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医生白大褂的去留争议：美国医学会考虑让白大褂退出历史舞台 [精华]

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医生白大褂该不该革去？

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Picture a doctor in your mind’s eye, and what do you see? A stethoscope, maybe. Perhaps a little black bag. And almost certainly a white lab coat. But that last item may be destined for oblivion.

The American Medical Association is studying a proposal made at its annual meeting in June that doctors hang up their lab coats — for good. The group’s Council on Science and Public Health is looking at the role clothing plays in transmitting bacteria and other microbes and is expected to announce its findings next year.

The objections have already begun.

“The coat is part of what defines me, and I couldn’t function without it,” said Dr. Richard Cohen, a clinical professor of medicine at Weill Medical College of Cornell University and an attending physician at New York-Presbyterian Hospital. “When a patient shares intimacies with you and you examine them in a manner that no one else does, you’d better look like a physician — not a guy who works at Starbuck’s.”

As Dr. Cohen suggests, in the popular imagination, a white lab coat is as much a part of a doctor’s persona as a cowboy’s 10-gallon hat or an engineer’s pocket protector. A Postgraduate Medical Journal study in 2004 found that 56 percent of patients surveyed felt that physicians should wear them. About 94 percent of schools of medicine and osteopathy in the United States have “white coat ceremonies” whereby new students don the garment to signify their entry into the profession.

Still, the current lab coat resolution reflects a growing suspicion that doctors may not be, well, always as clean as they can be. One 2004 study found that 48 percent of neckties worn by a sampling of New York City doctors and clinical workers carried at least one species of infectious microbe. Two years ago, the British National Health System adopted a “bare below the elbow” hospital dress policy that bans long fingernails, ties, hand and wrist jewelry — and, of course, lab coats.

“It doesn’t benefit the health of the patient if we wear a white coat,” said Peter Ragusa, the author of the resolution and a student at the Yale School of Public Health.

Mr. Ragusa acknowledged that little data existed that definitively ties lab coats and other accoutrements to the infections that kill nearly 100,000 hospital patients in the United States annually.

“I know I can’t prove it,” he said, “but my hand moves from one patient to another, and if my sleeve is rubbing from one patient onto another, then the potential for transmission is significant.”

Any battle against lab coats will be hard fought, said Nancy Tomes, chairwoman of the history department at Stony Brook University and author of “The Gospel of Germs” (Harvard, 1998).

“This is a reversal of tradition,” she said. “The way the physician showed his care for patients, beginning in the late 19th century, was to go from his street clothes into a white lab coat.”

This change took place in part because doctors wanted to spruce up their dubious reputation. Until the advent of such medical reformers as Abraham Flexner and Sir William Osler about 100 years ago, medical training in the United States was notoriously lax. Lectures, not clinical experience, were the norm. It was the age of horse sense and the quack.

So to more closely associate themselves in the public mind with sound science, physicians began donning the lab coats that were being worn by chemists and other laboratory types. These coats were generally beige. But white soon became the standard.

“Our notion since the 1880s, when the germ theory of disease began to take hold, is that microbes hide in dark, dirty places, and that white stands for purity, both material and moral,” said Guenter Risse, a physician and author of “Mending Bodies, Saving Souls: A History of Hospitals” (Oxford, 1999). “Wearing white coats was a symbol that you were clean.”

And yet, despite their powerful cultural history, white coats may be on their way out anyway. Not because of fears about disease, but because the authority they once connoted has been supplanted by anxiety. The term “white coat syndrome” or “white coat hypertension” is now commonly used to explain the nervousness that many patients feel upon seeing their doctor.

“There’s been a trend toward taking the coats off in the last 20 years because they were felt to be intimidating,” Dr. Risse said. “In this mechanistic and impersonal age of medicine we’re living in, some doctors have felt they could establish a better relationship in their street clothes.”

