美国看病常识 2
2015-12-08

★★医院、住院部和分科

一.医院:开放的外观、封闭的内部结构:

不管是临街而建,还是有独立小道进入的医院,美国医院大楼从外观上看是开放式的,没有围墙和门岗。如留学生们熟悉的美国校园那样,无正二八经的校门和围墙。
有两个入口进入医院:紧急通道( Emergency Entrance )和正门入口( Main Entrance )。看急诊时直接开进紧急通道( Emergency Entrance ),直达急诊室( ER : Emergency Room 或称 ED : Emergency Department );当天手术 / 当天检测 / 交费 / 探望病人时由正门( Main Entrance )或与多层停车场相连的边门入内。当然从正门进去看急诊也不违规。
医院可能是单独的一栋高层大楼(小医院),也可能是连接的综合楼群。楼楼相通,且是封闭式的。 担架 ( Stretcher) 、轮椅( wheelchair )或步行均可通往各楼各层各检验室。另外,病房内的窗户未经许可,不可擅自打开。因为有些病房是密封、负压设计的,为防止空气传播的某些疾病,如 TB (肺结核病)的传播。而中国的医院恰好相反。国内的大部分老式医院有较封闭式的围墙和门卫及开放式的独立小楼拍片、做 CT Scan 或抽血化验等,奔来波去,经风雨见阳光。(这里只是单纯地比较。无意评论两国医院的优劣。一切习惯了就好!)

二.住院部:

在美国看病,若不是急诊,一般要预约,在自己所选的家庭医生的诊所( Clinics or office )或由家庭医生转的专科医生诊所得到诊治。急诊或家庭医生认为你必须马上住院,就进医院治疗。所以美国的医院实际上是急诊室和住院部。当然现在的综合医院也提供当天就能回家的简单手术室 / 中心( Outpatient One-day Surgery Suite/Center )和对外开放的各种 X-ray , CT Scan , MRI , EEG , EGD/Colonoscopy ,抽血化验等服务项目(外面诊所的医生开的检验处方)。

三.布局与分科:

进入大门,迎接你的就是醒目的问讯处( Information Desk ),紧挨着的可能是顾客服务台( Customer Service )   - 专门受理患者或家属对医院服务不满的地方。严重的案件可直达医院的 CEO/ 医护人员的 Director 。左边或右边会是 Main Lobby (主厅堂),有椅子和小卖部提供咖啡、其它饮料及点心。另外还有入院手续办理与登记处( Admitting and Registration)、交费处( Cashier )、礼品小卖部( Gift Shop )、保安部( Security )、急诊室( ER )和相邻的重症监护室( ICU : Intensive Care Unit )、对外的药房( Pharmacy )(医院内部的药房一般在底层的地下室,和餐厅、供电、供应 / 维修及化验室 / 血库等部门一起。)、当天的手术室( Outpatient Surgery Suite/Center )和影像室( Image Center/Radiology Department )等,按医院格局的大小而分布不同。
急诊室里有专门的护士(叫 Triage Nurse )接待你,按病情的轻重缓急分类处理。心脏病、中风脑溢血、车祸枪伤或大出血等紧急状况最先处理。轻微的病人有时候可能等上 3-4 小时后才能看到医生。人多忙碌时等上个 6-7 小时也不足为奇。

除急诊医生和护士外,你在 ER 里可能还遇到:
1. 护士助理( PCT: Patient Care Technician 或称 PCA : Patient Care Associate ):帮你量体温、血压等指标,叫 Vital Sign 。或送饭或扶你下床、上厕所等 ……

2. 抽血者( Phlebotomist ):受训过的专业抽血人员来到你的跟前采血。但紧急时护士会自己先采样送检。

3. 放射科人员( Radiologic technologists and technicians ):为你做 x-ray , CT 或 MRI 等检测。

4. 呼吸治疗师 (Respirtory Therapist):帮助呼吸系统更有效地呼吸,采血检测ABG(Arterial Blood Gases)。是重症监护室( ICU )的一个重要成员。

