第九章 职业操守
1.Nor is the public aware of the temptation, which men of our profession withstand.Credit for great abilities, gratitude for services performed, and high emoluments are ready to be bestowed for a little deception, and that obliquity of conduct, which does not amount to actual crime.
—— Charles Bell, 1774——1842
【译文】公众也不了解我们（医生）这个职业所承受的诱惑。因出众的才能获得声望，因所提供的服务获得感激。哪怕耍了一点小把戏，一些不构成犯罪的歪门邪道就可以获得高额酬金。
【点评】 一百多年前用于临床的一些外科手段并不太成熟，很难在“犯罪”“骗术”，还是“治病”之间严格区分，并且就那么一点落后、不成熟的外科手段一旦为患者带来些许帮助或者万一治好了几个患者，外科医生就是民众心中的神，感激和酬谢随之而来。大师说这段话的意思应该是提醒外科医生要正确认识自己，懂得感恩并且守住“医”和“巫”的界限，经得起这些诱惑。
2.Physicians must particularly try to avoid being quacks.The fact that medicine is not an exact science favors quackery.
—— J.Chalmers Da Costa, 1863——1933
【译文】医生尤其须努力避免成为江湖骗子。因为事实上医学不是一门精确的科学而易于落入骗术。
【点评】百余年后的今天，医学的这种无奈改善并不多。
3.I say to all surgeons if there are two or several of them that they should never quarrel before the patient for that would frighten the patient very much.
—— Hieronymus Brunschwig, 1450——1512
【译文】 我对所有的外科医生说，你们彼此之间永远不要在患者面前争吵,否则会吓着患者。
4.You should not praise yourself but also not belittle the others.You should honour all men but particularly the priests and physicians so that you will have a good name.
—— Hieronymus Brunschwig, 1450——1512
【译文】不应自我赞美，也不要贬低他人，你要敬重所有人，特别是牧师和医生，这样你方能获得美誉。
5.I have notice a tendency on the part of an occasional elderly and distinguished man to think that the rules of medical ethics were meant for young fellows just starting out , but not for him.
—— J.Chalmers Da Costa, 1863——1933
【译文】我发现有一个倾向，偶尔有些上了年纪的杰出人士认为医学的道德规范只是为刚出道的年轻人制定的，而与他们自己无关。
6.From the class of medical tradesmen come the prescribing and operating quack, the divider of fees, the recipient of commissions, the advertiser, the exploiter of formulas, the stealer of patients, the deceiver of sick persons, the swindler, the jealous vilifier of his professional brethren, the wholescale dealer in innuendo and calumny… the tricks that are expected in a trade are disgraceful in a profession.The medical tradesman is being extremely low in the scale of animal creation, and he is responsible for most of the evils under which the profession labors.
—— J.Chalmers Da Costa, 1863——1933
【译文】从“医疗商人”阶层中滋生出一些开处方、做手术的江湖医生，分赃、接收佣金、卖广告、盘剥配方、偷患者（财物）、骗患者、欺诈、嫉妒、诋毁同行，影射和诽谤所有经销商……在其职业行医过程中追求这种商业交易的小把戏是可耻的，即使以动物视角来衡量，这种“医疗商人”也是非常低劣的，他应该对职业工作中的大多数恶行负责。
【点评】不良商业习性对医疗职业的侵染，玷污的不仅仅是医疗队伍的金钱，更可怕的是腐化我们的灵魂，影响着我们的思维定式与行为习惯。
7.The man who pays commission for cases has the effrontery of the confidence man, the skills of the pickpocket, the conscience of the burglar.It is a foul taint on the profession.
—— J.Chalmers Da Costa, 1863——1933
【译文】 按其处理的病例数来支付佣金的人有着骗子的无耻、扒手的伎俩、窃贼的德行。这是对这个职业的玷污。
【点评】如何科学、公平地支付医务人员的劳动报酬，是一件至关重要的事情！
8.He must avoid all advertising … as well as issuing of private cards inviting the attention of persons affected with particular diseases … avoid having on his letter heads … the word "specialist" … he must not promise to perform radical cures, must not publish cases of operations in the daily prints.He should not invite laypersons to be present at an operation, for it is a sort of method of advertising to do so.
—— J.Chalmers Da Costa, 1863——1933
【译文】医生不应该做任何形式的广告……如派发易引起特定患者关注的私人名片……应避免在信头上写上“专家”一词……不可承诺根治；不得在日报上发表手术案例；不得邀请非专业人士到现场观摩手术，因为这是一种变相广告。(https://www.daowen.com)
【点评】读完这段话，我们各位难道不觉得有一点点的汗颜与羞愧吗？当然，肯定也有很多人会理直气壮地说如今社会进步了、观念不同了，但无论如何在医疗服务这个领域多留几分“清、静、雅”还是必要的。
9.No physician may hold a patent for any surgical instrument or any medicine.
