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弥合生死鸿沟——精神疾病与医疗保健
Closing the Mortality Gap — Mental Illness and Medical Care


Lisa Rosenbaum ... 其他 • 2016.10.20

 我第一次与盖尔·莱文(Gail Levine)交谈时,她说了一些话让我至今仍难以释怀。盖尔·莱文是波士顿布里格姆和妇女医院(Brigham and Women’s Hospital)的一名内科医生,一心致力于帮助有严重精神疾病的患者。我当时正在治疗她的一名患者,是个50多岁的男性,患有偏执型精神分裂症。D先生当时刚发生了大面积心肌梗死,但他拒绝了血运重建术。尽管病情稳定下来,但那一天他明显出现呼吸困难,血流动力学检测结果证明有早期心脏压塞。由于他曾反复表示不愿接受针头刺入身体,我担心他也会拒绝心包穿刺术。因此莱文打电话来时,我松了一口气。

在与患有严重精神疾病并拒绝治疗的患者打交道方面,我的记录实在是不足道的。最近我治疗了一名比较年轻的患精神分裂症的女性患者。她有严重的症状性二尖瓣反流,是理想的手术治疗对象。但我根本无法说服她接受抽血检查,更不要提手术。她坐在床上,轻轻地摇晃着,梳自己的头发,毫不理会问她的问题,只是偶尔允许对她做个检查。我很快就放弃了说服她的尝试,也没有试图去理解她的逻辑推理。由于她明显缺乏做决定的能力,我们转而启动了申请法庭指定监护人的程序,这个程序长达数月。走这一步让我避免做出一个更为艰难的决定:如果拯救她的心脏会进一步损害她业已饱受折磨的灵魂,我们是否还应该这么做?

而对于D先生来说,当时已没有时间把艰难决定这一皮球踢给别人了。若是进入心脏压塞状态,他可能会死。尽管我不会让这种情况发生,莱文却没那么肯定。“你要知道,”她说,“患有严重精神疾病的患者平均死亡年龄是53岁。这就是一个重大原因。医生们总是想当然地以为由于他有精神病,他就没有生活质量。你不能就这么让他拒绝。”





作者信息

Lisa Rosenbaum, M.D.

 

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