Dr Chih-Hung Chang, Nephrologist,
New Hung Yuan Clinic
前長庚腎臟科醫師，分享醫療資訊，用HDF(Hemodiafiltration)、HD(Hemodialysis)、新式延展性血液透析術(HDx)治療尿毒症患者，包含高雄市、苓雅區、鳳山、前鎮、小港、大寮、鳥松等區，也接受國外腎友來台旅遊透析（Travel dialysis）和居護所合作居家醫療服務。
另外，缺乏同理心，也是一項問題，例如，有次患者淚流滿面談到自己親人的過世，醫師下一句話就問 “How is your abdominal pain?”
另外，「A good bedside manner is simply good medicine.」
醫師也是需要表現地有禮貌，具良好的溝通技巧的，例如作者的同事有一次就說了一個例子：一位控制很差的DM患者，遇到一位熱心的女meta醫師，
“I can’t continue to do this anymore,” he told her, on the verge of tears. “I’ve just given up.”
She placed a hand on his shoulder and just sat with him. After a pause, she said: “You have a heart that still beats, and legs you can still walk on — many of my patients don’t have that privilege.”
Five years later, recalling this episode, her patient credits her with inspiring him to take better care of himself. The entire encounter took less than five minutes.
然而並不是所有事都是令人開心的，也有在Christmas Eve被診斷出brain cancer，但是患者又想急著出院回家過節。在美國，Christmas或是過年前後，醫院的死亡率是比較高的(是經由統計57 million official death certificates produced in the United States between 1979 and 2004)，此外交通意外也比較多。
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Daniela Lamas is a pulmonary and critical care fellow at Brigham and Women’s Hospital, Beth Israel Deaconess Medical Center and Massachusetts General Hospital, in Boston.
But when I approached the infant to examine him more closely, I noted his nostrils flaring and the muscles between his ribs contracting into subtle channels across his chest with each inhalation. He was working hard to breathe.
Each medical case, like each mushroom, is a diagnostic puzzle.
LEARNING to diagnose diseases or identify mushrooms also means learning ecology. Just as an experienced forager knows which mushrooms to expect based on region, climate, season and recent rainfall patterns, the sort of tree overhead and forest duff underfoot, a physician understands that diseases have an ecological context of season and geography. Doctors expect Lyme disease in the summer and influenza in the winter, and, as with foraging, knowing what to look for helps us to see it. A fruity whiff in the forest tells of nearby black trumpet mushrooms, which are often smelled before they are seen, just as the slight movements of a child’s nostrils tell of more serious problems hidden inside the lungs.
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Jonathan Reisman is an internist and pediatrician at Massachusetts General Hospital, and the president of the World Health and Education Network.
Here are five things they say the CDC is getting wrong. 1. The CDC is telling possible Ebola patients to "call a doctor."
找到自己的醫生？不容易，而且，醫生一旦請疑似病例自行就醫，就中間可能散佈更多的感染。最好是用ambulance(119)系統，不然醫院或是急診一旦來了疑似ebola病例，ER有可能因而需要關閉數小時（例如：Massachusetts就曾發生過）
2. The CDC director says any hospital can care for Ebola patients.
事實上，不是所有的醫院都有處理病人和感染物能力的
"not all hospitals are created equally"
3. The CDC didn't encourage the "buddy system" for doctors and nurses.
沒錯，有時候自己無菌操作穿戴方式錯誤，或是被污染了，也不自知，有另一個buddy在旁監督，效果更好。
"buddy," another health care worker, who acts as a safety supervisor, monitoring the worker from the time he puts on the gear until the time he takes it off.
4. CDC didn't encourage doctors to develop Ebola treatment guidelines.
是否插管或是洗腎治療被感染的病人？也許是還沒有正式的治療指引，這需要時間來慢慢建立。
- inserting a breathing tube and giving kidney dialysis -- that were unlikely to help Duncan. He described them as a "desperate measure" to save his life.
5. The CDC put too much trust in protective gear.
照顧過確診ebola患者的醫護人員，也應該被追蹤是否被感染。因為，防護衣不是萬能的，也會有操作不當而自己被感染而不知情的狀況。
Public health experts said that was a misstep, as the CDC should have realized that putting on and taking off protective gear is often done imperfectly and one of the workers might get an infection.
