民国时期医生之甄训与评核

民国时期医生甄训与评核制度经历了一个不断发展和完善的过程.晚清政府对医生采取放任政策,致使医生品流芜杂,庸医盛行,给民众生命安全带来严重危害.民国初期到南京政府成立时期,政府颁布了一系列与医生行医资格有关的法规、条例,但由于政局动荡、医疗人才匮乏,医学教育及社团组织还在初创阶段,医生甄训与评核制度难以顺利实施.医界和政府由此产生了一系列纷争.民国中后期,政府加强了对医生甄训与评核制度的管理,医学界也对其中出现的各种问题进行了反省.尤其抗战胜利后,国民政府加大了对该项工作管理的力度,虽然有些法规没能做到真正贯彻实施,1940年代成立的医生检核委员会表明这一工作逐步制度化,医生的专业化程度不断提高.     

国家控制与医生临床自主性的滥用:对公立医院医生执业行为的分析

如何对医生的执业行为实施有效的社会控制是职业社会学的一个重要问题。本文通过对我国城市医生的执业环境与执业行为的分析,指出医生仍然依附于占据医疗服务市场垄断地位的公立医院,丧失法团自主性的他们无法与国家就收入与服务补偿进行协商。但也正是由于垄断地位,公立医院及其医生获得了对患者和医药厂商的双向支配地位,可以便利地将处方权转换为经济利益。但与此同时,医生对临床自主性的这种滥用意味着卫生行政部门的监管、职业规范内化后的自律等社会控制方式的失败。本文认为,医生这一职业群体在医疗卫生政策制定过程中的参与、逐步开放医生的执业自由以及给予非公立医疗机构平等的地位与待遇等措施会使这些问题得到改观。     

三浦梅园的“一元气”平议

三浦梅园(1723—1789,名晋、字安贞)作为一个摆脱了学派束缚而独立进行哲学创造的哲学家,在日本哲学史上占有一席地位。他生活于国家财政陷入严重危机、农民起义不断、町人暴动频繁的幕府制衰落时期,但因家住偏僻的乡村(今大分县东国东郡安歧町大字富清),故生活还不至于为社会动荡所干扰,得以以行医、教书、著述终其一生。他的主要     

工业国家医疗质量下降

据最近一次调查显示 ,大量美国以及其他工业国家的从业医生认为 ,在过去的五年中 ,他们能够提供给病人的医疗质量有所下降。接受调查的美国医生认为他们缺乏足够的护士 ,而其他工业国家的医生则抱怨资源匮乏 ,包括病床和治疗仪器的短缺。尽管多数医生对其本国的医疗体系和他们自己的医术还算满意 ,但是将近六分之一的美国医生和多于四分之一的澳大利亚、新西兰和英国医生觉得五年前他们的医疗质量比现在要好。他们还认为 ,如果医院能有更高效的报告体系、处方电脑化和电子医疗纪录 ,那么在防止误诊方面还能做得更好。令人欣慰的是 ,调查还显…     

建立医保医师库 加强医保费用管理

医师,被称为医保基金使用的"第一守门人",他们不仅肩负着救死扶伤,为患者提供优质的医疗服务的职责,而且,还担负着合理使用医保基金的重任。医保实行以来,广大医保医师认真按照规定行医看病,为医保基金的合理使用严格把关。但也有的医     

大医仁德——记长春市著名中医祝继兴

中医名家祝继兴教授自62年行医长春,四十多年的从医历程使祝教授始终把4个字沉甸甸地装在心里,那就是"医者仁心"。     

社会工作的哲理基础

正如“医师有守则,为执业行医的圭臬;记者有守则,为采访撰稿的指南针”,社会工作者有他们信守不渝的守则,便不足为奇了。守则的订立,并非自鸣清高,或作为跻身认许专业行列的手段,而是基于社会工作者的信念,及社会工作所期望达成的目标。     

关于甘肃省乡村医生培训工作的调查与思考

目的：通过调查乡村医生学历教育状况,分析目前乡村医生的学历层次。研究乡村医生的培训和素质状况,为提高村医质量提供依据。方法：依据地理位置、人口密度、诊所规模及区域划分等情况,整体抽取甘肃省内13市的3550名乡村医生为调查对象,采用现况调查的方法对乡村医生的基本情况、受教育程度、培训情况,进行问卷调查。结果：目前乡村医生的学历以中专最多,学历较2000年之前有明显提高,乡村医生总体培训次数较少,培训层次不高,培训形式单一,培训效果较差。结论：调查结果表明应该加强对乡村医生培训工作的组织领导,注重乡村医生培训工作的方法与形式,加强乡村医生培训工作培训质量管理,使其初步具备处理防治常见病、多发病、急难重症和突发卫生事件的能力。     

