作為局外人去看北區醫院錯割乳房事件，種種報導反映了今日傳媒缺乏跟進議題的能力，而市民大眾的討論亦有欠深度。
錯割乳房的源起，在於把兩個標本錯誤調換。醫生根據另一名有癌細胞病人的組織報告，去切除了沒有腫瘤病人的乳房。這等級的醫療事故，自然成為翌日頭條，傳媒和公眾的批評，自然不絕於耳。
可是，傳媒字裡行間，可以見到大家會有一個疑問：「為什麼沒有病的乳房都可以被割？」，卻未見一人進深一步提問：「究竟該有癌細胞的乳房組織標本，屬於那一位苦主？」
真正令人擔心的，不止於無病的乳房有被切之慮．而在於原來過去一兩個月，你獲醫生告知「沒有癌細胞」這報告，其實可能是錯的！過去兩個月以來，你一直帶著癌細胞，繼續生活，你可能以為自己「一天都光晒」，你可能為未來的生活重新計劃，你甚至可能在低位入市買了股票搏十年後反彈，甚至你為了慶祝沒有癌細胞的新生活，上星期才購入了豪宅付了首期！
過去兩個月的「無癌生活」，原來只是暫借的。一個你個半月前應該已經接受的手術，卻時空運轉施錯在別人身上。傳媒關心無病的她被錯施手術所帶來的心理影響，卻沒有人關心有病的你因這陰錯陽差而拖延了個半月的治療，並在虛假的安全感下虛耗了六星期的人生。這位不幸的她，有傳媒關心過嗎？
傳媒也有跟進過，八月份獲告知標本沒有癌細胞的病人的心路歷程嗎？我相信大部份的病人最終依然沒有癌細胞，但報導一出，這星期她們望著自己的乳房，有機會是帶病的身軀，又是否真的睡得安吃得樂？這群消失在傳媒的一群，又有什麼人去關注她們的感受呢？
作為威爾斯外科醫生（同時亦曾在北區外科工作）的梁家騮那麼快便站出來表示，「相信事件與臨床外科醫生無關」。又有沒有記者察覺到梁家騮說這番的同時，與北區外科醫生以及病理科醫生的關係？作為曾經任職北區醫院外科的議員，究竟他說這番話的時候，是代表了誰的利益？近來不少聯網把不同醫院的病理部門整合，有一間龍頭醫院負責所有的標本化驗工作，以節省資源。究竟有無記者再去仔細發掘醫院之間病理標本的運送過程，出現了什麼問題？究竟因資源整合，有幾多的服務減省了，但同時增加了病人的危險？
被錯割良好乳房的苦主，固然不幸；但誤以為沒有癌症而懵然不知的病人，其前途以及生命就更令人擔心。部門和部門之間的資源角力，候任議員和公立醫生之間利益交涉，就恐怕未必是吃香港傳媒奶水大的香港讀者會有所關注。俗話說經一事長一智，我相信，出錯的群體「原本無心害你」，我會雖有在機制上找出問題的原因，對症下藥，防止問題再發生。可是，當大家只顧沉醉家好月圓喪駡的快感，享受箇中混沌一片的關係，連病人組織以及候任議員「在對立時候爭取勝利」，就再沒有人去抽絲剝繭分清事理，同樣的悲劇，只會一而再、再而三的發生，連環不幸事件的出現，我們就只以嘆息：「無非人生道理」。
21個回應
九月 22, 2008 at 1:18 am
這例子正好用來在社會統計課堂上，教學生甚麼叫type I error / type 2 error 。
檢查毒奶，是寧枉勿縱，慎防吃壞人；
抓小毛賊，要寧縱勿枉，不要冤枉好人。
割錯乳房呢，type 1 和 type 2 error 一齊犯，唉。
九月 22, 2008 at 7:51 am
醫生, 你說”拖延了個半月的治療，並在虛假的安全感下虛耗了六星期的人生”, 只是從醫生的角度看事物. 有甚麼安全感不是虛假的? 六星期快快活活的人生, 只是沒付錢給醫生們治病吧, 就算是虛耗了? 節省一點吧, 我們”應該”體檢, 我們”應該”治療, 我們”應該”付錢給醫生 — 究竟醫生說這番話的時候，是代表了誰的利益？ 現代醫學, 用盡方法把人的性命苟延殘存, 增加了的多是老殘病人生命中的一段段雞肋般的年日, 生活不見得健康愉快, 反把痛苦延長了. 在社會層面, 用高深莫測的”專業”意見, 誘使人民把利益輸送至醫生口袋裡, 為社會帶來不必要的醫療負擔, 醫生, 恐怕是人口老化的罪魁禍首吧?