But plenty of doctors still cling to their white coats and are taking issue with Mr. Ragusa. “To quote one guy,” he said, “ ‘Are we going to go around naked?’ ”

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2009-07-26 20:30 浏览 : 26013 回复 : 143

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胭脂编辑于 2009-07-28 23:58

• 看图说话，29岁男性，反复头痛5年

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本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领

2009-07-26 23:06

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• （原创）重症高渗高血糖综合征的急诊急救？

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Picture a doctor in your mind’s eye, and what do you see? A stethoscope, maybe. Perhaps a little black bag. And almost certainly a white lab coat. But that last item may be destined for oblivion.
如果让你在脑海里想象一下医生的样子，你会想到什么？也许是听诊器，也许是那个小小的黑色出诊包，。但一定会有一件白色的大褂。但白衣也许注定会被忘却。

The American Medical Association is studying a proposal made at its annual meeting in June that doctors hang up their lab coats — for good. The group’s Council on Science and Public Health is looking at the role clothing plays in transmitting bacteria and other microbes and is expected to announce its findings next year.
美国医学会正在就今年七月在年会中提出的一个动议进行研究，该动议是医生是否应该为了自己和病人的利益而放弃穿着白大衣。该组织的科学与公共卫生委员会正在研究医生的白衣在传播细菌及其他微生物中的作用并有望在明年公布结果。

The objections have already begun.
但反对是声音早已有之。

“The coat is part of what defines me, and I couldn’t function without it,” said Dr. Richard Cohen, a clinical professor of medicine at Weill Medical College of Cornell University and an attending physician at New York-Presbyterian Hospital. “When a patient shares intimacies with you and you examine them in a manner that no one else does, you’d better look like a physician — not a guy who works at Starbuck’s.”
“白衣是医生的一部分，没有白衣我无法完成医生的工作。”康奈尔大学威尔医学院临床医学教授及New York-Presbyterian 医院内科主任医师Richard Cohen说。“当病人告诉你他的隐私而你又是为他检查的不二人选，你最好看起来像个医生而不是星巴克里的服务生。”

As Dr. Cohen suggests, in the popular imagination, a white lab coat is as much a part of a doctor’s persona as a cowboy’s 10-gallon hat or an engineer’s pocket protector. A Postgraduate Medical Journal study in 2004 found that 56 percent of patients surveyed felt that physicians should wear them. About 94 percent of schools of medicine and osteopathy in the United States have “white coat ceremonies” whereby new students don the garment to signify their entry into the profession.
如Cohen医生所言，在大众眼中，白大衣是医生的标志如同牛仔的呢帽或者工程师的安全帽。根据一个医学杂志2004年的研究显示56%的被调查患者认为医生应该身穿白大衣。在美国约94%的医学院校有“白大衣授予仪式”，即医学新生身着白大衣以表明他们正是进入医学殿堂。

Still, the current lab coat resolution reflects a growing suspicion that doctors may not be, well, always as clean as they can be. One 2004 study found that 48 percent of neckties worn by a sampling of New York City doctors and clinical workers carried at least one species of infectious microbe. Two years ago, the British National Health System adopted a “bare below the elbow” hospital dress policy that bans long fingernails, ties, hand and wrist jewelry — and, of course, lab coats.
然而目前对于白大衣的争论反映了一种正在增加的怀疑：也许医生并不总如他们说的那么干净。2004年一个研究发现48%纽约市医生及医务人员的领带携带有至少一种传染性微生物。两年前，英国国立卫生系统实施“不过肘”医院着装规范，该规范禁止留长指甲、领带及佩戴手部和腕部饰物——当然也包括白大衣。

“It doesn’t benefit the health of the patient if we wear a white coat,” said Peter Ragusa, the author of the resolution and a student at the Yale School of Public Health.
该规范的作者同时也是耶鲁公共卫生学院学生的Peter Ragusa说：“如果我们身穿白大衣并不会给患者的健康带来好处。”

Mr. Ragusa acknowledged that little data existed that definitively ties lab coats and other accoutrements to the infections that kill nearly 100,000 hospital patients in the United States annually.
Ragusa先生声称没有数据证明白大衣及其他制服与每年全国因感染而死亡的近10万住院病人间有紧密的联系。

“I know I can’t prove it,” he said, “but my hand moves from one patient to another, and if my sleeve is rubbing from one patient onto another, then the potential for transmission is significant.”
“我知道我无法证明我的假设，”他说，“但在诊疗过程中我的手从一个病人到另一个病人如果我的衣袖也挨过一个病人又挪到另外一个身上，那（微生物）传播的可能性是显而易见的。”

