black;">亦</span>有些动摇，觉得回家一天似乎还<span style="color: black;">能够</span>接受。<span style="color: black;">不外</span>母亲已<span style="color: black;">不可</span><span style="color: black;">摄食</span>，在家打不了营养针，怎么办？她鼓励母亲试试吃一点小米粥，但母亲吃了一口就<span style="color: black;">起始</span>吐咖啡色液体。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">28日晚，负责照顾的家人<span style="color: black;">说到</span>“这几天药少了<span style="color: black;">非常多</span>”。小战上医院App<span style="color: black;">查找</span>每日用药记录，<span style="color: black;">发掘</span>母亲之前<span style="color: black;">每日</span>打的丙氨酰-谷氨酰胺、肽力佳等肠外营养液已被停掉。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">小战<span style="color: black;">暗示</span>不可置信。她找到主治<span style="color: black;">大夫</span>，<span style="color: black;">暗示</span><span style="color: black;">倘若</span>继续减少营养液就投诉、找<span style="color: black;">媒介</span><span style="color: black;">揭发</span>，<span style="color: black;">需求</span>马上自费住院。<span style="color: black;">大夫</span>解释减少营养液是当天一个小手术后的治疗<span style="color: black;">必须</span>，并答应与<span style="color: black;">专家</span>沟通，随后告诉她，<span style="color: black;">专家</span>已同意自费住院。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">火速</span>，母亲用的营养液又<span style="color: black;">增多</span>了。</span></p><img src="https://mmbiz.qpic.cn/mmbiz_jpg/JFpaScNWP4etWQeRYaJFZURcZSiaWGZ3EPUUHw2XQ16Uo6nGWSiarOemflyFXSy0WdiajMhfM11mgibmv8fApFJm9w/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">▲</span> </span><span style="color: black;"><span style="color: black;">照片</span><span style="color: black;">源自</span>：视觉中国</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">8月29日，小战陪床，听着母亲喊了一<span style="color: black;">夜晚</span>痛。30日凌晨4点多，她才睡着。早上6点多醒来，她<span style="color: black;">发掘</span>母亲已没了气息。护士听她说后，搬来了心电监护仪，但<span style="color: black;">表示</span><span style="color: black;">已经是</span>一条直线。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">“我就睡在她旁边。<span style="color: black;">倘若</span>有心电监护仪，她去世的时候我还能<span style="color: black;">晓得</span>。说不定，还能听到她对我说什么话，人在最后一刻想到的东西可能跟之前不<span style="color: black;">同样</span>……”</span></strong><span style="color: black;">小战回忆，有点哽咽。那天<span style="color: black;">败兴</span>，“妈妈是不是还有<span style="color: black;">有些</span>什么话<span style="color: black;">无</span>跟我来得及跟我讲”这个念头，<span style="color: black;">始终</span>在她脑中盘旋。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">更让小战难过的是，母亲的最后几天是在惶恐不安中度过的。她常对女儿说：“医院要赶我走，怎么办？”又说，自己不想转院，觉得身体折腾不起。小战<span style="color: black;">始终</span>安慰她：“你不会转院的。我都搞定了，你就安心在<span style="color: black;">这儿</span>躺着。”转身再去找<span style="color: black;">大夫</span>交涉。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">3</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">15天潜规则</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">“这个医院让住15天，<span style="color: black;">已然</span>算<span style="color: black;">非常多</span>了。”</span></strong><span style="color: black;">某三甲医院的一位肿瘤科<span style="color: black;">大夫</span>向八点健闻分析。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">几家三甲医院的肿瘤科<span style="color: black;">大夫</span>都对八点健闻分析：这个案例中，住院日是医院<span style="color: black;">根据</span><span style="color: black;">医疗保险</span>所付的<span style="color: black;">花费</span>倒推的，自己医院<span style="color: black;">通常</span>会<span style="color: black;">掌控</span>在7-10天。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">不少三甲医院的肿瘤科<span style="color: black;">大夫</span>，都不得不<span style="color: black;">需求</span><span style="color: black;">病人</span>转院，<span style="color: black;">导致</span><span style="color: black;">海量</span>“候鸟病人”，经常<span style="color: black;">引起</span>医患纠纷、<span style="color: black;">病人</span>家属四处投诉。“很头痛，给<span style="color: black;">咱们</span>的压力确实是很大。”