九月 22, 2008 at 9:09 am
看來「路人」想找一個醫生博客來攻擊整個醫生群體，而且似是非常新來這博客的讀者，未曾看過我過去的文章。
一直以來，我反對不需要的體檢，反對醫學效益有限的治療，當然我不會反對付錢給醫生，（難道你搭巴士不用付錢嗎），卻對很多醫生天皇級的收費嗤之以鼻。
同樣，我經常批判現在醫學只是延長了生命，卻提高不了生活質素。醫學知識本身是一門專業，但專業知識能夠大眾化，一直是一班醫生博客的目標。不少受訪的「名醫」把醫學知識說得高深莫測，沒有病的也被看成患了絕症，雖然雙手奉送金錢給「名醫」打點；有些「名醫」更為病人以及家屬提供虛假的期望，為了那「一線生機」而將自己最後積蓄全部花光，這難道不是我一直在批評嗎？
本博客一直維持有容乃大的精神，就算是針對肥醫生本身的人身攻擊，我也會盡量保留，除非留言有廣告成份又或粗言穢語。
「路人」，節省一點吧，攻擊一個和你取態非常相近的醫生，對改善醫療霸權的生態根本無益。如果你打算找地方一竹桿打一船人，你恐怕找錯了目標和對象，但如何你曾經因為醫療霸權而受到傷害，我倒非常願意聆聽你的故事。(不用再留下虛假的電郵了，你留下的電郵只有我看得到。)
九月 22, 2008 at 10:11 am
Problem of Type one type two error, positive and negative predictability, risk ratio and odds.
compounded with disclosed of information based on system error.
Also exposed the weakness of Dr Leung, he has to know his role and perspective, safeguard the HK citizen’s health by look after the HK medical system, not just NDH or PWH.
路人 ’s posting has some reasons behind, 現代醫學, 用盡方法把人的性命苟延殘存, 增加了的多是老殘病人生命中的一段段雞肋般的年日, 生活不見得健康愉快, 反把痛苦延長了. 在社會層面, 用高深莫測的”專業”意見, 誘使人民把利益輸送至醫生口袋裡, 為社會帶來不必要的醫療負擔, 醫生, 恐怕是人口老化的罪魁禍首吧?, there are school of thoughts sharing these views, but do make a difference 路人, as the views from public doctors differs from private doctors, and even private doctors ,there are reasonable Fam doctors vs there are money interest driven private doctors. further more there are social workers, OAH, welfare workers, relatives all may sustained the ‘live long movement?!’
It is not doctors to decide, it is more doctors are as a tool to practice this life sustained wishes of the society….
also that 6 weeks not knowing (having cancer) and have no treatment may be positive for the patient concern, we do not know. But erro is an error, the spirit is to learn from mistake and cekc all parties concerned.
路人will know dr fat is the type of good doctor he (路人) wanted or demands.
九月 22, 2008 at 11:53 am
其實我反而想知, 怎會有這事故發生。 而一般的程序又是怎樣的?
肥醫生又可否以知情者身份解釋程序呢? 而你又有甚麼建議給我們大眾呢?
九月 22, 2008 at 1:52 pm
肥醫生是「知情者」嗎? …….
九月 22, 2008 at 4:05 pm
肥醫生:
看來多多得罪了.
“看來「路人」想找一個醫生博客來攻擊整個醫生群體…攻擊一個和你取態非常相近的醫生”
– 不是的. 我無意”攻擊”你, 只是以事論事, 不用起gong, 也不用以”一竹桿打一船人”來諷刺我, 我打的只是”在虛假的安全感下虛耗了六星期的人生”這句話及其背後的心態. 很高興原來你跟我”取態非常相近”, 那麼, 我更不明白, 為何是”虛耗”呢? 算了, 若不喜歡, 便不用回應我的問題.
“似是非常新來這博客的讀者，未曾看過我過去的文章”
– 是的. 希望你歡迎我這個新讀者.
“你曾經因為醫療霸權而受到傷害，我倒非常願意聆聽你的故事”
– 沒有. 我只是以事論事.
