#46
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Öèòàòà:
À ÷òîáû âàì åù¸ ñìåøíåå ñòàëî, òî ÿ òóò òîëüêî ÷òî ïîîáùàëàñü ñ îäíèì èç ðåçèäåíòîâ, êîòîðûé ïîëíîñòüþ çàêîí÷èë ñâîé òðýéíèíã â Àíãëèè ãäå-òî ãîä íàçàä: ó íèõ â ãîñïèòàëå òîæå, çíàåòå ëè, ìûëè ñ äåçèíôåêòàíòàìè ïîë è âñå ïîâåðõíîñòè â îðòîïåäè÷åñêèõ îïåðàöèîííûõ ìåæäó îïåðàöèÿìè, õèðóðãè ðàáîòàëè â ñïåöèàëüíûõ øëåìàõ, ïðè òîì ÷òî â îáû÷íûõ îïåðàöèîííûõ (çà èñêëþ÷åíèåì ñîñóäèñòûõ) äàæå õèðóðãè íå âñåãäà îäåâàëè ìàñêè. Íó à ïîòîëîê ìîþò òîëüêî åñëè óæ õèðóðãè è òàì êðîâüþ óìóäðÿòñÿ çàáðûçãàòü ![]() |
#47
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Öèòàòà:
Öèòàòà:
4. Âàì íå çíàêîìà òàêòèêà, êîãäà ÝÒÍ äåëàåòñÿ âñåì ïîäðÿä ïðîñòî ïîòîìó, ÷òî òàê äåëàåòñÿ è âñå òóò? Âïîëíå ìîæåò áûòü, ÷òî ïðîñòîé ïîõîä ê àíåñòåçèîëîãàì ñ ïðîñüáîé ÷àùå äåëàòü ñïèíàëüíóþ àíåñòåçèþ è óâåí÷àåòñÿ óñïåõîì, íî, ïîâòîðþñü, ïðàâèëî íàøåé êîìàíäû ïåðåä ïîõîäîì ïî÷èòàòü. 5. À àíåñòåçèîëîãè îâöû áåççàùèòíûå è îòâåòèòü èì íå÷åãî. Âîò ïóñêàé è ïðîàðãóìåíòèðóþò ïèñüìåííûì äîêëàäîì íåîáõîäèìîñòü ðóòèííîé ÝÒÍ ââèäó îáùåé ñìåðòíîñòè, ÷àñòîòû òðîìáîýìáîëè÷åñêèõ îñëîæíåíèé, ðàííåé àêòèâèçàöèè, ëó÷øèì ôóíêöèîíàëüíûì ðåçóëüòàòàì, ôèíàíñîâîé ñòîèìîñòè è óðîâíþ áîëè â ïîñëåîïåðàöèîííîì ïåðèîäå. À òî ïîêà ïî ìîèì äàííûì êàðòèíêà ïî ýòèì ïàðàìåòðàì áîëåå áëàãîñêëîííà ê ñïèíàëüíîé àíåñòåçèè. À åñëè èì ÷òî-òî íóæíî, èëè íå õâàòàåò ÷åãî-òî, êóïèòüü òàì íàäî ñíàäîáüå êàêîå èëè ðàñõîäíèê, òàê òóò áåç àäìèíèñòðàöèè íèêàê. Òàê ê ÷åìó îò íåå ïðÿòàòüñÿ? Èëè âû ñ÷èòàåòå, ÷òî â ÐÔ àäìèíèñòðàöèÿ - áè÷, îò êîòîðîãî õîâàòüñÿ íàäîòü? 6. Òàê âñå-òàêè, ïîòîëîê âû ïîñëå êàæäîé îïåðàöèè ìîåòå? Î÷åíü èíòåðåñíî. |
#48
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Öèòàòà:
Îïÿòü äâàäöàòü ïÿòü. Ïåðñîíàë - ýòî äåéñòâèòåëüíî èñòî÷íèê èíôåêöèè è ïî òåì æå ñêàôàíäðàì åñòü èññëåäîâàíèÿ. À ïî ïîâîäó ìûòüÿ - íåò. È, êñòàòè, ïðî ñêàôàíäðû ÿ íå òîëüêî ñëûøàë. Öèòàòà:
Çàáðûçãàåì - ïîìîåì. Áðûçãàòü íå íàäî. |
#49
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Ïî÷åìó ðåãèîíàðíàÿ àíåñòåçèÿ èñïîëüçóåòñÿ ÷àùå? Äà ïîòîìó, ÷òî â 70-80-90õ, êîãäà è õèðóðãè÷åñêèå òåõíèêè (ñ áîëüøîé êðîâîïîòåðåé), è íåäîñòàòî÷íàÿ ïðîôèëàêòèêà ãëóáîêèõ òðîìáîçîâ áûëè ðåàëüíîñòüþ, òî ðåãèîíàðíàÿ àíåñòåçèÿ èìåëà ïðåèìóùåñòâà ïåðåä îáùåé (ìåíüøå êðîâîïîòåðÿ, ìåíüøå ãëóáîêèõ òðîìáîçîâ ñ ïðîäîëæàþùåéñÿ ýïèäóðàëüíîé), à ñåé÷àñ ýòî óæå íå òàê àêòóàëüíî. Âû ÷àñòî ïåðåëèâàåòå êðîâü íà ïåðâè÷íûå ïðîòåçèðîâàíèÿ òàçîáåäðåííîãî ñóñòàâà? Íàâåðíÿêà ïðàêòè÷åñêè íå ïåðåëèâàåòå, åñëè íà ðåâèçèþ, òî ýòî ñîâñåì äðóãîé ðàçãîâîð (äà è òî çàâèñèò îò ìíîãèõ ôàêòîðîâ), íî íà ñëîæíûå ðåâèçèè ðåãèîíàðíàÿ äåëàåòñÿ äàëåêî íå âñåãäà (÷àùå âñ¸-òàêè îáùàÿ). Âû ïðîäîëæàåòå èñïîëüçîâàòü ãåïàðèí äëÿ ïðîôèëàêòèêè ãëóáîêèõ òðîìáîçîâ èëè ÍÌÃ? À òóò óæå ëþáîå ïðåèìóùåñòâî ýïèäóðàëüíîé â ýòîì ïëàíå îòñóòñòâóåò, à ñàìà ýïèäóðàëüíàÿ ñòàíîâèòñÿ ïîòåíöèàëüíîé ïðîáëåìîé. Íèêòî åù¸ íå äîêàçàë, ÷òî ðåãèîíàðíûå ìåòîäû äåéñòâèòåëüíî óëó÷øàþò ïîêàçàòåëè ñìåðòíîñòè. À â âîïðîñå ïîñëåîïåðàöèîííîé áîëè íóæíî èëè èñïîëüçîâàòü ýïèäóðàëüíóþ (ïðîäîëæàþùóþñÿ), èëè ïåðèôåðè÷åñêèå (ìîæíî è ïðîäîëæàþùèåñÿ) íåðâíûå áëîêè, íó èëè ââîäèòü èíòðàòåêàëüíûé ìîðôèé, íî òàêèå ïàöèåíòû äî 24õ ÷àñîâ íóæäàþòñÿ â íàáëþäåíèè äëÿ ïðåäîòâðàùåíèÿ äåïðåññèè äûõàíèÿ. Òàê ÷òî âñå "ïëþñû" ðåãèîíàðíîé â êîíå÷íîì èòîãå âûðàâíèâàþòñÿ. Äàæå â ýêîíîìè÷åñêîì ïëàíå, åñëè íåîáõîäèì äîïîëíèòåëüíûé ïåðñîíàë (äëÿ îïåðàöèîííîé, ñîçäàíèå íîðìàëüíîé ïîñëåîïåðàöèîííîé), âñ¸ ìîæåò îêàçàòüñÿ äàëåêî íå òàê óæ è ïðèâëåêàòåëüíî.