前述<span style="color: black;">大夫</span>说。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">母亲去世后这两个多月，小战四处搜索<span style="color: black;">资讯</span>，<span style="color: black;">发掘</span>像母亲<span style="color: black;">这般</span>全身插管还要被<span style="color: black;">需求</span>转院，并不是孤例，频繁发生在全国多个地区。</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">在三甲医院住十来天，转到另一家三甲医院，再过十来天继续转院……<span style="color: black;">她们</span>本该在<span style="color: black;">安定</span>中度过最后时光，却被迫四处流离迁徙，精神焦虑不安，遭受了<span style="color: black;">不应</span>有的痛苦。<strong style="color: blue;">病人们和家属们怨言<span style="color: black;">持续</span>却又<span style="color: black;">没</span>可奈何，不同的医院、<span style="color: black;">大夫</span>对此<span style="color: black;">亦</span>有不同的处理<span style="color: black;">办法</span>，<span style="color: black;">引起</span>医疗纠纷<span style="color: black;">持续</span>。</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">数年</span>来，因住院平均花费不高、住院时间长，癌症晚期病人以及其他<span style="color: black;">步行到</span>人生尽头、只需支持性治疗和<span style="color: black;">平常</span>护理的人们，一向是三甲医院最不愿接受的病人。</span></strong></p><img src="https://mmbiz.qpic.cn/mmbiz_jpg/JFpaScNWP4etWQeRYaJFZURcZSiaWGZ3EWx1dp4VZA5oDHGtQA9fVH0h7QPTQyTuwchGia3YnwJBvJibdO7tTib9BA/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">▲</span> </span><span style="color: black;"><span style="color: black;">照片</span><span style="color: black;">源自</span>：视觉中国</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">前几年，<span style="color: black;">医疗保险</span>支付采取总额控费制度，一旦医院收治病人<span style="color: black;">太多</span>、医疗<span style="color: black;">花费</span><span style="color: black;">太多</span>，尤其是在年底有可能超出全年<span style="color: black;">花费</span>指标时，医院就<span style="color: black;">更易</span>推诿这些病人。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">2018年，广东省<span style="color: black;">起始</span>推行按病种分值付费<span style="color: black;">医疗保险</span>支付制度。新制度将病种和治疗方式打包支付固定金额，与总额控费制度相比，更能<span style="color: black;">保准</span>医院得到<span style="color: black;">医疗保险</span>支付，降低推诿病人的可能。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">八点健闻咨询了几位广州市的肿瘤科<span style="color: black;">大夫</span>，<span style="color: black;">日前</span>三甲医院的癌症晚期病人住院，会<span style="color: black;">根据</span>支持性治疗结算。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">她们</span>介绍，<span style="color: black;">根据</span>广州市<span style="color: black;">医疗保险</span>规定，胰腺癌治疗一次住院期总<span style="color: black;">花费</span>据诊断不同约为：</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">积极治疗——手术3-5万；化疗2万<span style="color: black;">上下</span>；</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">支持性治疗——1-2万。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">详细</span>数额视不同级别而定，三级医院金额最高。对自费比例<span style="color: black;">亦</span>有<span style="color: black;">需求</span>。<span style="color: black;">根据</span>《广州市社会保险<span style="color: black;">选定</span>医疗<span style="color: black;">公司</span>履行服务协议<span style="color: black;">状况</span>年度考核项目与评分标准（2020年度）》三级医院住院医疗<span style="color: black;">花费</span>的年度总体自费率应<span style="color: black;">掌控</span>在15%以内。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">小战<span style="color: black;">发掘</span>，在后一家三级医院的自费比例，比起在<span style="color: black;">第1</span>家医院化疗时高<span style="color: black;">有些</span>。而这较高的自费比例，<span style="color: black;">亦</span>是母亲能住15天之久的<span style="color: black;">重点</span><span style="color: black;">原由</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">刚入院那几天，小战问<span style="color: black;">怎样</span><span style="color: black;">才可</span><span style="color: black;">尽可能</span>延长住院时间。