“不用再留下虛假的電郵了，你留下的電郵只有我看得到”
– 我不想留下電郵, 但那是”required”的, 唯有留下虛假的電郵; 那虛假的電郵豈不已含有sorry的信息?
another doctor:
謝謝你的理解. 你說得對, 苟延殘喘的願望, 本是來自人的求生意志, 但這種可敬的意志變了質, 反而忽視了生命的質素, 而醫學則成了這種慾望的主要工具. 人口老化, 最終極的禍首, 可是人的貪生之慾. 當這種”長命文化”越演越烈, 難得有(partly)靠其餬口的醫生寫blog與之抗衡, 在下是求之不得的; 很欣賞你和肥醫生有這份反省.
九月 22, 2008 at 4:09 pm
p.s.
tony就是”路人”
九月 22, 2008 at 5:37 pm
我有想過這個問題。報導說，抽了六條，其中一條有癌細胞。沒說是六條都調轉了，還是一只這一條調轉了。
我不知為何，有點覺得是當中一條調錯。因為我覺得做完一個，執執執send咗，再唞一唞才做第二個病人。所以我覺得出錯在 lab，若六條調錯，應該不只一條 show 惡性。
六條都錯和其中一條錯，原因和結果就會很不同。若是其中一條調錯，就應該不存在一個 false negative 的病人。因為那五個組織都很可能show 到有嘢。
九月 23, 2008 at 10:45 am
Dr fat, many resaonable and experienced doctor share your view:
1. 反對不需要的體檢，
2. 反對醫學效益有限的治療，
3.不會反對付 affordable and reasonable 錢給醫生\
4. 對醫生天皇級的收費嗤之以鼻。
5. 批判現在醫學只是延長了生命，卻提高不了生活質素。
6.「名醫」把醫學知識說得高深莫測，沒有病的也被看成患了絕症，雙手奉送金錢給「名醫」打點；
7.有些「名醫」intentionally 更為病人以及家屬提供虛假的期望，為了那「一線生機」而將自己(病人以及家屬)最後積蓄全部花光，
8.這難道不是dr fat 一直在批評嗎？– very true, keep the hot blood running. in year 2020, please look after me (or the healthcare of HK)
most of my colleagues in Senatorium suffers from cortical blindness induced by peer group financial standard, deluded by the grand new building, forgeting their very original reasons to do medicine.
Their act or deeds are that they serve the top 5% money earner of the population. ( though many go to the church and pray for the wellbeing of the world……
Tony road man: 人的求生意志, 但這種可敬的意志變了質, 反而忽視了生命的質素, 而醫學則成了這種慾望的主要工具. ….
well, medicine mainly exists as a response to human demand, it can be a tool , as a means, as an art (like music or drama, or muse)or as a science to work on the biological mechanism of human body…..it is also a icon of what life is all about….
many doctors have very deep concern on life qualities, only that they may be the minority in a society that weighs qualities by superficial parameters.
—找地方一竹桿打一船人—- most doctors in public service would have beared the verbal abuse, that is why (even good dr) like dr fat will react so. many of our ”dear ” lower class citizen use the public service to ventilate their anger and in such way, they HURT many good doctors and nurses heart.
九月 23, 2008 at 12:05 pm
為左慳錢，將D野送黎送去。
但其實每經多一個人的手，就多一次搞錯的機會。甚麼quality assurance都避免不了。
否則為左慳錢，教育局不如cut晒駐校社工，有乜事搵機構社工黎就成了。
九月 26, 2008 at 1:15 am
EUGENICS RULES!
LET the fittest survives and
KILL the poor / sick / old.
That is THE WAY, THE TRUTH and THE LIGHT!
TONY, I am on your side always !!!
九月 26, 2008 at 10:49 am
To TONY:
Quote from appledaily 20th SEPT. 2008
北 區 醫 院 發 生 駭 人 聽 聞 醫 療 事 故 ， 一 名 36 歲 女 病 人 因 左 乳 房 有 硬 塊 向 該 院 求 診 ， 被 確 診 患 上 乳 癌 ， 整 個 左 乳 切 除 後 才 證 實 腫 瘤 屬 良 性 ， 手 術 前 檢 測 的 癌 細 胞 樣 本 並 非 來 自 她 本 人 。
Quote from TONY
“現代醫學, 用盡方法把人的性命苟延殘存, 增加了的多是老殘病人生命中的一段段雞肋般的年日”
Although I love to have more old people die peacefully and decrease the burden of our “honorable” society, is it too aggressive to suggest an “OLD” lady as old as 36 years old to leave her breast cancer alone, accept all the morbidities and die “peacefully”?
Even Hitler cannot match your advance position in promoting eugenics, afterall, for sick people as a burden to society, Hitler killed institutionalised psychiatric patients only.