—— J.Chalmers Da Costa, 1863——1933
【译文】任何医生不得拥有任何手术器械或药物的专利权。
【考注】据查证：1952年前美国专利商标局（USPTO）一直遵循“医生针对疾病采用的治疗方法或者方式不能获得专利权”这一法条（参见：美国医学协会1847年第一版《道德规范》），但在后来的司法实践中不断有争议和修正，这是个很专业的国际法问题，无法在此展开。但至少让我们看到早年的医学领域曾经有过这样一片天使的净土。
10.What I object to … is having "professional ethics" paraded like an innocent-eyed sacred cow, by men moved in their heads by nothing more noble than good old-fashioned jealousy.
—— Max Thorek, 1880——1960
【译文】我所反对的是……把“职业道德”当作天真无邪的圣牛拿出来招摇，而这样做的人脑子里除了老套的嫉妒，就没有更高尚的东西了。
【点评】就是不要把这“职业道德”的经念歪了，把它当成排除异己、攻讦同行的武器。
11.The public, who are so ready to determine on the merits of our profession,and even the patients who are to suffer, are surprisingly ignorant both of the surgeon's motives for what he does, and the propriety of the methods he puts in practice.He is continually operating in secret as a matter of necessity.The most sensible give the decision up to him, so that he is answerable to his own conscience,and to that alone.
—— Charles Bell, 1774——1842
【译文】公众如此乐于评判我们这一职业的价值，令人难以置信的是，即使是将要接受诊疗的患者，他们对外科医生所做事情的动机及所用方法的适当性都一无所知。作为应尽之责，他（外科医生）只知一台接一台地默默手术。最明智的患者应把决定权交给他，这样外科医生就要对自己的良心负责，别无他念。
【点评】因为医患信息的不对称，最明智最理想的境界是患方充分信任，医方尽职尽责。
12.In performing the operations of surgery, this neglect of yourself is very necessary.Why simplicity should be so rare a virtue in operations, is very remarkable since it requires but this one rule——think only of your patient.
—— Charles Bell, 1774——1842
【译文】手术中，完全忘掉自我是非常必要的。为什么手术中这种“淡泊”的品行是如此稀罕，它是一种非常出色的品质，因为只有一条规则——心中只有患者。
13.The surgeon's art is exercised at its expense, not for its gratification.We do not go to the operating table as we go to the theatre, to the picture gallery, to the concert room, to be entertained and delighted: we go to be tormented and maimed,lest a worse thing should befall us.It is of the most extreme importance to us that the experts on whose assurance we face this horror and suffer this mutilation should leave no interests but our own to think of, should judge our cases scientifically, and should feel about them kindly.
—— George Bernard Shaw, 1856——1950
【译文】外科医生的技艺是以牺牲自己为代价，而不是为了满足自己。我们上手术台，不像去剧院、画廊、音乐厅是为了寻娱乐开心，我们是去承受折磨和伤害，以避免更糟的事情发生。面对这种恐怖和伤害，对我们而言此刻最重要的是，确保我们的专家除了其自身以外，不应有任何其他利益诉求，应科学判断病例、善待患者。
14.Surgical Humanism as TPN ...the "T" stands for "tolerance" of our patients, especially at times of emotional stress; the "P" for "perspective" to enable us to see the much larger human picture framing the central pathology of the threatening lesion; and the "N" for "nurture" of our own talents so that we may have justifiable pride in the quality of our surgery and a fuller appreciation of our responsibilities to society.
—— Alexander J.Walt, 1923——1996
【译文】用TPN代表外科人道主义……“T”代表对患者的“宽容（tolerance）”，特别是在情绪紧张的时候；“P”代表“视角（perspective）”，让我们能从人类更广阔的视角去理解构成威胁性病变的核心病理； N代表“培养（nurture）”才能，让我们有充分理由对我们的手术品质感到自豪，并充分认识到我们对社会的责任。
【点评】可见人道主义不仅仅是情感的抚慰那么简单，还应包含能实实在在为病患解除疾苦的学识和技能。
15.In our concentration on spectacular cures, we have paid less attention to the concomitant burgeoning population of the deprived——the poor and our new large iatrogenic wave of medical immigrants, the aged.So we have a public greatly impressed by our technical achievements but disgruntled with what they regard as our careless, callous, thoughtless or even absent psychosocial sensitivities.
—— Alexander J.Walt, 1923——1996
【译文】在集中精力研究备受关注的治疗方法时，我们很少关注随之而来的贫困人口的迅速增长——穷人和老龄化，后者形成了大规模医源性医疗移民新浪潮。因此，我们留给公众一个非常深刻的印象，即我们有技术成就，但也因粗心、无情、轻率，甚至缺乏社会心理敏感性而引发了他们的不满。
【点评】这好像说的就是我们当下的处境。