周一清晨

医患伦理是大学里单独的课程不是没有原因的。它可以黑就是黑白就是白，但是也可以在边界的模糊里找到人性的弱点或者光芒。

医疗剧着重伦理是这部剧最大的亮点：没有眼花缭乱的名词和炫技，重头戏从来不在病房或者是手术室，而是他们开会的会议室，是主任的那一张桌子和上面那一壶透明的水，是医生被叫上来做个人陈述的那一方讲台。站上讲台后他们在主人眼里也像那壶水一样透明，做过什么想的是什么全部在主任眼里无所遁形（其实很好奇主任是怎么知道这么多细节的）。但没有人可以像那壶水一样四平八稳，纯净无垢。神圣的医生也有犯错的时候，也有自己的私心，也会罔顾伦理的存在自走自路。主任也不例外。在看的时候最大的感受就是医生要兼顾治疗和伦理真的很不容易。两者之间经常会有不可调和的矛盾出现。

失望的点可能是生硬的个人生活和感情线。可能是想在第二季展开吧，看下来感觉很突兀。

冲着医学奇迹和炫技来的可以去看豪斯医生，不然你会发现这部剧其实很失望，因为它讲的更多的是人性的弱点以及在医疗系统在伦理面前的矛盾和无可奈何。

在众多闻名的医疗美剧中，《周一清晨》绝对算得上极为特殊的一个，水准高、口碑好，但是仅仅播出了一季，网上资源难找，所以相对其他几部显得很是小众。

我一直追着更新、长达十几季的《实习医生格蕾》以狗血的剧情、复杂的角色私人关系闻名，实则包罗万象，尽诉人生冷暖、社会百态，像是医生生活的长篇百科全书。而《豪斯医生》则是胜在一个个极其巧妙和专业性强的病例上，可算是罕见不典型病例精选集。至于《周一清晨》，则是着重在对医疗行为中涉及到的一个个伦理问题的深入剖析和探讨，短短的10集篇幅，包含的伦理问题浓度之高令人惊叹。备考美国职业医生考试USMLE的小伙伴们常常会开玩笑说，看《豪斯医生》会让你行为医学部分的题统统答错（Dr. House是不按常理、不相信病人的怪才），而《周一清晨》则真正的能让你学到一些行为医学和医学伦理准则，加深理解。

故事发生在Chelsea General Hospital(CGH), 主要人物大多是神经外科医生。最为特别的是外科主任Dr. Harding和他总是在周一早上举行的MM会议(Mobility and Mortality). 当每个外科医生（内科医生无缘参加这神秘的会议）的寻呼机上出现“311 meeting”字样，则意味着“批斗会“又开始了。最初会议主要是死亡病例分析，一般由最近刚刚失去病人的医生会被请上台去，汇报整个病例的经过，而Dr. Harding则会一步步抽丝剥茧般地找出整个医疗行为中出现的错误，或者说有待完善的地方，它可能是一次被忽略的家族史、不向同事咨询的自大、对患者个性化需求的无视、知情同意的缺失、对死者家属感情的漠视等等。被请上台”批斗“的医生一开始往往自信满满，认为自己没有做错任何事情。但Dr. Hardin的强大之处就在于，总是能发现问题，让所有人心服口服。正是通过这样一次次刨根问底、直击灵魂的MM会议，医疗行为得到更好的完善，人文和伦理观念更加深入人心。几位主人公的变化也可以在10季的篇幅中有所体现。

剧中印象使我最为深刻的几个伦理问题是Dr. Tyler Wilson对于“患者利益最大化“的抉择，器官移植医生Dr. Buck Tierney面临与捐献者家属沟通的问题，亚裔 “书呆子”Dr. Sung Park在如何和患者及家属共情、人文关怀上的转变等。下面就其中一个展开讲讲。

“Do No Harm”,究竟什么才是对病人有利？

Dr. Tyler Wilson是一位最优秀的神外医生、金发帅哥。在一开始的MM上，他的问题被归结为 “arrogance”，没有去落实男孩儿失联父亲的疾病史，结果男孩术中死于无法控制的出血，而最终发现他的父亲有von Willebrand disease(常染色体显性遗传的凝血障碍疾病，也就是说后代有50%的风险)。男孩的死是可以避免的，这对家属和Tyler的打击都是巨大的。并且Tyler在做这样一个可能致命的手术前也没有和任何一个人神外同事讨论,这也被归结为“arrogance”.

