医疗：回到希波克拉底时代
# In Medicine,
# Sometimes It’s Better to Do Nothing
我愿以此纯洁与神圣的精兔子手工灯笼
神，终⽣执⾏我职务……⽆论⾝
处何处，遇男遇⼥，贵⼈及奴婢，我之唯⼀⽬的，为病家谋幸福，并检点吾⾝，不作各种害⼈及恶劣⾏为……
——选⾃《希波克拉底誓⾔》
That Latin maxim (格⾔) roughly translated as “above all, do no harm” is a key element of the Hippocratic Oath.改善近义词
拉丁语⾥有⼀条格⾔，粗略翻译过来便是“⾸要的原则是，不要给病⼈带来危害”，这是《希波克拉底誓⾔》(指的是刚⼊⾏的医⽣向希波克拉底进⾏的宣誓，内容涉及医⽣职业道德。希波克拉底为古希腊名医，被称为“医学之⽗”。 )的核⼼要素。
One of the foundational elements of medical ethics is nonm aleficence (罪⾏) , the notion that when treating a patient, it may be preferable to not do something, or even do nothing at all, if the intervention risks causing more harm than good.
医学职业道德中最基本的原则之⼀是“不为害”。该原则表述的是这样⼀个概念：在治疗病⼈时，如果某项治疗可能产⽣的负⾯作⽤⽐其产⽣的积极作⽤要⼤，那应该偏向于不使⽤该治疗⼿段，甚⾄可以不使⽤任何治疗⼿段。
Yet, in our modern era, with its dizzying (使⼈眼花缭乱的) technological innovation, ready access to a cornucopia (丰富) of drugs and impatience driven by the jolts-per-minute pace of daily life,
the guiding maxim has become“Do something. Do anything.”
然⽽，在当今时代，技术⾰新令⼈眼花缭乱，各⾊药物变得唾⼿可得，每分每秒都需要新鲜刺激的⽇常⽣活节奏使⼈们变得毫⽆耐⼼。这使得医学的指导性格⾔实际上已经变成：“快做点什么，能做的都做。”
温柔的惩罚You e it every day in medical practice. No one wants to leave a physician' s office without a preion or a high-tech test. Everybody wants to be screened so they can nip (阻⽌) cancer in the bud (萌芽状态) or catch Alzheimer’s early, even when this information can do more harm than good.
这种现象在⽇常的医学实践中随处可见。没⼈想两⼿空空地⾛出医⽣办公室，谁都想拿到⼀张处⽅或⾼科技化验单。每个⼈都想作检查，好把癌症消灭在萌芽状态，或者及早发现⽼年痴呆症(阿尔茨海默症，俗称⽼年痴呆症，临床表现为认知和记忆功能不断下降，⽇常⽣活能⼒逐渐减退，并有各种神经精神症状和⾏为障碍)的苗头，即使这样带来的负⾯作⽤⼤于积极作⽤也在所不惜。
The Nike “JUST DO IT” and the consumerist philosophy that more is always better may carry the day (获胜) on TV dramas, but it has no place in real-life medicine. Acting swiftly and firmly may provide succour (救援), at least temporarily, but every action has an equal and often greater reaction.
耐克的⼴告语“放⼿去做”以及“更多就是更好”的消费理念也许可以在电视剧⾥⼤⾏其道，但在现实的医疗环境中却并不可取。迅速⽽果断地采取⾏动也许能提供紧急救援，⾄少暂时来看是如此，但每个⾏动都会带来等量甚⾄常常是更⼤的副作⽤。
We em—in medicine as in life—to have lost the precious ability to ponder. To wait. To utter the three magic words “I don’t know.” To wily do nothing until we do know more, or until nature takes its cour.数开头的成语
如同对待⽣活⼀样，我们对待医疗时似乎都丧失了宝贵的思考能⼒，我们不愿意等待，也不愿意说出“
我不知道”这⼏个奇妙的字眼。在我们了解更多情况或者顺其⾃然之前，也不愿理智⽆为。是如此，但每个⾏动都会带来等量甚⾄常常是
一什么湖水奇妙的字眼。在我们了解更多情况或者顺其⾃然之前，也不愿理智⽆为。是如此，但每个⾏动都会带来等量甚⾄常常是更⼤的副作⽤。
The result is an epidemic of overtreatment that is both financially costly and physically harmful. The reality was expod in a sobering book by journalist Shannon Brownlee entitled Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer .
以上⾏为导致的结果便是泛滥成灾的过度治疗，这不仅耗费⼤量资⾦，⽽且对⾝体有害。记者莎朗·布朗利(莎朗·布朗利，美国著名记者与评论家，常在《⼤西洋⽉刊》《纽约时报》等著名媒体发表⽂章，代表作即⽂中提到的《过度治疗：太多药物为何会加剧病情与贫困》⼀书)在⾃⼰所著的《过度治疗：太多药物为何会加剧病情与贫困》⼀书中冷静地为我们指出了这⼀现状。
In May, 2011, the Good Stewardship Working Group—physicians who believe good care can be delivered costeffectively—published a list of commonly ud tests and treatments that are unnecessary.
2011年5⽉，促进临床优质服务组织——该组织的医⽣相信能够以更低的成本和更⾼的效率来提供医疗服务——发布了⼀份清单，列出了⼀些并⾮必需却被经常使⽤的化验和治疗⼿段。
2011年12⽉初，⼀组学者进⾏了⼀项估算，如果去掉⼀些毫⽆必要的诊治项⽬，全美每年可节省的开⽀数额惊⼈——⾼达68亿美元。
Health-care costs are not on the ri becau physicians are going around doing unnecessary heart transplants. Rather, it is the routine u of banal (⽼⼀套的)—and generally uless—tests that is costing us all a bundle (⼀⼤笔钱).
医疗卫⽣费⽤不断上涨并不是因为医⽣们忙着做没有必要的⼼脏移植⼿术。相反，耗费我们⼤把⾦钱的是那些惯⽤但基本上毫⽆⽤处的常规化验。
The rearchers found, for example, that blood, urine (尿) and electrocardiogram (⼼电图) tests are routinely ordered for patients with no related symptoms or risk factors. The are too often done merely to give a patient the n that the doctor is “doing something.”
⽐如，研究⼈员发现，对于没有相关症状或危险因素的病⼈，医⽣也会例⾏公事似的要求验⾎、验尿以及做⼼电图测试。做这些化验的⽬的常常只是为了让病⼈觉得医⽣在“做些什么”。
在室料理新鲜人
Among the most frequently inappropriate practices were tho that involved children with minor ailments (疾病): Writing antibiotics (抗⽣素) preions for children with sore throats who didn’t have strep (链球菌) infection; recommending unnecessary cough syrup (⽌咳糖浆) for children with upper respiratory (呼吸的) infections, and ordering imaging tests such as CT scans for kids with minor head injuries (tho that did not involve dizziness or loss of consciousness). Again, there are real negative conquences to this kind of overtreatment, including fuelling antibiotic resistance (抗⽣素的耐药性) and exposing them to potentially harmful radiation.
在最常发⽣的不当医疗实践中，对微恙的⼩孩进⾏过度医疗是其中的典型：给嗓⼦疼但并未受链球菌感染的孩⼦开抗⽣素；给上呼吸道感染的孩⼦推荐⽆⽤的⽌咳糖浆；给头部受到轻微创伤(没有晕眩或昏迷症状)的孩⼦做CT扫描等成像检查。要再次强调的是，这种过度治疗的的确确存在负⾯后果，包括增加孩⼦对抗⽣素的耐药性，以及让孩⼦遭受可能有害的辐射危险。
It’s worth noting that the Good Stewardship Working Group focud strictly on the blatantly (公然地) wasteful.
值得注意的是，促进临床优质服务组织关注的焦点仅仅是那些极为明显的医疗浪费。
It deliberately avoided tackling more controversial issues such as PSA (前列腺的) testing for prostate
cancer and mass screening of young women for breast cancer. In tho cas, the admonition (警告) is not for doctors to do nothing, but rather to be more targeted in their interventions. For some young women—tho with veral risk factors—early screening is appropriate. And for some men, the PSA test can be uful, as can surgery and radiation.