Any battle against lab coats will be hard fought, said Nancy Tomes, chairwoman of the history department at Stony Brook University and author of “The Gospel of Germs” (Harvard, 1998).
针对白大衣的斗争将是一场硬仗，Stony Brook大学历史系主任Nancy Tomes说，她还是《革兰氏菌福音书》的作者。

“This is a reversal of tradition,” she said. “The way the physician showed his care for patients, beginning in the late 19th century, was to go from his street clothes into a white lab coat.”
“这是对传统的颠覆，”她说。“在19世纪末，医生在诊疗患者时都在便装外套上白色的实验大衣。”

This change took place in part because doctors wanted to spruce up their dubious reputation. Until the advent of such medical reformers as Abraham Flexner and Sir William Osler about 100 years ago, medical training in the United States was notoriously lax. Lectures, not clinical experience, were the norm. It was the age of horse sense and the quack.
这种改变部分是因为医生想要竭力净化自己不很好的声誉。知道诸如Abraham Flexner和Sir William Osler等医学改革者在100年前进行变革前，美国的医学教育都是出了名的松懈拖沓。那时讲义而非临床经验才是衡量标准。那是个骗子和庸医横行的年代。

So to more closely associate themselves in the public mind with sound science, physicians began donning the lab coats that were being worn by chemists and other laboratory types. These coats were generally beige. But white soon became the standard.
因此为了更加接近大众印象中的科学家形象，医生们开始穿着原先化学家和其他实验室人员专有的白大衣。白衣总是让人觉得悲伤，但很快它就成了医生的标准制服。

“Our notion since the 1880s, when the germ theory of disease began to take hold, is that microbes hide in dark, dirty places, and that white stands for purity, both material and moral,” said Guenter Risse, a physician and author of “Mending Bodies, Saving Souls: A History of Hospitals” (Oxford, 1999). “Wearing white coats was a symbol that you were clean.”
“我们注意到从1880年代当病原菌致病理论开始盛行，该理论认为微生物躲藏在黑暗肮脏的角落，而白色则象征着纯净，无论是物质上还是精神上。”Guenter Risse医生说，他曾写过一本名叫《医治躯体拯救灵魂：医院的历史》。“穿着白大衣表示你很干净。”

And yet, despite their powerful cultural history, white coats may be on their way out anyway. Not because of fears about disease, but because the authority they once connoted has been supplanted by anxiety. The term “white coat syndrome” or “white coat hypertension” is now commonly used to explain the nervousness that many patients feel upon seeing their doctor.
然而尽管它有着很长的历史和文化渊源，但白大衣可能还是会淡出医学历史的舞台。并不是因为害怕疾病，而是因为主管部门曾暗示它与焦虑相关，在医学上称为“白大衣综合征”或“白大衣高血压”。后两者现在常用来解释病人去医院看到医生后的紧张情绪及生理反应。

“There’s been a trend toward taking the coats off in the last 20 years because they were felt to be intimidating,” Dr. Risse said. “In this mechanistic and impersonal age of medicine we’re living in, some doctors have felt they could establish a better relationship in their street clothes.”
“近20年有逐步脱掉白大衣的趋势，因为患者有可能受惊吓，”Risse医生说“在这个机械论及非个性化医学盛行的时代，一些医生开始穿着便装以便和患者建立更好的关系。”

But plenty of doctors still cling to their white coats and are taking issue with Mr. Ragusa. “To quote one guy,” he said, “ ‘Are we going to go around naked?’ ”
但大多数医生仍然守旧的穿着白大衣并和Ragusa先生争论着。“拿其中一个人的话说”他说“‘我们都将光着身子出诊吗？’”

编译如下：

[iframe]白大衣该不该革去[/iframe]

如果让你在脑海里想象一下医生的样子，你会想到什么？也许是听诊器，也许是那个小小的黑色出诊包，。但一定会有一件白色的大褂。但白衣也许注定会被忘却。

美国医学会正在就今年七月在年会中提出的一个动议进行研究，该动议是医生是否应该为了自己和病人的利益而放弃穿着白大衣。该组织的科学与公共卫生委员会正在研究医生的白衣在传播细菌及其他微生物中的作用并有望在明年公布结果。