青出於藍勝於藍
You reign! You reign!
九月 26, 2008 at 6:32 pm
I would not suggest that a 36-year-old lady suffering from breast cancer should give up treatment, not to mention have her KILLED. But she has the freedom to give up, regardless of what the doctor says. I would say, I am closer to Taoism than eugenics or social darwinism. I would not advocate eugenics as an ideology, but survival for the fittest has always been a fact of life. We could try to counter the tyranny of “evolution” by humanitarian means, as all civilized societies have always been trying; in fact, I think it is what being “human” is all about. Otherwise, we would be no different from the animals. Nevertheless, we cannot afford to be blinded or muted by political correctness.
As for the financial burden of medical expenses, the ideal arrangement is everybody pays for her own expenses. But if a poor patient could not pay for her own expenses, the society would still consider to help. But to what limit? It depends on the social values, the chance of recovery and the cost involved, etc. There is always a point beyond which an average person in society considers it unreasonable to extend the treatment. Beyond that point, the poor patient would have to appeal to charity instead of taxation, or, accept all the morbidities and die peacefully. This is life.
What I’m suggesting is, some black sheep of the medical profession are indoctrinating that “average person” to push that “point” further and further up, WITHOUT bringing real health to the patient (or for that matter, real benefits for the society), with the intension of extracting more money from the ignorant patients (and the society) to their pockets, together with more social power and job security. (Some “black sheep” do not do it intentionally; they are only following the prevailing trend.)
Now that is a form of medical tyranny.
九月 26, 2008 at 6:53 pm
Tony Roadman, I share with your thoughts when I was young.
But Please be careful of doctor bashing.
How the society treats the doctor, the doctor repay the society.
If HA treats the doctors like dog, the doctors when they left ??? will certain get back what they think they are entitle to….
BUT
In my many many years of doctoring,
MOST doctors want to help patients.
Most doctors are normal people, and part of the community, so if the community worship money, they worship money as well.
There may be 1 in a thousand have some tyranny thought, but NEVER a culture nor organised act in medicine. We have pletny of tyanny in the church, NGOs, social workers , teachers, nurses, lawers, merchants, universities….we all know that.
At most, doctors do what the society expects them to do.
A few doctors would like to lead, and become the leaders in the profession. But these leaders still operates with some higher values. There are plenty of examples of good deeds and guts.
Work with the doctors, bashing all doctors only discourage good doctors to care for themselves and stop the already diminishing good heart. And reinforcing those determined ’selfcare doctors’…. It will become a selfish society.
It is human nature, I have seen many many examples.
九月 29, 2008 at 1:11 am
我仍在恨！
我不是事主，也不是女人，但醫院當人是豬來隨手？！
奇恥大辱！
仍在恨！
可憐事主怕曝光，暗啞底死忍！
本來可整容的。
九月 29, 2008 at 9:48 am
Garlic hing, I have worked in hosptial for decades, no doctor will deliberately mistreat patient. Most follow orders or their clinical judgment.
dr fat will know first hand.
This is a system error, the error mostly lies in the pathology handling, labelling or clerical, the doctor at the operating table worked according to the pathology report, he would not be able to challenge the biopsy report and called off the operation.
The spokesman for the hospital should apologise and laern more about patient-centre medicine, perhaps take some course in family medicine or psychology. He must be in adminstration for a long time, mind got rotten , only deal with statistic and forget about the patient.
九月 29, 2008 at 10:39 am
但見過太多草率地(雖然有程序)工作的的人，信心所存無幾了….
工作是否認真跟程序是否嚴謹可以是來回事
九月 29, 2008 at 10:40 am
更正錯字：
可以是件兩回事
十月 1, 2008 at 10:55 am
又是醫療事故﹗香港的醫療設備、
醫護人員的專業水評絕對屬世界級。
但發生醫療事故的機會率，
似乎比中六合彩要高得多。
每聽到這些新聞都會想，如果我是是主會怎樣？
自己將要入院做一個手術，亦明白任何手術都有風險。
但近年醫療事故頻生，能不心驚肉跳嗎？
十月 2, 2008 at 10:05 am
When I discussed this type of problem with my consultant colleagues many years ago, I suggested the patient, if in doubt and have minimal confidence can request the doctor and nurse or the maid to pray with them, to promise to them with a vow that they will do their best to there knowledge for the benefit of doubt.
I myself before the opretation will say/pray so, in my heart. Only that it may be a joke to the patient , OT nurse or the workman, and start wondering why…..
not good to your name.