医疗过失与法律责任
1.If a physician has treated a man with a metal knife for a severe wound, and has caused the man to die, or has opened a man's tumor with a metal knife, and destroyed the man's eye, his hands shall be cut off …
—— Hammurabi's Code, 1800 BC
【译文】如果一个医生操刀救治重伤患者而导致了他的死亡，或者切除肿瘤时毁坏了他的眼睛，那么，就应该砍掉这个医生的手……
【考注】这句话出自公元前18世纪的《汉穆拉比法典》（Hammurabi's Code）。那个时代两河流域的美索不达米亚（Mesopotamia）文明就对医疗过错有那么严厉的罚则，一方面体现法治精神，另一方面可能是那个年代动刀做手术所导致死亡或致残率太高，必须加以严管。
2.If Hammurabi's Code would be in effect today, almost half of the surgeons would go around without arms.
—— Moshe Schein
【译文】如果《汉穆拉比法典》今天仍有效，那么我们周围几乎一半的外科医生没了双臂。
3.I had to pay two hundred pounds damage, and the law expenses were two hundred pounds more.The loss of the money I did not feel, but I have severely felt being pointed at as an ignorant man.
—— Astley Paston Cooper, 1768——1841
【译文】我不得不赔偿200英镑（按现在汇率计算约1683.84元）的损失，外加200英镑律师费。破财我不在意，但让我深感严重的是我被指为无知之徒。
4.How rarely do our medicines do good? How often do they make our patients really worse! I fearlessly assert that in most cases the sufferer would be safer without a physician than with one.I have seen enough of malpractice of my professional brethren to warrant the strong language I employ.
—— Francis Hopkins Ramadge, 1793——1867
【译文】我们的药物有多少时候是有效的？反倒是常让我们的患者病情恶化！我大胆地断言，多数情况下，患者没有医生比有医生更安全，我见到过太多我们同仁的医疗过失，所以才让我使用如此武断的措辞。
5.Difficult as it may be to cure, it is always easy to poison and to kill.
—— Ralph Waldo Emerson, 1803——1882
【译文】治愈很难，但伤害与致命很容易。
6.These people say further, that the greater part of the illness, which exists in their country, is brought about by the insane manner in which it is treated.
—— Samuel Butler, 1835——1902
【译文】这些人补充说道，在他们国家现有的大多数疾病是由疯狂的治疗方式所导致的。
【点评】抗生素滥用所带来的一些疾病就是一个很好的佐证。
7.Doctors are just the same as lawyers; the only difference is that lawyers merely rob you, whereas doctors rob you and kill you, too.
—— Anton Chekhov, 1860——1904
【译文】医生和律师一样，唯一的区别在于：律师只是打劫你，而医生不仅打劫你还会要你的命。
【点评】常听到坊间老百姓有这种说法，今天终于知道其出处了。
8.The knife is dangerous in the hand of the wise, let alone in the hand of the fool.
—— Hebrew Proverb
【译文】刀子在智者手中都是危险的，更不用说在傻瓜手中了。
9.Not that I am unaware that the wickedness of many of our craft,accompanied by ignorance, is the reason that this part of surgery is so held in contempt.
—— Pierre Franco, 1500——1561
【译文】其实我很清楚，不少开刀匠的不道德，加上无知，才是这些外科手术如此不受待见的原因。
【点评】几粒老鼠屎，往往坏的不是这几个人，而是毁坏了整个行业。
10.We waste much time blushing for the evil things done by our friends.
—— J.Chalmers Da Costa, 1863——1933
【译文】我们浪费了很多时间为同仁所行不义而羞愧。
【点评】 可惜的不是时间而是全体医务人员的声誉。常常是成千上万医务人员长年累月、忍辱负重的平凡工作，好不容易赢得了社会对这个群体的理解与支持之时，突然爆出某些个别败类的恶行丑闻，给全社会迎头一棒，让整个医疗界为之蒙羞。
11.Surgeons who commit indefinite frauds inputting forth their charms and their superstitions, who often spend much time to charm, after which they begin by making an incision but are unable to complete the operation, keeping the poor patient in the meantime, in great languishment.
—— Pierre Franco, 1500——1561
【译文】有些外科医生不惜以欺骗手段来赢得他们的魅力和患者对他们的迷信，并花不少时间以此来吸引患者，之后他们拉开了切口开始手术时却又无法完成手术，从而让可怜的患者陷于极度苦闷之中。
【点评】如今我们依然能见到不少这类外科医生。
12.Surgery, like aviation, is in itself not inherently dangerous.But to an even greater degree than the sea, it is terribly unforgiving of any carelessness, incapacity,or neglect.
—— Francis D.Moore, 1913——2001
【译文】手术犹如飞行，本身并不危险，但无论如何，任何的粗心、能力不足或疏漏都是极其不可宽恕的。
13.Surgery is the most dangerous activity of legal society.
—— P.O.Nystrom
【译文】外科手术是法制社会中最具风险的活动。
【点评】乍一听似乎过于夸张，静思却恰如其分。
14.The real problem isn't how to stop bad doctors from harming, even killing the patients.It's how to prevent good doctors from doing so.
—— Atul Gawande
【译文】真正的问题不是如何阻止不良医生伤害甚至致患者死亡，而是如何防止好医生也这么做。
15.Risk management begins just when you first meet the patient and family.
【译文】风险管理要从你第一次见到患者及其家属开始。
16.If it has not been written it did not exist.
【译文】如果没写下来，就相当于不存在。
【点评】医疗文书真的很重要。
17.The case record is written for the public prosecutor.