Òàê ÷òî îòâå÷àÿ íà âàø âîïðîñ, åù¸ ðàç çàìå÷ó, ÷òî íèêàêîé áîëüøîé ðàçíèöû ìåæäó ñîâðåìåííîé îáùåé è ðåãèîíàðíîé àíåñòåçèåé îñîáî íå ñóùåñòâóåò, ïî êðàéíåé ìåðå, ïîêà íå äîêàçàíî îáðàòíîå (à ðàáîòàåì ìû òàê èñòîðè÷åñêè ![]() Åñëè óæ äåéñòâèòåëüíî òàê çàèíòåðåñîâàíû â ýôôåêòèâíîñòè, òî ëó÷øå íà÷èíàéòå ðàçãîâîð ñ âàøèìè àíåñòåçèîëîãàìè ñ ðåàëüíîé ôèíàíñîâîé çàèíòåðåñîâàííîñòè. ![]() Cochrane Database Syst Rev. 2004 Oct 18;(4):CD000521. Anaesthesia for hip fracture surgery in adults. Parker MJ, Handoll HH, Griffiths R. Orthopaedic Department, Peterborough District Hospital, Thorpe Road, Peterborough, Cambridgeshire, UK, PE3 6DA. Update of: Cochrane Database Syst Rev. 2001;(4):CD000521. BACKGROUND: The majority of people with hip fracture are treated surgically, requiring anaesthesia. OBJECTIVES: To compare different types of anaesthesia for surgical repair of hip fractures (proximal femoral fractures) in adults. SEARCH STRATEGY: We searched the Cochrane Musculoskeletal Injuries Group specialised register (November 2003), MEDLINE (1996 to February week 2 2004), EMBASE (1988 to 2004 week 10) and reference lists of relevant articles. SELECTION CRITERIA: Randomised and quasi-randomised trials comparing different methods of anaesthesia for hip fracture surgery in adults. The primary focus of this review was the comparison of regional (spinal or epidural) anaesthesia versus general anaesthesia. The use of nerve blocks preoperatively or in conjunction with general anaesthesia is evaluated in another review. The primary outcome was mortality. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. MAIN RESULTS: Twenty two trials, involving 2567 predominantly female and elderly patients, comparing regional anaesthesia with general anaesthesia were included. All trials had methodological flaws and many do not reflect current anaesthetic practice. Pooled results from eight trials showed regional anaesthesia to be associated with a decreased mortality at one month (56/811 (6.9%) versus 86/857 (10.0%)); however, this was of borderline statistical significance (relative risk (RR) 0.69, 95% confidence interval (CI) 0.50 to 0.95). The results from six trials for three month mortality were not statistically significant, although the confidence interval does not exclude the possibility of a clinically relevant reduction (86/726 (11.8%) versus 98/765 (12.8%), RR 0.92, 95% CI 0.71 to 1.21). The reduced numbers of trial participants at one year, coming exclusively from two trials, preclude any useful conclusions for long-term mortality (80/354 (22.6%) versus 78/372 (21.0%), RR 1.07, 95% CI 0.82 to 1.41).Regional anaesthesia was associated with a reduced risk of deep venous thrombosis (39/129 (30%) versus 61/130 (47%); RR 0.64, 95% CI 0.48 to 0.86). However, this finding is insecure due to possible selection bias in the subgroups in whom this outcome was measured. Regional anaesthesia was also associated with a reduced risk of acute postoperative confusion (11/117 (9.4%) versus 23/120 (19.2%), RR 0.50, 95% CI 0.26 to 0.95). There was insufficient evidence to draw any conclusions from a further four included trials, involving a total of 179 participants, which compared other methods of anaesthesia (a 'light' general with spinal anaesthesia; intravenous ketamine; nerve blocks). REVIEWERS' CONCLUSIONS: Overall, there