但反对是声音早已有之。

“白衣是医生的一部分，没有白衣我无法完成医生的工作。”康奈尔大学威尔医学院临床医学教授及New York-Presbyterian 医院内科主任医师Richard Cohen说。“当病人告诉你他的隐私而你又是为他检查的不二人选，你最好看起来像个医生而不是星巴克里的服务生。”

如Cohen医生所言，在大众眼中，白大衣是医生的标志如同牛仔的呢帽或者工程师的安全帽。根据一个医学杂志2004年的研究显示56%的被调查患者认为医生应该身穿白大衣。在美国约94%的医学院校有“白大衣授予仪式”，即医学新生身着白大衣以表明他们正是进入医学殿堂。

然而目前对于白大衣的争论反映了一种正在增加的怀疑：也许医生并不总如他们说的那么干净。2004年一个研究发现48%纽约市医生及医务人员的领带携带有至少一种传染性微生物。两年前，英国国立卫生系统实施“不过肘”医院着装规范，该规范禁止留长指甲、领带及佩戴手部和腕部饰物——当然也包括白大衣。

该规范的作者同时也是耶鲁公共卫生学院学生的Peter Ragusa说：“如果我们身穿白大衣并不会给患者的健康带来好处。”

Ragusa先生声称没有数据证明白大衣及其他制服与每年全国因感染而死亡的近10万住院病人间有紧密的联系。“我知道我无法证明我的假设，”他说，“但在诊疗过程中我的手从一个病人到另一个病人如果我的衣袖也挨过一个病人又挪到另外一个身上，那（微生物）传播的可能性是显而易见的。”

针对白大衣的斗争将是一场硬仗，Stony Brook大学历史系主任Nancy Tomes说，她还是《革兰氏菌福音书》的作者。“这是对传统的颠覆，”她说。“在19世纪末，医生在诊疗患者时都在便装外套上白色的实验大衣。”

这种改变部分是因为医生想要竭力净化自己不很好的声誉。知道诸如Abraham Flexner和Sir William Osler等医学改革者在100年前进行变革前，美国的医学教育都是出了名的松懈拖沓。那时讲义而非临床经验才是衡量标准。那是个骗子和庸医横行的年代。

因此为了更加接近大众印象中的科学家形象，医生们开始穿着原先化学家和其他实验室人员专有的白大衣。白衣总是让人觉得悲伤，但很快它就成了医生的标准制服。

“我们注意到从1880年代当病原菌致病理论开始盛行，该理论认为微生物躲藏在黑暗肮脏的角落，而白色则象征着纯净，无论是物质上还是精神上。”Guenter Risse医生说，他曾写过一本名叫《医治躯体拯救灵魂：医院的历史》。“穿着白大衣表示你很干净。”

然而尽管它有着很长的历史和文化渊源，但白大衣可能还是会淡出医学历史的舞台。并不是因为害怕疾病，而是因为主管部门曾暗示它与焦虑相关，在医学上称为“白大衣综合征”或“白大衣高血压”。后两者现在常用来解释病人去医院看到医生后的紧张情绪及生理反应。

“近20年有逐步脱掉白大衣的趋势，因为患者有可能受惊吓，”Risse医生说“在这个机械论及非个性化医学盛行的时代，一些医生开始穿着便装以便和患者建立更好的关系。”

但大多数医生仍然守旧的穿着白大衣并和Ragusa先生争论着。“拿其中一个人的话说”他说“‘我们都将光着身子出诊吗？’”

2009-07-28 22:44

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zs19820414 编辑于 2009-07-28 22:48

• 看图说话，29岁男性，反复头痛5年

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翻译的真好~~

有处有点小瑕疵哦，如下。
The American Medical Association is studying a proposal made at its annual meeting in June that doctors hang up their lab coats — for good. The group’s Council on Science and Public Health is looking at the role clothing plays in transmitting bacteria and other microbes and is expected to announce its findings next year.
美国医学会正在就今年七月在年会中提出的一个动议进行研究，该动议是医生是否应该为了自己和病人的利益而放弃穿着白大衣。该组织的科学与公共卫生委员会正在研究医生的白衣在传播细菌及其他微生物中的作用并有望在明年公布结果。

June：应该是六月吧。

2009-07-29 10:32

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