精神病患者:人身自由与强制治疗

瑞典国家健康与福利署指出 ,由于精神科医生不希望病人完全脱离治疗 ,致使精神病患者接受强制治疗的时间过长。即使一个病人已经有能力过正常的生活 ,他也仅能获得阶段性的假期 ,但不能完全脱离精神科医生的控制。在瑞典 ,当精神病人对自己或他人的生命造成威胁时 ,就可以对其实施强制治疗。当医生认定一位患者的病情可以在院外得到控制时 ,该患者就被获准回家治疗。即便如此 ,患者仍不能得到完全的人身自由。 2 0 0 0年 ,瑞典通过一项新的法规 ,强调当强制治疗不再必要的时候就应该被停止。瑞典国家健康与福利署近日的报告指出 ,此条法规在…     

纽约市1788年医闹平议

纽约市1788年医闹是美国建国初期第一次民众骚乱事件。医闹的发生与殖民时代业已存在的种族不平等、社会阶层失序、行医制度问题和围绕革命话语产生的公共讨论的流行等因素密切相关。1788年医闹持续四天,医闹本身通过各种版本的故事进行流传。而前因后果及其形成的影响在美国历史和美国医学史上得到持续讨论。1788年医闹反映了一个变动社会存在重重矛盾,是从革命到探寻建国方略过程中各种积怨的一个宣泄口。而今,1788年医闹通过位于纽约的非裔公墓国家纪念碑成为人们的历史记忆。     

Physical and moral regeneration after the Terror: medical culture,sensibility and family politics in France, 1794–1804

Physical and moral regeneration was one of the great aspirations of the French Revolution. Revolutionaries fashioned new cultural practices to emphasize collective rebirth and the individual citizen’s own break with a degenerate past. Often associated with radical politics, this article emphasizes regeneration’s conservative manifestations after the Reign of Terror and the Thermidorean reaction of 1794. Against the backdrop of revolutionary transformations in medical theory and practice, doctors and surgeons sought to bring new biomedical knowledge upon previous regenerative projects, arguing that unrestrained biological passions had enervated the polity and caused social disaggregation. By studying domestic hygiene and the ‘limited sensibility’ of living matter, practitioners hoped they could reverse the Jacobin excess and popular upheaval through physical and moral education. These doctors claimed that recent clinical discoveries showed that human nature was less malleable than earlier revolutionaries had believed. Therefore, greater elements of emotional and corporal self-control, taught by practitioners and internalized within the family, could heal civil society and encourage social improvement. This bio-medical programme of regeneration radiated out across three levels, moving from elite clinical theorists to a kind of ‘literary underground’ of medical practice: a hygienic regimen aimed at controlling limited amounts of vital energy in the human body; a ‘physical and moral’ rehabilitation of women to anchor them in the domestic sphere; and reproductive strategies to breed new generations of rejuvenated citizens. In their efforts to incorporate republican hygienic sensibilities within traditional law and custom, doctors helped efface revolutionary memory and contributed to the paternalistic family law of the Civil Code in 1804.     

Ticking Boxes and Changing the Social World: Data Collection and the New UK General Practice Contract

The new General Medical Services contract was introduced into general practice in the UK in 2004, and it links pay to performance far more than in the past. As a result, accurate data collection about patients and the care that they receive is now not only important for good patient care but also to prove that targets are being met. The use of electronic records and information technology has thus become much more sophisticated. This article reports the results from an ethnographic study of the early stages of the new contract in two general practices. As expected, electronic data collection had increased in importance in both practices, with consequences both for clinician–patient interactions and for the structures and processes in the practices, as uniform data collection instruments are put in place that privilege ‘hard’ biomedical data that can be easily coded above ‘softer’, more patient-centred information. Roles and responsibilities had been changed to reflect the needs of the new systems, and new software applications allowed increased surveillance of both doctors’ and nurses’ performance; both of these had an impact on patterns of authority in our study practices. Furthermore, the structural changes that were found acted to embed the new ways of working, ensuring their reproduction in the future. In spite of these effects, we found little opposition to or critical reflection on the changes, and the doctors in our study continued to view their improved computer systems as neutral recording devices. The implication of these findings is discussed.     