与其说是arrogance，不如说是Tyler在“如何对病人有利”这件事上有自己不同的看法。MRI发现男孩巨大的肿瘤，不立即手术的话危在旦夕。于是，出于对自己技艺的自信（这也是事实），Tyler跳过了尽力去完善详细的家族病史、同行会诊，这些在他看来耗费时间、对病人获利很小的事情。我有充分理由相信，Tyler的做法，是为了让病人更加获利。但是，意外总是会有的，正如Dr. Harding所言，我们一路医学培训下来所要遵守的规则，不仅仅是冰冷的规则，都有其存在的重要意义，像“家族病史”这是必不可少的。由此我对医学上那些看似教条化的规范，又多了一份敬畏。

同样的“如何对病人有利”， Tyler又面临了一次选择。没有保险、被诊断为精神分裂症的流浪汉，偶然MRI发现如果不手术就要致命的脑瘤。病人不具有做知情同意的capacity，也没有可以联系上的代理人。Tyler选择了做没有“知情”的“同意”，尽管这遭到了住院医师、麻醉师的质疑。在这种情况下，确实可以依据Beneficence（有利）原则，医生做出自己认为最符合患者利益的医疗决定。戏剧性的结果是，术后患者“精神病”消失，恢复了7年之前的记忆，但惊觉世事以变、妻子已改嫁。不过依然获得了新生。如果不是遇上Tyler这样的医生，患者恐怕要继续一辈子活在“精神分裂症”之中。

从这两个case来看，医生所坚持的“对病人有利”，到底是好是坏，还真难说。但是必要的医疗规范、伦理规则，则需要我们去严格遵守，在此基础上才是医生个人的判断，如此一来，才可使患者的利益最大化，同时避免不必要的麻烦，做到“Do No Harm”.

这绝对是一部值得细细品味的好剧，节奏紧凑，挖掘和思考问题深刻。将来有闲暇一定会再次品味，相信一定会使自己加深对从事的医疗工作的理解。

Episode 1:

1.Medical devices pay for Dr.Tierney ‘s heart and ambulatory wing, revealed some interest relationships between device corporations and doctors.

2.Dr.Martin didn’t do a full physical examination for Mary when he first saw her, even no X-rays, no blood work, made a cursory conclusion——prescribed extra strength Tylenol for her according to the retrospect, regardless of the possibility of bone cancer, just allowed metastatic cancer to run amok for four months. Dr.Martin was good at separating the conjoined twins, rebuilding the shattered faces ,but had at least killed three people. He was known as 007 among peers and colleagues cause license to kill.Actually, some doctors prefer complicated surgeries and make light of normal symptoms, leading to some misdiagnoses, at the same time, patients always complain about expensive examining cost, misunderstanding their doctors in charge.

3.Dr.Wilson failed to save the little boy Quinn McDaniels’ life due to uncontrollable bleeder. Quinn’s CT scan releaved a massive temporal-lobe tumor, which appeared malignant, so Dr.Wilson decided to operate immediately but he didn’t discuss it with his colleagues. The boy had never met his father but unfortunately his father has Von Willebrand’s disease. The doctor’s arrogance, unwillingness to seek a consult, neglecting to get a full and thorough history are responsible for the boy’s death though Dr.Wilson is not only one of the best surgeons in the world but also a committed and compassionate doctor who treated the little boy as if he were his son.What a tragedy, I had to admit that arrogance is fatal to each doctor as well as to people of all fields…

Episode two:

1.Dr. Park used Deep brain stimulation to treat a patient who was troubled by intention tremor, but DBS maybe the last resort. The operation was successful at that time, but later, the patient, Beth, prosecuted Dr. Park for she was left with an overactive libido. Dr. Park blamed her and the lawyer very strictly, in fact Beth begged Park to stop her tremor and was willing to receive the dangerous operation herself, but now she comes with lawyer, asking for money. Dr. Park’s words stimulated Beth, she dismissed the lawsuit and gave him a portraiture, she was a painter before. Beth conveyed her profound apology and sincere gratitude, this really touched me, brain is so mysterious that we cannot foresee what will happen after DBS. Such is human nature that people sometimes bite the hand that feeds one.

2.Dr. Tierney breached in protocol towards his donor, one of the patient donors Mr. Jasper wasn’t deceased but Dr. Tierney determined incorrectly that he was brain dead though he asked the neuro resident to examine Jasper and Jasper even reflect to the doctor’s commands. The transplant stuff is exciting, Dr. Tierney was called predator, a vulture trolling around the ICU, scavenging to harvest organs, not to be annoyed with annoying little things. Buck has been done his job well for 20 years, he has run a transport service that has made Chelsea one of the highest-volume centers in the country and keep the success high at the same time. This time he saved four lives, but neglected humanity and discriminated black people.

3.Dr. Ridgeway allowed Dr. Robidaux, a doctor-in-training, to operate on Miss Cash’s brain cause she thought Robidaux was perfectly capable of handling a Meningioma and that what a teaching hospital is. But because of Robidaux’s lack of experience, Cash’s olfactory nerve was damaged and unfortunately she was a chief. I have to say Ridgeway didn’t do any wrong but she is indisputably blame for this accident though the risk is permitted by the patients before the operation. No practice, no progress, no one hatches from an egg as a polished surgeon, but this is so unfair to the patient. The only way to avoid such tragedy is to perfect medico’s skill, hu…I guess Dr. Robidaux was so sorry.

（to be continued... the passage is originally written by me , no reprints without permission)