5. 急诊专科医生或手术医生/ 麻醉师: 根据病情,医院有专门的 Emergency Team ,有的病人必须马上手术或由专科处理。

一般情况,你将在 ER 被观察几小时,根据病情的轻重,或出院或住院。重症病人立即转到重症监护室( ICU ),其他的按病症分到各科室,称 Unit 。
各科按楼按层用代号取名。一般用大楼的捐助者的姓氏的第一字母或 ABC 字母或楼群的“东西南北”走向命名。如: C wing 的楼层称 C1 , C2 , C3……South 方向的称 1S , 2S , 3S…… 朝东的称 E1 , E2 , E3…… 等等。你到达那一层时,会看到标示: OR ( Operating Room ), PACU ( Post Anesthesia Care Unit ) , Cardiac/Pulmonary Unit , Stroke Unit , Pediatrics , Oncology Unit , Dialysis Center , Sleep Center , Wound Care Center 等 …… 但有的医院除了明显标示 ER , ICU , OR 外,却以代号标示其它的Units   -为方便内部电话 /Page System 紧急联络和定位,你询问时才告诉你具体的科名。但产科例外,几乎所有的医院都醒目地标着: Women’s Center 或 Birth Center 。也许是因为产妇从某种意义上来说不算病人,且迎接的又是新生命,极少死亡或加护,所以总是令人兴奋、欢喜的缘故吧。

得到急诊医生的处理、住进相应的科室( Unit )后,根据医院的不同设置和管理体系,你可能见到你的家庭医生( PCP : Primary Care Physician )  - 他 / 她是这家医院的合约医生;或者医院指定一医生给你,叫 Hospitalist( 驻诊医师)  -他 / 她替代你的家庭医生为你服务;或者医院指定一专科医生( Specialist )  - 比如心、肺、肾、骨科专科或肿瘤专科等。

医院根据自己的大小和医护人员的配备,会列出它的服务范围( Programs and Services ),各有增减、各有强项/优势。

举例:
* Emergency Room
* Radiology
* Plastic Surgery
* General/Vascular Surgery
* Neurosurgery/Neurology

* Radiation-Oncology
* Orthopedics
* Dermatology
* Gastroenterology
* Urology

* Cardiology
* OB/GYN
* Ophthalmology
* Otorhinolaryngology
* Internal Medicine

* Geriatrics
* Family Medicine
* Psychiatry
* Physical Therapy & Rehabilitation
......

四.外科医生和一些专科医生的分类与介绍:

1.外科医生(Surgeon):

1) General surgery 普通外科 :
a) Cardiothoracic surgery 心胸肺外科
b) Colorectal surgery 结肠直肠外科
c) Pediatric surgery 小儿外科
d) Plastic surgery 整形手术
e) Vascular surgery 血管外科
f) Trauma surgery 创伤外科
g) Breast surgery 乳腺外科
h) Surgical Oncology 肿瘤外科
i)Endocrine surgery 内分泌外科
j) Dermatological Surgery 皮肤科手术

2) Otolaryngology 耳鼻喉科
3) Oral and maxillofacial surgery 口腔颌面外科
4) Orthopaedic surgery 矫形外科
5) Neurosurgery 神经外科
6) Ophthalmology 眼科
7) Podiatric surgery 足外科
8) Urology 泌尿外科
......
(注:与外科医生密切配合的是Anesthesiologist 麻醉师。In the United States, anesthesiologists are physicians (MD or DO) who have chosen to specialize in anesthesiology。当然有的时候有Nurse Anesthetist或Anesthesiologist's Assistants来担负/协助麻醉。他们的工作十分重要。想一想,总要把病人麻倒了,外科医生的牛刀才能上啊!)

