評論
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Five years ago, I was on a sabbatical,
五年前趁休假的時候，
and I returned to the medical university where I studied.
我回到我曾就讀的醫學院。
I saw real patients and I wore the white coat for the first time in 17 years,in fact since I became a management consultant.
我穿上白大褂，見了真正的病人，這是自我17年前成為管理顧問以來的頭一次。
There were two things that surprised me during the month I spent.
我在那里的一個月，有兩件事情讓我吃驚。
The first one was that the common theme of the discussions we had were hospital budgets and cost-cutting,
第一，醫學院里常常討論的話題是醫院的預算和削減開支。
and the second thing, which really bothered me,
第二，也是真正讓我憂心的
actually, was that several of the colleagues I met,
是我遇到的幾位同事。
former friends from medical school,
他們是我在醫學院的昔日好友，
who I knew to be some of the smartest,
他們是我所認識的最聰明，
most motivated, engaged and passionate people I'd ever met,
最有積極性的，熱衷參與并富有激情的人。
many of them had turned cynical, disengaged,
但是，他們中的很多人，現在變得漠然且憤世嫉俗，
or had distanced themselves from hospital management.
或與醫院管理保持距離。
So with this focus on cost-cutting,
當我們專注于削減開支的時候，
I asked myself, are we forgetting the patient?
我問我自己，我們是否忘記了病人的存在？
Many countries that you represent and where I come from struggle with the cost of healthcare.
很多國家，包括你們的，也包括我的都在為醫療保健支出而煩惱。
It's a big part of the national budgets.
這項支出占據了國家預算的很大一部分。
And many different reforms aim at holding back this growth.
而許多醫療體制改革的目標就是控制這項支出的增加。
In some countries, we have long waiting times for patients for surgery.
在一些國家，看病等待期很長,特別是需要手術的病人。
In other countries, new drugs are not being reimbursed,
還有一些國家，新藥沒有補助，
and therefore don't reach patients.
于是病人也不能用上新藥。
In several countries, doctors and nurses are the targets, to some extent, for the governments.
在很多的國家，醫生和護士在一定程度上成為政府削減開支的針對目標。
After all, the costly decisions in health care are taken by doctors and nurses.
畢竟，那些花費昂貴的醫療措施都是由醫生和護士來決定的。
You choose an expensive lab test,
是這些人在選擇高成本的實驗，
you choose to operate on an old and frail patient.
也是這些人在選擇給孱弱的老人做手術。
So, by limiting the degrees of freedom of physicians,
所以，（政府想）通過限制醫生的自由，
this is a way to hold costs down.
來達到降低開支的目的。
And ultimately, some physicians will say today that they don't have the full liberty to make the choices they think are right for their patients.
最后導致的結果是醫生發現他們沒有充分的自由來為他們的病人選擇最適合他們的治療方案，