主治<span style="color: black;">大夫</span><span style="color: black;">意见</span>，<span style="color: black;">有些</span>高价的自费药可去院外购买，否则药费会<span style="color: black;">快速</span><span style="color: black;">提升</span>，可能住不到10天就得转院了。<span style="color: black;">因此呢</span>，由<span style="color: black;">大夫</span>开具处方，小战去院外自费购买了白蛋白。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">小战整理<span style="color: black;">花费</span><span style="color: black;">名单</span>，<span style="color: black;">发掘</span>到8月24日（被<span style="color: black;">需求</span>转院前一天），总<span style="color: black;">花费</span>为16026元，而<span style="color: black;">全部</span>住院<span style="color: black;">时期</span>总<span style="color: black;">花费</span>共计19450.19元。被<span style="color: black;">需求</span>转院后，小战曾在<span style="color: black;">大夫</span>的电脑上看到，自己母亲的<span style="color: black;">花费</span>那一栏变<span style="color: black;">成为了</span>红色，而之前是绿色。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">主治<span style="color: black;">大夫</span>曾对小战解释，<span style="color: black;">倘若</span>继续住院，超出<span style="color: black;">医疗保险</span>限额的<span style="color: black;">花费</span>，将由科室经费支付。小战感到不安，她觉得这必定<span style="color: black;">引起</span><span style="color: black;">大夫</span><span style="color: black;">掌控</span><span style="color: black;">花费</span>，于是更<span style="color: black;">保持</span><span style="color: black;">需求</span>自费。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">小战的一个疑惑是：<span style="color: black;">为何</span><span style="color: black;">不可</span>以自费身份继续住院？</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">熟悉广州<span style="color: black;">医疗保险</span>的业内人士分析，<span style="color: black;">医疗保险</span>病人转为自费继续住院<span style="color: black;">是不是</span>违规，分两种<span style="color: black;">状况</span>：</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">“<span style="color: black;">倘若</span>医院认为达到出院标准，但<span style="color: black;">病人</span><span style="color: black;">不愿</span>走非要继续住。<span style="color: black;">此时</span><span style="color: black;">倘若</span><span style="color: black;">病人</span>自费，不<span style="color: black;">运用</span><span style="color: black;">医疗保险</span>基金，不属于<span style="color: black;">医疗保险</span><span style="color: black;">分部</span>管辖范围；<span style="color: black;">倘若</span>医院认为没达到出院标准，但<span style="color: black;">需求</span><span style="color: black;">病人</span>转为自费，那就违规了，<span style="color: black;">医疗保险</span><span style="color: black;">分部</span>会对此进行查处。”</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">这位人士还指出，<span style="color: black;">重要</span>在于对出院标准的认定，卫生行政<span style="color: black;">分部</span>并<span style="color: black;">无</span><span style="color: black;">知道</span>统一的标准。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">一位广东的肿瘤科<span style="color: black;">大夫</span>对八点健闻分析：<strong style="color: blue;"><span style="color: black;">有些</span>医院会让<span style="color: black;">医疗保险</span>病人转为自费住院，但这从政策上<span style="color: black;">来讲</span>是违规的，医院<span style="color: black;">这般</span>做冒着很大的<span style="color: black;">危害</span>。“<span style="color: black;">例如</span>肿瘤晚期，<span style="color: black;">状况</span>只会越来越差。<span style="color: black;">倘若</span>家属转头说病情这么重达不到住院标准，说是医院诱导、逼迫<span style="color: black;">转载</span>费，找社保局告，社保局肯定是站在病人那边的。这种<span style="color: black;">状况</span><span style="color: black;">显现</span>一次，医院就怕了。”</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">4</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">终末期癌症病人的最佳去处是三甲医院吗？</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">除了<span style="color: black;">医疗保险</span>付费问题，一位三甲医院的肿瘤科<span style="color: black;">大夫</span>还对八点健闻分析，三甲医院<span style="color: black;">常常</span><span style="color: black;">需求</span>转院，还与<strong style="color: blue;">“平均住院日”</strong>这个卫健委对医院的考核指标<span style="color: black;">相关</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">“医院有平均住院日的压力，它就会进一步分解到<span style="color: black;">每一个</span>科室，再给科室下<span style="color: black;">详细</span>的任务。