该组织有意回避了更有争议的医疗项⽬，⽐如针对前列腺癌进⾏的前列腺特异性抗原化验和针对乳腺癌对年轻⼥性进⾏的⼤范围检查。对于这些状况，需要提醒医⽣的不是什么都不做，⽽是在诊疗过程中更有针对性。对于有些年轻⼥性——那些有患乳腺癌风险因素的⼥性——及早检查是适⽤的。对有些男性来讲，前列腺特异性抗原化验可能是有⽤的，
——那些有患乳腺癌风险因素的⼥性——及早检查是适⽤的。对有些男性来讲，前列腺特异性抗原化验可能是有⽤的，就像⼿术和放疗可能有⽤⼀样。
But watchful waiting also has its place. While that terminology is just coming into vogue (流⾏起来), there is a more long-standing term, clinical inertia (临床惯性), though it ems to have more negative connotations.
然⽽，观察等候疗法在治疗中也应该有⼀席之地。观察等候是刚刚流⾏起来的叫法，事实上它有⼀个存在已久的名称，叫做临床惯性，虽然该叫法听起来更具负⾯含义。
For example, clinical inertia means having a patient with mildly elevated blood pressure or high cholesterol (胆固醇) and deciding to not prescribe a drug. Instead, the doctor might encourage him to take a brisk walk each day or lo a few pounds, approaches that would be as effective as drugs and have no negative side effects.
举个例⼦来说明。临床惯性就是指在病⼈⾎压略升⾼或胆固醇偏⾼的情况下，医⽣决定不给病⼈开药。相反，医⽣可能会⿎励患者每天轻松地散散步或者减掉⼏磅体重。这些⽅法可能与药物治疗同样有效，但却不会产⽣任何副作⽤。
There was a time, not so long ago, when health
professionals ud this approach much more commonly, rather than immediately reaching for the preion pad or the diagnostic test. Yet, over time, physicians have been trained increasingly to become technicians, and overly dependent on technology.
曾经，在并不久远的过去，健康专家们更多的是采⽤这些⽅法，⽽不是⽴刻去拿处⽅本或化验单。但是，随着时间的推移，医⽣们越来越多地被训练成了技术员，在治疗过程中过度依赖技术。
Medicine is a science, but it is also an art. At its heart should be the art of listening, and the recognition that not acting is as important as acting.
医学是⼀门科学，但同时也是⼀门艺术。从本质上说，它应该是⼀门倾听的艺术，是承认不作为和积极作为同等重要的艺术。
In the minal (产⽣重⼤影响的) work of satire The Hou of God , author Samuel Shem provided a list of commandments for good medical care. The infamous 13th Law of The Hou of God was: “The delivery of good medical care is to do as much nothing as possible.”
⼀位名为塞缪尔·谢姆的作者写了⼀部影响深远的讽刺作品《上帝之屋》（作者为精神病医⽣斯蒂芬·贝格曼，其笔名为塞缪尔·谢姆。该⼩说出版于1978年，描述的是20世纪70年代的实习医⽣在实习期间遭到的⼼理伤害。⼩说中有位实习医⽣的指导医⽣，他教导学⽣违背医院的规定，并推荐⾃⼰的医疗准则，⽂中提到的第13条戒律便是其中的⼀条)。他在书中列出了作为优秀的医疗护理应遵循的⼀系列戒律。书中臭名昭著的第13条戒律这样说道：“好的医疗就是要尽可能地少做事。”
Yet, since the book’s publication in 1978, overtreatment has reached such tragicomic (悲喜剧的) proportions that the satire has melted away, leaving only age-old wisdom.
⽽⾃该书1978年出版之后，过度治疗的问题已发展到如今这样令⼈悲哀⼜叫⼈觉得滑稽的地步。这使得该书含有的讽刺意味消失殆尽，反成了古⽼的真知灼见。
It’s as if we have come full circle back to Hippocrates, who said: “To do nothing is sometimes a good remedy.”
仿佛我们兜转了⼀圈，⼜回到了希波克拉底治疗的时代。他说：“有时候，什么都不做反⽽是个好药⽅。”
By André Picard 译 / 夏辉更多雅思/托福英语备考资料、考试资讯和课程优惠
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