现代学徒制早期实践的个案考察与反思--以民国京师第一艺徒学校为例

选取民国时期京师第一艺徒学校为个案，对现代学徒制在近代中国的早期实践与转型原因进行探讨。研究表明，作为地方教育行政部门和基层教育工作者中摸索成长起来的教育形态，京师第一艺徒学校已然具备了现代学徒制的基本特征；学校在运行中存在诸多不足，但这并不是导致其转型的决定因素；从办学者和职教界围绕这种教育形态进行的思考与理论争议可以探知，重道轻艺的民族潜意识是现代学徒制实践在近代中国未能延续的根本原因。     

明代西方传教士对中国国情的调查

地理大发现之后,西欧商人、士兵、官吏和传教士纷纷来到中国,调查中国国情。其中传教士的表现尤为突出。明代西方传教士调查中国国情有明确的指导思想。所获得的情报或用于在中国的传教实践之中,或汇集起来传回欧洲。这既对他们在中国的传教有较大的帮助作用,同时也形成了东学西渐的局面,在一定程度上促进了欧洲早期启蒙思想的产生和发展     

残疾人专职委员队伍建设的调查与思考

当前一支数量充足的残疾人专职委员队伍已基本形成，提高队伍素质成为新时期残疾人专职委员队伍建设的重心。调查发现新上岗残疾人专职委员结构更加合理，全身心投入工作岗位意识较强，但是残疾人事业相关理论素养和服务技能不足，开展工作力不从心，本文提出理论层面上需要加强残疾人专职委员专业化建设模式的研究，实践层面上需要积极推进残疾人专职委员专业化人才培养和培训工作，并重点在培训内容、形式和对象上提出了相关意见和建议。     

Sensory Work of Diagnosis: A Crisis of Legitimacy

Sensory judgments have always been a part of medical practice, as sensory studies scholars have emphasized. However, in current regulatory, management and technological contexts, there is a push toward rational decision-making procedures and test-based evidence over clinical diagnosis. Sociological scholarship highlights that in focusing on explicit medical knowledge and disembodied data we take for granted aspects of healthcare work, including the ways in which health and illness is sensed. Research in sociologies of diagnosis and social studies of science and technology has captured that while the senses continue to play a role in medical work, the status and practice of this sensory work is not straightforward as evidenced by dual use of the senses and tests and the delegation of sensory work. Based on semi-structured interviews with expert doctors in diverse specialties, this article examines the sensory work of medical decision-making, with attention to its legitimacy. It examines applications of the senses from auscultation to ongoing sensing of patients’ bodies unmediated and via technological outputs. While critical to clinical judgments, there is discomfort with this sensory work in light of medico-legal pressures. I argue that the sensory work of diagnosis is vital, to the extent that gaps in sensory information imply gaps in understanding.     

介乎士大夫与平民之间的文学形态——南宋中后期游士阶层的诗歌创作

游士自视为士人阶级并努力向士大夫靠近，但其社会身份却更接近平民。游士议政诗歌具有士大夫般的忧时忧国情怀，却因为过于激烈直白而被质疑为卖直钓名、粗豪亢厉之作；游士诗歌力求风雅，却被视作矫语高蹈的伪风雅；游士诗歌情调语调通俗，却与平民赏爱的话本、杂剧、南戏尚有一点距离，无法被庶民百姓广泛接受。游士阶层介乎士大夫与平民之间的中间游移性质，使其诗歌成为传统文体大幅度变革的载体，是南宋文化转型以及文学转型时期一个士庶交接、雅俗杂糅的文学形态，也是俗文学冲击下雅文体之俗化达到了临界点的标本。     

春秋时期家臣职权扩展与宗法制嬗变

西周时期小宗世袭为大宗家臣，异姓亦可世袭为家臣，“事保厥家”乃其职责。然至春秋，家臣势力逐渐增强，由西周“事保厥家”的“宗法性家臣”发展成春秋后期“执国命”的“陪臣”。伴随着春秋时期权力下移，家臣权力上升、职能增强且家臣身份也呈现多样化发展。家臣制源于宗法制，在不断调整与完善的过程中又不可避免地要摆脱宗法制的约束，逐渐发展成为后世帝国时期官僚制的雏形。同时，家臣选任及流动的自由冲击了宗法制下世卿世禄的原则，也折射出宗法制下传统社会观念的演变趋势，最终影响到后世“家”“国”关系的构建。     

Psychiatric nursing in the Netherlands and Great Britain: class,status and gender in the making of a profession

ABSTRACT

In most Western countries psychiatric nursing, from the late nineteenth century onwards, developed as a specialization under medical supervision and within one general training scheme for all nurses. In the Netherlands as well as in the United Kingdom (UK), this occupation, initiated by psychiatrists, more or less distanced itself from somatic nursing. A comparison of the twentieth-century development of psychiatric nursing in these two countries shows similarities in its basic conditions and some of the problems it faced, but also some remarkable differences, which are largely of a social nature. We argue that Dutch mental health nurses, in cooperation with asylum doctors rather than in opposition to them, succeeded in establishing a stronger professional identity than their British colleagues: earlier in time and to a greater extent they had opportunities to voice their views on their work and to define the social and didactic nature of their vocation. Our explanation of these national contrasts focuses on gender, class and social status, which had dissimilar effects in the two countries because of some fundamental differences in the hierarchies and religious affiliations of institutional psychiatry as well as in the more general class structure of the Netherlands and the UK.