</span></strong><span style="color: black;"><span style="color: black;">详细</span>住院日期会<span style="color: black;">思虑</span>各科室的<span style="color: black;">状况</span>，<span style="color: black;">然则</span>整体都是往下压的。<span style="color: black;">例如</span>说肿瘤科去年的平均住院日是10天，<span style="color: black;">那样</span>今年就会被<span style="color: black;">需求</span>适当降低一点。”这位<span style="color: black;">大夫</span>解释。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">医疗保险</span>作出这些限制，初衷是<span style="color: black;">保证</span>病人权利、防止过度医疗，<span style="color: black;">同期</span>更<span style="color: black;">有效</span>地利用<span style="color: black;">医疗保险</span>资金。卫健委的考核，是出于<span style="color: black;">加强</span>三甲医院资源利用率、更<span style="color: black;">有效</span>地治疗病人。</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">一个问题是，小战母亲<span style="color: black;">这般</span>失去积极治疗<span style="color: black;">道理</span>、更<span style="color: black;">必须</span>支持性治疗的<span style="color: black;">长时间</span>住院病人，最好的去处是三甲医院吗？</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">三甲医院的定位</strong></span><span style="color: black;">，是<span style="color: black;">供给</span>高水平专科性医疗卫生服务和执行教育、<span style="color: black;">研究</span>任务，聚焦在</span><strong style="color: blue;"><span style="color: black;">“治愈”</span></strong><span style="color: black;">。<strong style="color: blue;"><span style="color: black;">医疗保险</span>对三级医院医疗<span style="color: black;">花费</span>的测算和<span style="color: black;">掌控</span>，是基于治疗的<span style="color: black;">规律</span>，治疗的<span style="color: black;">规律</span><span style="color: black;">花费</span>较多、天数较短 ；卫健委<span style="color: black;">针对</span>日住院天数的<span style="color: black;">需求</span>，是<span style="color: black;">加强</span>治疗型医疗资源的<span style="color: black;">运用</span>率。</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">这与终末期癌症病人所<span style="color: black;">必须</span>的<span style="color: black;">安定</span>疗护临终关怀理念相差甚远。</span></strong><span style="color: black;">终末期癌症病人所真正<span style="color: black;">必须</span>的，与三甲医院治疗的<span style="color: black;">规律</span>是相悖的——<span style="color: black;">她们</span><span style="color: black;">必须</span>一个相对<span style="color: black;">长时间</span>的床位占用<span style="color: black;">或</span>是护理，所需<span style="color: black;">花费</span><span style="color: black;">亦</span>较低，并不<span style="color: black;">必须</span>动用高级别医疗资源。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">三甲医院的医疗资源稀缺，讲究效率，<span style="color: black;">每一个</span>床位的成本更高，因此<span style="color: black;">海量</span>开设临终病房并不是最佳<span style="color: black;">选取</span>。<strong style="color: blue;">显然，社区和基层医院在临终关怀方面应负起更大责任。</strong></span></p><img src="https://mmbiz.qpic.cn/mmbiz_jpg/JFpaScNWP4etWQeRYaJFZURcZSiaWGZ3EtkbadDveticRwYeC4xFye1Lia8A5CiaNaz7DzhYG2jsLoibY4SFuIN6gFA/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">▲</span> </span><span style="color: black;"><span style="color: black;">照片</span><span style="color: black;">源自</span>：视觉中国</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">癌症终末期的病人，在大<span style="color: black;">都数</span>时候，<span style="color: black;">并不</span>应纳入以治愈为目的的三甲医院体系，更应进入专门的临终关怀体系。