美國看病常識(2)---醫院、住院部和分科 2010-01-05 13:40:26



一.醫院︰開放的外觀、封閉的內部結構︰

        不管是臨街而建,還是有獨立小道進入的醫院,美國的醫院大樓從外觀上是開放式的,沒有圍牆和門崗。如留學生們熟悉的美國校園那樣,無正二八經的校門和圍牆。

        有兩個入口進入醫院︰緊急通道( Emergency Entrance )和正門入口( Main Entrance )。看急診時直接開進緊急通道( Emergency Entrance ),直達急診室( ER ︰ Emergency Room 或稱 ED ︰ Emergency Department );當天手術 / 當天檢測 / 交費 / 探望病人時由正門( Main Entrance )或與多層停車場相連的邊門入內。當然從正門進去看急診也不違規。

        醫院可能是單獨的一棟高層大樓(小醫院),也可能是連接的綜合樓群。樓樓相通,且是封閉式的。 擔架 ( Stretcher) 、輪椅( wheelchair )或步行均可通往各樓各層各檢驗室。另外,病房內的窗戶未經許可,不可擅自打開。因為有些病房是密封、負壓設計的,為防止空氣傳播的某些疾病,如 TB (肺結核病)的傳播。而中國的醫院恰好相反。國內的大部分老式醫院有較封閉式的圍牆和門衛和開放式的獨立小樓拍片、做 CT Scan 或抽血化驗等,奔來波去,經風雨見陽光。(這里只是單純地比較。無意評論兩國醫院的優劣。一切習慣了就好!)

 

   

二.住院部︰

        在美國看病,若不是急診,一般要預約,在自己所選的家庭醫生的診所( Clinics or office )或由家庭醫生轉的專科醫生診所得到診治。急診或家庭醫生認為你必須馬上住院,就進醫院治療。所以美國的醫院實際上是急診室和住院部。當然現在的綜合醫院 也提供當天就能回家的簡單手術室 / 中心( Outpatient One-day Surgery Suite/Center )和對外開放的各種 X-ray , CT Scan , MRI , EEG , EGD/Colonoscopy ,抽血化驗等服務項目(外面診所的醫生開的檢驗處方)。

三.布局與分科︰

        進入大門,迎接你的就是醒目的問訊處( Information Desk ),緊挨著的可能是顧客服務台( Customer Service ) --- 專門受理患者或家屬對醫院服務不滿的地方。嚴重的案件可直達醫院的 CEO/ 醫護人員的 Director 。左邊或右邊會是 Main Lobby (主廳堂),有椅子和小賣部提供咖啡、其它飲料及點心。另外還有入院手續辦理與登記處( Admitting and Registration)、交費處( Cashier )、禮品小賣部( Gift Shop )、保安部( Security )、急診室( ER )和相鄰的重癥監護室( ICU ︰ Intensive Care Unit )、對外的藥房( Pharmacy )(醫院內部的藥房一般在底層的地下室,和餐廳、供電、供應 / 維修及化驗室 / 血庫等部門一起。)、當天的手術室( Outpatient Surgery Suite/Center )和影像室( Image Center/Radiology Department )等,按醫院格局的大小而分布不同。

        急診室里有專門的護士(叫 Triage Nurse )接待你,按病情的輕重緩急分類處理。心髒病、中風腦溢血、車禍槍傷或大出血等緊急狀況最先處理。輕微的病人有時候可能等上 3-4 小時後才能看到醫生。人多忙碌時等上個 6-7 小時也不足為奇。

        除急診醫生和護士外,你在 ER 里可能還遇到︰

        1. 護士助理( PCT: Patient Care Technician 或稱 PCA ︰ Patient Care Associate )︰幫你量體溫、血壓等指標,叫 Vital Sign 。或送飯或扶你下床、上廁所等 ……

        2. 抽血者( Phlebotomist )︰受訓過的專業 抽血人員來到你的跟前采血。但緊急時護士會自己先采樣送檢。

        3. 放射科人員( Radiologic technologists and technicians )︰為你做 x-ray , CT 或 MRI 等檢測。

        4. 呼吸治療師 (Respirtory Therapist  )︰幫助呼吸系統更有效地呼吸,采血檢測ABG(Arterial Blood Gases)。是重癥監護室( ICU )的一個重要成員。
      
        5. 急診專科醫生或手術醫生/ 麻醉師︰ 根據病情,醫院有專門的 Emergency Team ,有的病人必須馬上手術或由專科處理。

        一般情況,你將在 ER 被觀察幾小時,根據病情的輕重,或出院或住院。重癥病人立即轉到重癥監護室( ICU ),其他的按病癥分到各科室,稱 Unit 。

        各科按樓按層用代號取名。一般用大樓的捐助者的姓氏的第一字母或 ABC 字母或樓群的“東西南北”走向命名。如︰ C wing 的樓層稱 C1 , C2 , C3……South 方向的稱 1S , 2S , 3S…… 朝東的稱 E1 , E2 , E3…… 等等。你到達那一層時,會看到標示︰ OR ( Operating Room ), PACU ( Post Anesthesia Care Unit ) , Cardiac/Pulmonary UnitStroke Unit Pediatrics Oncology UnitDialysis CenterSleep CenterWound Care Center 等 …… 但有的醫院除了明顯標示 ER , ICU , OR 外,卻以代號標示其它的Units ---為方便內部電話 /Page System 緊急聯絡和定位,你詢問時才告訴你具體的科名。但產科例外,幾乎所有的醫院都醒目地標著︰ Women’s CenterBirth Center 。也許是因為產婦從某種意義上來說不算病人,且迎接的又是新生命,極少死亡或加護,所以總是令人興奮、歡喜的緣故吧。
 