—— Youry Vladimirovitch Plotnicov(https://www.daowen.com)
【译文】病历记录是为公诉人而写的。
【点评】这不正是我们病历质量督察员每天说的话吗？
18.Acknowledge each member of the family——look into his or her eye——one of them may be the one to initiate the lawsuit against you.
【译文】知情告知给患者的每一位家庭成员——注视着他们的眼睛——因为其中可能就有一个会起诉你。
【点评】看来随时准备当被告的情况不只发生在中国！
19.If it is good medicine, it is good law.
—— Ivor Lewis, 1895——1982
【译文】好医学也应该是好法律。
20.Why won't a systems approach (to malpractice) work? Well, there is no system.There is no medical system.There is no single integrated process.There are multiple parallel patch-work systems.They all compete——the surgeon, the hospital,the residency, the legal, the political, the patients, and the advocacy system.This is the basis of the medicolegal system.You would have to have this all together to solve any problem.
—— Kenneth A.Kern
【译文】为什么没有一个解决医疗事故的系统路径？嗯，没有这样一个体系，至少没有一个独立的、综合流程的医疗体系，只是多个并行、相互拼凑的一个工作系统，外科医生、医院、住院医师、法律、政治、患者和宣传系统等，他们全都在竞争。这是法医学体系的基础。你要想解决问题，就得把这一切整合在一起。
【点评】的确，现行的医疗服务系统有很多参与者，各自有其不同的诉求和利益，但很多参与者并不直接面对患者，而是通过各种渠道间接聚焦到了直接面对患者的医护人员这个节点，因此要想有效防范医疗过失的发生必须从整个系统着手。
21.It is generally the ignorant who condemn the doctor.Intelligent people give him credit.
—— Arthur E.Hertzler, 1870——1946
【译文】通常，无知的人才会指责医生，给医生以信任的才是智者。
【点评】的确，信任是对医生最大的尊重，可惜不是每个患者都那么理性。
22.Patients sue not when the patient gets angry with the doctor, but when the doctor gets angry at the patient.
—— Thomas J.Krizek
【译文】患者不是在他对医生生气时起诉医生，而是在医生对患者发脾气时。
【点评】不对患者发火不一定就可免遭患者投诉，但不对患者发火应该是做医生的基本职业素养。
23.Sins of omission are harder to prove than sins of commission.
【译文】不作为之罪比乱作为之罪更难以取证。
24.I prefer to die by the decree of God rather than by the hand of man.
—— Guillaume Dupuytren, 1777——1835
【译文】我接受上帝安排的死，而不愿死在人手上。
25.Who wants to pay for the dead?
—— Monte Python
【译文】谁也不想为死者买单。
26.Every now and then an expert witness is found to possess one of those well-trained memories which is able to remember everything advantageous and nothing harmful to that side of the case.
—— J.Chalmers Da Costa, 1863——1933
【译文】我们常常发现专家证人拥有一种训练有素的记忆力，能记住所有对本案有利的每一件事情，而对其不利的事情一概不记得。
【点评】屁股决定脑袋。
27.At the M & M like in Brooklyn courts——lie or die!
【译文】 在“并发症和死亡病例”讨论会上——就像在布鲁克林法庭上一样——要么说谎，要么死!
【点评】无论是讨论会还是法庭上，事实终归是事实，谎言是不可持久的。
28.The only thing jurors hate more than cocky surgeons are cocky lawyers.
【译文】对陪审员来说，唯一比自大的外科医生更令人讨厌的就是神气十足的律师。
29.Two thirds of the world's lawyers live in the USA.
【译文】世界上有2/3的律师在美国。
【点评】所以要有与律师打交道的充分心理准备。
30.Medical practice has also evolved so that now a defensive element tempers the physician's diagnostic and therapeutic approach ...defensive medicine, with its economic and emotional consequences, is a pollutant byproduct of society that should be eradicated.
—— Seymour I.Schwartz
【译文】医疗实践也在不断演变，导致现在医生的诊断和治疗都受到一种（自身）防御性因素的左右……即防御性医学（defensive medicine），其所带来的经济和情感后果，是一种受污染的社会副产品，应予根除。
【点评】“防御性医学”的确是全人类的一大公害。国内这一情形的泛滥和加剧应该是2002年9月新的《医疗事故处理条例》开始实行所谓“举证责任倒置”之后的事。如何鼓励医务人员的责任担当又避免他们动辄就陷入当被告的泥潭，需要全社会的共同努力。
31.A CT scan a day keeps the lawyers away.
—— Howard Bennett
【译文】一天一次CT，律师远离你。
【点评】典型的“防御性医学”思维。
32.As I understand surgeons in the US should follow the standards of care.Then how do you try new techniques——because every new way of treatment is the deviation from standard of care?
—— Nick Mende
【译文】据我所知，美国的外科医生都应该遵循标准治疗。那么，你如何尝试新技术——因为每一种新的治疗方法都与标准治疗相背离？
【点评】规矩与创新相辅相成，无法分割。我们既要生活在规矩中，更需要在规矩中创新，不能因为怕吃官司就拒绝去探索新的未知世界。
33.Lawyers sue us for the slightest provocation——put us under subpoena even when we know nothing of the case on trial——cross examine us with scorn and with a morbid interest in our private affairs, and combat us when we try to collect a proper fee from a reluctant millionaire.
—— J.Chalmers Da Costa, 1863——1933
【译文】律师会因为某些无足轻重的行为而起诉我们——即使我们对在审的案件完全不知情，他们也会传唤我们——带着轻蔑和对我们私人事务的病态兴趣盘问我们。如果我们试图从一个不情愿的百万富翁那里收取适当费用时，他们会与我们抗争。
【点评】看来这些律师真不是省油的灯！