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">临终关怀，又<span style="color: black;">叫作</span><span style="color: black;">安定</span>疗护，旨在为<span style="color: black;">疾患</span>终末期或老年<span style="color: black;">病人</span>在临终前<span style="color: black;">供给</span>身体、心理、精神等方面的照料和人文关怀，<span style="color: black;">掌控</span>痛苦和不适症状，<span style="color: black;">加强</span>生命质量，<span style="color: black;">帮忙</span><span style="color: black;">病人</span>舒适、安详、有尊严地<span style="color: black;">逝去</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">当初，在<span style="color: black;">第1</span>家医院宣布<span style="color: black;">没</span>积极治疗<span style="color: black;">道理</span>、可能<span style="color: black;">仅有</span>一两个月时间之后，小战想到过</span><span style="color: black;"><strong style="color: blue;">“临终关怀”</strong></span><span style="color: black;">这个词。后来收到病重<span style="color: black;">通告</span>时，她<span style="color: black;">选取</span>了不同意进行气管切开、胸外按压、<span style="color: black;">呼气</span>机辅助<span style="color: black;">呼气</span>等一切有创救治<span style="color: black;">办法</span>。她对母亲最后时光的期待，其实正是临终关怀能<span style="color: black;">供给</span>的。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">小战平时爱看<span style="color: black;">资讯</span>，见识颇广。<span style="color: black;">不外</span>，与大部分普通人<span style="color: black;">同样</span>，她<span style="color: black;">整家</span>人都很少跟医院打交道，对医院没什么<span style="color: black;">认识</span>。她搜索过“临终关怀医院”，<span style="color: black;">发掘</span>广州很少，就没继续。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">其实，对临终关怀体系，国家层面已有<span style="color: black;">关联</span>设计。2017 年 1 月，原国家卫计委制定《<span style="color: black;">安定</span>疗护中心基本标准和管理规范(试行)》和《<span style="color: black;">安定</span>疗护实践指南(试行)》，从科室设置、人员、床位、设备、建筑、<span style="color: black;">公司</span>管理、质量管理等方面对各地<span style="color: black;">安定</span>疗护中心的建设和管理进行<span style="color: black;">指点</span>和规范。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">包含</span>广州在内的多地<span style="color: black;">医疗保险</span>对此<span style="color: black;">亦</span>有<span style="color: black;">关联</span>规定：对因脑血管意外<span style="color: black;">恢复</span>期、恶性肿瘤晚期等<span style="color: black;">疾患</span><span style="color: black;">必须</span><span style="color: black;">长时间</span>住院或在护理医疗<span style="color: black;">公司</span>接受住院治疗的<span style="color: black;">病人</span>，采用按床日分值付费管理。任何一级、二级医院都<span style="color: black;">能够</span>申请按床日付费，<span style="color: black;">没</span>需专门资格。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">广州市番禺市桥医院是广东省<span style="color: black;">第1</span>家开展临终关怀服务的公立医院，今年年初刚由一级甲等升为二级甲等。</span></strong><span style="color: black;">据新华网2019年<span style="color: black;">报告</span>《呵护生命的最后一程：中国多地探索临终关怀服务》，2018年，这家医院“部分<span style="color: black;">医疗保险</span><span style="color: black;">病人</span>在康宁科的每床每日总<span style="color: black;">花费</span>为280元至330元人民币，除去<span style="color: black;">医疗保险</span><span style="color: black;">统一</span>之外，每床每日自费约50元。”</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">理论上看，小战母亲<span style="color: black;">这般</span>的癌症晚期病人，<span style="color: black;">能够</span>在一家一级或二级医院得到临终关怀服务并得到<span style="color: black;">医疗保险</span>支付，还不会受到住院天数的限制。但<span style="color: black;">她们</span><span style="color: black;">为么</span>没进入临终关怀体系，仍然在三甲医院之间仓皇转院？</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">5</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">她们</span><span style="color: black;">为么</span>没进入临终关怀体系？</strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">2012年初，上海一位高中语文老师秦岭，给当时的市委书记俞正声写了一封公开信。秦岭的父亲患肺癌晚期，已<span style="color: black;">没</span>积极治疗<span style="color: black;">道理</span>。而大医院床位紧张，要秦岭父亲出院，但秦岭好<span style="color: black;">不易</span>将父亲<span style="color: black;">安排</span>到另一家医院，<span style="color: black;">火速</span>又被<span style="color: black;">需求</span>出院。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">秦岭的故事得到了广泛的共鸣，<span style="color: black;">亦</span>得到俞正声的关注。2012年，上海正式<span style="color: black;">起步</span>试点<span style="color: black;">安定</span>疗护。