        讀得累了吧,看一組Centennial Hills Hospital Medical Center (6900 North Durango Dr.  Las Vegas, NV 89149-4409)的照片︰

   

Main Lobby and Welcome Desk                     Main Lobby West Wing—Mountain View 

 

    

OR(Surgery Room  )                                PACU(Surgery Recovery Area)

        得到急診醫生的處理、住進相應的科室( Unit )後,根據醫院的不同設置和管理體系,你可能見到你的家庭醫生( PCP ︰ Primary Care Physician )--- 他 / 她是這家醫院的合約醫生;或者醫院指定一醫生給你,叫 Hospitalist( 駐診醫師)---他 / 她替代你的家庭醫生為你服務;或者醫院指定一專科醫生( Specialist )--- 比如心、肺、腎、骨科專科或腫瘤專科等。

        醫院根據自己的大小和醫護人員的配備,會列出它的服務範圍( Programs and Services ),各有增減、各有強項/優勢。
舉例︰

        *  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.外科醫生和一些專科醫生的分類與介紹(供新移民參考。人老了,腦子不靈了。若有遺漏和錯誤,敬請指正。)

1.外科醫生(Surgeon)︰

1) General surgery
    普通外科

       
a)  Cardiothoracic surgery   心胸肺外科

        b)  Colorectal surgery   結腸直腸外科
 
        c)  Pediatric surgery   小兒外科 
   
        d)  Plastic surgery   整形手術 

        e)  Vascular surgery    血管外科 

        f)  Trauma surgery   創傷外科 

        g)  Breast surgery   乳腺外科  

        h)  Surgical Oncology   腫瘤外科

        i)  Endocrine surgery   內分泌外科

        j)  Dermatological Surgery   皮膚科手術

2)  Otolaryngology   耳鼻喉科

3)  Oral and maxillofacial surgery   口腔頜面外科

4)  Orthopaedic surgery    矯形外科

5)  Neurosurgery   神經外科 

6)  Ophthalmology   眼科

7)  Podiatric surgery   足外科

8)  Urology   泌尿外科  
 ......

(注︰與外科醫生密切配合的是Anesthesiologist 麻醉師。In the United States, anesthesiologists are physicians (MD or DO) who have chosen to specialize in anesthesiology。當然有的時候有Nurse AnesthetistAnesthesiologist's Assistants來擔負/協助麻醉。他們的工作十分重要。想一想,總要把病人麻倒了,外科醫生的牛刀才能上啊!:)

2.專科醫生︰

Specialist

Specialty

Focus

Anesthesiologist 麻醉師 Anesthesia Anesthesia : the administration of drugs to dull sensation or awareness.
Cardiologist 心髒科醫生 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 皮膚科醫生 Dermatology Skin and its appendages (hair, nails, sweat glands etc).
Emergency MD 急診醫生 Emergency medicine

The initial management of emergent medical conditions, often in hospital emergency departments or the field.

Endocrinologist 內分泌科醫生 Endocrinology

The endocrine system (i.e. endocrine glands and hormones ) and its diseases, including diabetes and thyroid diseases.

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Gastroenterologist 胃腸科醫師 Gastroenterology The alimentary tract.
Geriatrician 老年病科醫師 Geriatrics Elderly patients.
Hematologist 血液學家 Hematology The Blood, the blood-forming organs, and blood diseases. Hematology is grouped with oncology in the US.
Hepatologist 肝髒病學家 Hepatology The liver and biliary tract, usually a part of gastroenterology.
Infectious disease MD 傳染病學家 Infectious disease Diseases caused by biological agents
Intensive care medicine MD 重癥監護專家 Intensive care medicine Life support and management of critically ill patients, often in an ICU.
Nephrologist 腎髒專科醫師 Nephrology Kidney disease.
Neurologist 神經科醫師 Neurology Diseases involving the central, peripheral, and autonomic nervous systems.
Obstetrician and Gynecologist 婦產科醫師 Obstetrics and gynecology Female reproductive organs, pregnancy, and childbirth.
Oncologist 腫瘤學家/ 腫瘤科醫師 Oncology Cancer and other malignant diseases, often grouped with hematology.
Ophthalmologist 眼科醫師 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 痛癥專科醫師 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 舒緩療法專家 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 病理學家 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 兒科醫師 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 理療師(受訓過的專家,有的擁有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 肛腸科醫師 Proctology Disease in the rectum, anus, and colon.
Psychiatrist 精神病科醫師 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 肺科醫師 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 放射科醫師 Radiology The use of radiation in medical imaging and diagnosis. X-rays, etc.
Rheumatologist 風濕病科醫師 Rheumatology Autoimmune and inflammatory diseases of the joints and other organ systems, such as arthritis and other rheumatic diseases.
Wound Care Specialist傷口醫治專家 Wound Care Provide specialized care for complex wounds which are often difficult to treat and require the attention of skilled professionals.
*表內的英文解釋來自網絡.

        另外,還有Clinical Dietitians(臨床營養學專家/營養師)、Speech Therapists(言語治療師)不能列入專科醫生里的各類的有處方權的Physician's Assistants(醫生助理)Nurse Practitioners(碩士學位以上的有專門執照的護士)。他們協助醫生為你服務。其中一些人相當優秀,經驗十足。

    

資訊來源:閩姑的網站

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