2.专科医生:

Specialist  Specialty  Focus
Anesthesiologist 麻醉师  Anesthesia  The administration of drugs to dull sensation or awareness.
Cardiologist 心脏科医生  Cardiology  Disease of the cardiovascular system . The field is commonly divided into subdisciplines dealing with congenital heart defects, coronary artery disease, heart failure, valvular heart disease and electrophysiology.
Dermatologist 皮肤科医生  Dermatology  Skin and its appendages (hair, nails, sweat glands etc).
Emergency MD 急诊医生  Emergency medicine  The initial management of emergent medical conditions, often in hospital emergency departments or the field.
Endocrinologist 内分泌科医生  Endocrinology  The endocrine system (i.e. endocrine glands and hormones ) and its diseases, including diabetes and thyroid diseases.
Gastroenterologist 胃肠科医师  Gastroenterology  The alimentary tract.
Geriatrician 老年病科医师  Geriatrics  Elderly patients.
Hematologist 血液学家  Hematology  The Blood, the blood-forming organs, and blood diseases. Hematology is grouped with oncology in the US.
Hepatologist 肝脏病学家  Hepatology  The liver and biliary tract, usually a part of gastroenterology.
Infectious disease MD 传染病学家  Infectious disease  Diseases caused by biological agents
Intensive care medicine MD 重症监护专家  Intensive care medicine  Life support and management of critically ill patients, often in an ICU.
Nephrologist 肾脏专科医师  Nephrology  Kidney disease.
Neurologist 神经科医师  Neurology  Diseases involving the central, peripheral, and autonomic nervous systems.
Obstetrician and Gynecologist 妇产科医师  Obstetrics and gynecology  Female reproductive organs, pregnancy, and childbirth.
Oncologist 肿瘤学家/ 肿瘤科医师  Oncology  Cancer and other malignant diseases, often grouped with hematology.
Ophthalmologist 眼科医师  Ophthalmology  Deal with the diseases and surgery of the visual pathways, including the eye, hairs and areas surrounding the eye, such as the lacrimal system and eyelids.
Pain Specialist 痛症专科医师  Pain Management  A new specialty of medicine that deals with the evaluation and treatment of people with acute or chronic pain. Anesthesiologists, neurologists, neurosurgeons and orthopedic surgeons most frequently specialize in pain management. Some physiatrists also specialize in pain management.
Palliative care MD 舒缓疗法专家  Palliative care  A relatively modern branch of clinical medicine that deals with pain and symptom relief and emotional support in patients with terminal illnesses including cancer and heart failure.
Pathologist 病理学家  Pathology  Understanding disease through examination of molecules, cells, tissues and organs. The term encompasses both the medical specialty which uses tissues and body fluids to obtain clinically useful information, as well as the related scientific study of disease processes.
Pediatrician 儿科医师  Pediatrics  Deal with the medical care of infants, children, and adolescents (from newborn to age 16-21, depending on the country).
Physical Therapist or Physical Therapy Physician 理疗师(受训过的专家,有的拥有doctorate degree.)  Physical Therapy  Provide treatment to individuals to develop, maintain and restore maximum movement and function throughout life. This includes providing treatment in circumstances where movement and function are threatened by aging, injury, disease or environmental factors.
Proctologist 肛肠科医师  Proctology  Disease in the rectum, anus, and colon.
Psychiatrist 精神病科医师  Psychiatry  The bio-psycho-social study of the etiology, diagnosis, treatment and prevention of cognitive, perceptual, emotional and behavioral disorders. Related non-medical fields include psychotherapy and clinical psychology.
Pulmonologist 肺科医师  Pulmonology  The lungs and respiratory system. Pulmonology is generally considered a branch of internal medicine, although it is closely related to intensive care medicine when dealing with patients requiring mechanical ventilation.
Radiologist 放射科医师  Radiology  The use of radiation in medical imaging and diagnosis. X-rays, etc.
Rheumatologist 风湿病科医师  Rheumatology  Autoimmune and inflammatory diseases of the joints and other organ systems, such as arthritis and other rheumatic diseases.
Wound Care Specialist伤口医治专家  Wound Care  Provide specialized care for complex wounds which are often difficult to treat and require the attention of skilled professionals.
*表内的英文解释来自网络.

另外,还有Clinical Dietitians(临床营养学专家/营养师)、Speech Therapists(言语治疗师)及不能列入专科医生里的各类的有处方权的Physician's Assistants(医生助理)和Nurse Practitioners(硕士学位以上的有专门执照的护士)。他们协助医生为你服务。其中一些人相当优秀,经验十足。
来源: 网络 责编: Kitt

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