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">如今，在临终关怀<span style="color: black;">行业</span>，上海走在全国最前列——全市246家社区卫生服务中心已全部开展<span style="color: black;">安定</span>疗护服务，<span style="color: black;">安定</span>疗护还在向<span style="color: black;">2、</span>三级医疗<span style="color: black;">公司</span>延伸。自2019年9月至2020年8月，上海共<span style="color: black;">供给</span><span style="color: black;">安定</span>疗护服务1.16万人次。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">而在全国，<span style="color: black;">安定</span>疗护体系的发展还<span style="color: black;">非常</span>滞后。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">北京师范大学中国社会管理<span style="color: black;">科研</span>院/社会学院教授谢琼在2020年<span style="color: black;">发布</span>的论文《死得其安：临终关怀服务体系的构建与完善》中指出：“……临终关怀发展<span style="color: black;">始终</span>疲软、力量不足，<span style="color: black;">重点</span>表<span style="color: black;">此刻</span>服务<span style="color: black;">供给</span>仅零星分布于医院、社区，覆盖面小，未形成规模；已设立的临终关怀<span style="color: black;">分部</span>和<span style="color: black;">公司</span>因利润低、财务支持不足等<span style="color: black;">原由</span>撤转现象时有<span style="color: black;">出现</span>，等等。”</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">她还在这篇论文中援引中国生命关怀协会的内部交流数据: 我国临终关怀的社会<span style="color: black;">实质</span>覆盖率仅为10%，而发达国家和地区的服务覆盖率均在80%以上。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_jpg/JFpaScNWP4ePibly1LOHuTjPZzu2yvrkGO31JRHw6KOBibC1OYp6ZYMB4o98rU2KLtfWJdsRiajycx72wffkMfIbg/640?wx_fmt=jpeg&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"><span style="color: black;"><span style="color: black;">▲</span> </span><span style="color: black;"><span style="color: black;">照片</span><span style="color: black;">源自</span>：视觉中国</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">肿瘤监测数据统计<span style="color: black;">拥有</span><span style="color: black;">必定</span>滞后性。<span style="color: black;">根据</span>广州市最新的数据，2014-2015年该市恶性肿瘤发病率为299.10/10万，死亡率为158．28／10万。<span style="color: black;">根据</span>广州市常住人口约1530万人计算，广州市每年有24000多人因癌症去世，这<span style="color: black;">亦</span><span style="color: black;">寓意</span>着，广州市每年最少有24000人<span style="color: black;">必须</span>得到临终关怀体系的支持。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">广州医科大学护理学院外科护理教研室讲师郝燕萍在《中国公共卫生》上<span style="color: black;">发布</span>的《广州市临终关怀<span style="color: black;">公司</span>资源及<span style="color: black;">状况</span>调查》，截止2016年底，广州<span style="color: black;">仅有</span>13家卫生<span style="color: black;">公司</span>开展临终关怀服务，临终病床共672张。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">为何</span>在大部分地区，临终关怀体系还<span style="color: black;">无</span>建起来？</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">首要</span>，最<span style="color: black;">平常</span>的问题是病人不愿意。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">8月10日，在第二家医院办理入院手续时，<span style="color: black;">因为</span><span style="color: black;">大夫</span>的一时“失言”，小战母亲才<span style="color: black;">第1</span>次听说自己的真实病况。当时，母亲确诊胰腺癌已近3个月。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">之前，<span style="color: black;">整家</span>人怕母亲心理受不了、病情<span style="color: black;">发展</span>更快，<span style="color: black;">始终</span>瞒着，对母亲说只是“腰椎长了个东西，化疗把它除掉就好了”。住肿瘤科病房，小战的解释是“其他科没床位，刚好<span style="color: black;">仅有</span>肿瘤科有”。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">“直到最后几天，她才告诉我，其实她早就<span style="color: black;">晓得</span>得了什么病。假装不<span style="color: black;">晓得</span>，<span style="color: black;">亦</span>是在骗我。她<span style="color: black;">重点</span><span style="color: black;">亦</span>是怕我担心难过。”小战回忆，又红了眼圈。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">决定<span style="color: black;">起始</span>支持性治疗的时候，小战和丈夫还<span style="color: black;">思虑</span>过民营医院，觉得那里有可能能住更久，<span style="color: black;">前提</span><span style="color: black;">亦</span>更好。