Statium | Response human pain is not a dispute over the medical concept

Author: Wang Yifang Peking University Professor Professor

The Presbyterian Hospital of Columbia University is located in a bustling trouble in New York, but it is an authentic civilian hospital. The doctors here are facing various human pain every day. In addition to medical problems, there are poverty and hunger. The health issue, where to serve, Dr. Lita Karen realized a new truth. The purpose of medicine is not only to save the wounded, but also respond to human pain. However, people seem to be tangled again. Whether it is painful or pain is called disease, and no one can say that it may constitute the unbearable weight of modern medicine. Although "big medical country, traditional Chinese medicine doctors", according to Buddhist teachings, there are seven sufferings in life, and the suffering of life and death is a medical problem. The pain of the dead is the problem of war and scourge. It is related to international political disputes, national territorial disputes, and doctors who hang a stethoscope on the neck.

"Pain cannot be seen"

In daily life, toothache is not sick, it is really terrible; the goddess may be painful when dysmenorrhea, and all thoughts; the lingering of migraine is inexhaustible, and the pain must hit the wall; ; Although the pain of childbirth is "painful and happy", its intensity impacts the peak experience (level 12); the pain of cancer pain is that the body and mind are trembling, and they can't commit suicide to terminate the pain ...

Once the pain is painful to the doctor, we must first go clinical procedures. It is also abdominal pain. It may be appendicitis or intestinal obstruction. Girls may also be an ectopic pregnancy and must do a different diagnosis. I did not figure out the painkillers that could not be rashly given before, otherwise they would confuse the diagnosis. Even if they entered the diagnosis, there were no artifacts to capture the signs of pain and pain, because the pain originated from some kind of "internal experience", most of which are subjective experiences, and most of them are subjective experiences. With self -narrative, such as uncomfortable and wanting to cry, objective testing often blinds. Susan Santag, a thinker who suffers from cancer, has his own unique experience: "Pain cannot be seen!"

Can be described with color

Throughout the history of history, the soul painter can express his redemption with a brush: pain does not need to be seen, but can be painted with color. For example, Norwegian painter Monke's two masterpieces: The first is "Children in the disease", which originated from a unforgettable memory. The mother died of tuberculosis due to tuberculosis at the age of five. He also suffered from tuberculosis and died at the age of 14. The deaths and deaths caused deep damage to Monks again, making him never be relieved, and he did not get out of the shadow in his life. Through the memories of the serious illness scene of the sister, the painter showed the weakness and fear of death, and expressed his pain and sadness in the face of his loved ones. In fact, the prototype of the girl in the painting is not a sister, but a red -haired girl named "Pei Nielsen", and is the sister of a little boy who has been healed by his doctor's father. No matter who it is, the painter really depicts the girl's pain and the sadness of the family. The girl in the picture described it with a pale face. The family next to the family was powerless and could only help the girl's hand silently ... Later, Mongolian, Mongolia Ke once repeatedly depicted the painting, which was intended to find the initial impression. The skin that is close to the pillow, transparent and pale skin, the cracked lips and the trembling hands ...

The other is "Scream". Under the red sky, a blue -shaped blue boy like a skeleton panicked. I do n’t know how to deal with it. I can only cover my ears to yell and vent my fear in my heart. The protagonist's expression was exaggerated, and his body was like a leaf grass in the wind. Stretch back, cover your ears with both hands, and open your mouth! Monks' strokes are like Van Gogh, and they have a "feeling of chasing the wind." Some boats on the sea of ​​the distance show the location of the medical care, which seems to be very far away. The doctor's father was powerless for his illness; the bridge under his feet showed the hope of healing. People did not know where the bridge started and which direction to extend?

The professional posture of the doctor when facing suffering

Back to the topic, since the pain is the target of medical healing, why does it not be set up in pain, and there is no specialist hospital for pain? First of all, the boundary of pain is uncertain, involving multiple systems, multiple parts, and the intensity. It is based on the subjective description of patients, such as "spiritual pain", which is incompatible with the demands of precision medicine. Second, it is necessary to review clinical evidence thinking. As Foucault said, modern clinical medicine has changed, from paying attention to "how uncomfortable" (process experience), to "where is uncomfortable", pain is disease or symptom? The purpose of medicine is to conquer the disease. The relief of the symptoms is only a measure of authority. The clinical level of pain treatment is not high, the cause of the cause, the most important treatment of onset, and the secondary symptom the treatment. The placebo and humanistic care are the last position. Medical care mainly focuses on cure. Pain is only the secondary symptoms of the disease. The disease is relieved, and the pain naturally subsides. Therefore, pain treatment is not a priority option.

In fact, the pain was born due to the disease, but it may not stop with the disease. The radius of human pain is much wider than the disease spectrum, and the means of intervention is richer. The more painful, the more you need to comfort and settle it. It is said that it involves clinical ethics. The core of clinical ethics is pain ethics. Various human pain is a position of reclining, sympathy, compassion, and comfort, or is obsessed with the glory of technology, indifference, numbness, tolerance, and quochrome, testing everyone in a white coat. To put it bluntly, the prosperous humanities are changing the attitude and appearance of clinical medicine, and the medical pattern of human pain is getting closer and closer to us. Nowadays, many hospitals already have pain department. It is an Asian specialist divided from the anesthesiology department. Some people are in charge of pain, and the pain will be worried. Pain in all suffering, especially cancer pain. Cancer pain is more severe than cancer itself. At the end of the cancer at the end of the cancer, healing is impossible. It can only abandon the etiology and focus on symptomatic intervention. The new health care unit has incorporated the pain of psychological pain and social relationships, and spiritual pain in the intervention. However, to change the care of human pain and suffering, it is not only the concept of technology, humanities, specialist medical treatment and medical medicine, but also testing the governance art of the dean and the director of the interdisciplinary management and integration of medical treatment.

Source ｜ Jingbao APP

Edit: Chen Jianguo

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