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">但要离开<span style="color: black;">第1</span>家以肿瘤治疗见长的<span style="color: black;">第1</span>家顶级三甲医院，母亲已有被放弃的感觉。听到“民营医院”，她更想到“水平差”，很抗拒。<span style="color: black;">整家</span>人怕<span style="color: black;">保持</span>下去，母亲会猜测到自己<span style="color: black;">无</span>治疗<span style="color: black;">道理</span>、时日<span style="color: black;">没</span>多，于是不敢再提。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">转院时，小战<span style="color: black;">亦</span>小心翼翼编了理由，说化疗对身体<span style="color: black;">损害</span>大，<span style="color: black;">大夫</span><span style="color: black;">需求</span>疗养一阵<span style="color: black;">弥补</span>营养<span style="color: black;">才可</span>继续，而<span style="color: black;">第1</span>家医院床位太紧，第二家医院床位宽裕还离家近。母亲这才接受。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">直到最后，母亲都<span style="color: black;">特别有</span>求生欲，<span style="color: black;">始终</span><span style="color: black;">期盼</span>继续治疗。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">这<span style="color: black;">亦</span>是国内从事安宁疗护的<span style="color: black;">大夫</span>们在劝说病人接受临终关怀理念时，颇为熟悉的<span style="color: black;">状况</span>。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">一位在广东地区从事<span style="color: black;">安定</span>疗护的<span style="color: black;">大夫</span>告诉八点健闻，“<span style="color: black;">她们</span><span style="color: black;">通常</span>就说，我跟家人商量一下。过后就不见<span style="color: black;">咱们</span>了，<span style="color: black;">仅在</span><span style="color: black;">tel</span>里说商量过了、还要继续治，不想放弃最后一丝<span style="color: black;">期盼</span>。”</span></p><img src="data:image/svg+xml,%3C%3Fxml version=1.0 encoding=UTF-8%3F%3E%3Csvg width=1px height=1px viewBox=0 0 1 1 version=1.1 xmlns=http://www.w3.org/2000/svg xmlns:xlink=http://www.w3.org/1999/xlink%3E%3Ctitle%3E%3C/title%3E%3Cg stroke=none stroke-width=1 fill=none fill-rule=evenodd fill-opacity=0%3E%3Cg transform=translate(-249.000000, -126.000000) fill=%23FFFFFF%3E%3Crect x=249 y=126 width=1 height=1%3E%3C/rect%3E%3C/g%3E%3C/g%3E%3C/svg%3E" style="width: 50%; margin-bottom: 20px;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">▲</span> </span><span style="color: black;"><span style="color: black;">照片</span><span style="color: black;">源自</span>：视觉中国</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">小战向医院争取自费住院那几天，母亲肚子上的腹水管掉了，重新做了个小手术装上去。而<span style="color: black;">倘若</span>在<span style="color: black;">1、</span>二级医院，不<span style="color: black;">必定</span>有<span style="color: black;">大夫</span>能做这个手术。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">这是<span style="color: black;">安定</span>疗护体系未能发展起来的第二个<span style="color: black;">原由</span>——终末期病人有<span style="color: black;">非常多</span><span style="color: black;">尤其</span>的医疗需求，而一二级医院技术水平参差不齐，未必能满足。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">“<span style="color: black;">例如</span>症状<span style="color: black;">掌控</span>，放腹水之类，<span style="color: black;">仅有</span>专科<span style="color: black;">大夫</span>才有能力做。”<span style="color: black;">以上</span><span style="color: black;">大夫</span>分析。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">另外</span>，他还指出，这<span style="color: black;">周期</span>病人的常规护理，<span style="color: black;">亦</span>与<span style="color: black;">一般</span>治疗阶段有所不同，许多一二级医院<span style="color: black;">大夫</span><span style="color: black;">亦</span>仍需<span style="color: black;">增多</span><span style="color: black;">认识</span>。<span style="color: black;">例如</span>：“<span style="color: black;">麻木</span><span style="color: black;">是不是</span>适合上？多少合适？这<span style="color: black;">周期</span>病人还<span style="color: black;">必须</span><span style="color: black;">思虑</span>吗啡成瘾问题吗？<span style="color: black;">有些</span>病人病情不适合<span style="color: black;">摄食</span>，但在<span style="color: black;">安定</span>疗护病房，<span style="color: black;">咱们</span><span style="color: black;">通常</span>说想吃什么就吃，大不了不咽下去，但<span style="color: black;">能够</span>尝尝味道。”</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">母亲去世两个多月后，再提起“临终关怀”，小战说：“<span style="color: black;">倘若</span>一<span style="color: black;">起始</span><span style="color: black;">大夫</span>就介绍了这类型的医院，<span style="color: black;">或</span>我就会想其他的话术去骗妈妈，到这种医院继续住下去。”</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">然而，哪怕是那家顶级三甲医院肿瘤科的<span style="color: black;">大夫</span>，在<span style="color: black;">意见</span>小战母亲转院时，给出的<span style="color: black;">意见</span>是同为三级、只是床位充裕的医院。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">一位从事<span style="color: black;">安定</span>疗护<span style="color: black;">数年</span>的<span style="color: black;">大夫</span>还<span style="color: black;">说到</span>，“<span style="color: black;">日前</span><span style="color: black;">非常多</span>医护人员都没<span style="color: black;">安定</span>疗护的概念，会<span style="color: black;">意见</span>病人去三甲。”</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">乃至</span>在他所在医院，刚<span style="color: black;">起始</span>做<span style="color: black;">安定</span>疗护<span style="color: black;">关联</span>院内培训时，<span style="color: black;">亦</span>有被培训的医护人员说，“好残忍，怎么就不治他了？”</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">他所在的一家三甲医院，是当地的临终关怀服务试点之一，还负责对下级医院的诊疗技术支持和带教，<span style="color: black;">安定</span>疗护病房设置已相当成熟。除了症状<span style="color: black;">掌控</span>、身体护理，还有心理咨询师进行心理辅导，社工帮忙<span style="color: black;">处理</span>家庭困难等等。兼顾“身心社灵”，<span style="color: black;">才可</span>真正达到<span style="color: black;">安定</span>疗护的标准。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">不外</span>，不论是近年流行的按床日付费，还是按项目付费的制度，只能覆盖其中“身”的部分，心理咨询、社工服务的<span style="color: black;">花费</span>，在<span style="color: black;">日前</span><span style="color: black;">医疗保险</span>体系中仍是一片空白。这<span style="color: black;">亦</span>是各家医院<span style="color: black;">供给</span><span style="color: black;">安定</span>疗护服务的又一重限制。</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">正是<span style="color: black;">因为</span><span style="color: black;">迄今</span>尚不完善的临终关怀体系，像小战母亲<span style="color: black;">这般</span>的癌症终末期病人，仍然被迫变为三甲医院的“候鸟病人”，在辗转和仓皇中<span style="color: black;">逝去</span>。</span></strong><span style="color: black;"><span style="color: black;">■</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="data:image/svg+xml,%3C%3Fxml version=1.0 encoding=UTF-8%3F%3E%3Csvg width=1px height=1px viewBox=0 0 1 1 version=1.1 xmlns=http://www.w3.org/2000/svg xmlns:xlink=http://www.w3.org/1999/xlink%3E%3Ctitle%3E%3C/title%3E%3Cg stroke=none stroke-width=1 fill=none fill-rule=evenodd fill-opacity=0%3E%3Cg transform=translate(-249.000000, -126.000000) fill=%23FFFFFF%3E%3Crect x=249 y=126 width=1 height=1%3E%3C/rect%3E%3C/g%3E%3C/g%3E%3C/svg%3E" style="width: 50%; margin-bottom: 20px;"></p><span style="color: black;"><strong style="color: blue;"><span style="color: black;">咱们</span>尊重原创版权，未经授权严禁转载。</strong></span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">本文<span style="color: black;">源自</span>：</span><span style="color: black;">八点健闻（ID:Healthlnsight）</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">本文编辑：小璇</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><strong style="color: blue;">▼</strong><span style="color: black;">爱好</span>，就给我一个</strong></span><span style="color: black;"><strong style="color: blue;">“在看”</strong></span></p>
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