was insufficient evidence available from trials comparing regional versus general anaesthesia to rule out clinically important differences. Regional anaesthesia may reduce acute postoperative confusion but no conclusions can be drawn for mortality or other outcomes. Ýòî äëÿ ëþáèòåëåé êîêðàíîâñêèõ îáçîðîâ ![]() Clin Orthop Relat Res. 2009 Sep;467(9):2379-402. Epub 2009 Jan 7. Does regional anesthesia improve outcome after total knee arthroplasty? Macfarlane AJ, Prasad GA, Chan VW, Brull R. Department of Anesthesia and Pain Management, Toronto Western Hospital, University Health Network, 399 Bathurst Street, Toronto, ON, Canada. Total knee arthroplasty (TKA) is amenable to various regional anesthesia techniques that may improve patient outcome. We sought to answer whether regional anesthesia decreased mortality, cardiovascular morbidity, deep venous thrombosis and pulmonary embolism, blood loss, duration of surgery, pain, opioid-related adverse effects, cognitive defects, and length of stay. We also questioned whether regional anesthesia improved rehabilitation. To do so, we performed a systematic review of the contemporary literature comparing general anesthesia and/or systemic analgesia with regional anesthesia and/or regional analgesia for TKA. To reflect contemporary surgical and anesthetic practice, only randomized, controlled trials from 1990 onward were included. We identified 28 studies involving 1538 patients. There was insufficient evidence from randomized, controlled trials alone to conclude if anesthetic technique influenced mortality, cardiovascular morbidity other than postoperative hypotension, or the incidence of deep venous thrombosis and pulmonary embolism when using thromboprophylaxis. Our review suggests there was no difference in perioperative blood loss or duration of surgery in patients who received general anesthesia versus regional anesthesia. Compared with general anesthesia and/or systemic analgesia, regional anesthesia and/or analgesia reduced postoperative pain, morphine consumption, and opioid-related adverse effects. Length of stay may be reduced and rehabilitation facilitated for patients undergoing regional anesthesia and analgesia for TKA. |
#50
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Èçâèíèòå, íî âñ¸ ðàâíî ïîëíûé áðåä! Íåò, çàìå÷àòåëüíî, êîíå÷íî, ÷òî õèðóðãè çàèíòåðåñîâàëèñü àíåñòåçèîëîãèåé, íî âû ðåàëüíî ìîæåòå îöåíèòü ïîëó÷åííóþ èíôîðìàöèþ? Íå áóäó÷è ñïåöèàëèñòîì? Èëè âû, ê ïðèìåðó, ðàçãîâàðèâàÿ ñ òåðàïåâòàìè, ãîòîâÿùèìè ïàöèåíòîâ ê îïåðàöèè, òîæå ñíà÷àëà èçó÷àåòå âñå ïîñëåäíèå ðåêîìåíäàöèè ïî ïîâîäó ïåðèîïåðàöèîííîãî âåäåíèÿ ïàöèåíòîâ, ñêàæåì, ñ êîðîíàðíîé íåäîñòàòî÷íîñòüþ, à òîëüêî ïîòîì çàäà¸òå ñâîè âîïðîñû? Èëè ïðîñòî êàæåòñÿ, ÷òî àíåñòåçèîëîãèÿ - ýòî òî, ÷òî ëþáîé ìîæåò ñäåëàòü èãðàþ÷è??? Íàïîìèíàåò ÷åì-òî ðåêîìåíäàöèè êàðäèîëîãîâ: "èçáåãàòü ãèïîêñèè, ãèïîòåíçèè, íå èñïîëüçîâàòü ïðîïîôîë..."
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#51
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Öèòàòà:
![]() Ìû íå çíàåì, ÷åì îáóñëîâëåíû ïðîáëåìû ñ âíåäðåíèåì ðåãèîíàðíîé àíåñòåçèè â äàííîé êëèíèêå è íå ìîæåì ïîëíîöåííî ñóäèòü î ñèòóàöèè. Âîò òîëüêî èíòåðåñíî, êàê ó âàñ äëèòåëüíîñòü ðàáî÷åãî äíÿ íå âñòóïàåò â ïðîòèâîðå÷èå ñ íîðìàìè ÒÊ (ïðîäîëæèòåëüíîñòü ðàáî÷åé íåäåëè -39 ÷àñîâ). Ó âàñ 2-ñìåííûé ãðàôèê, ÷òî ëè? Âåäü äàæå ñ òî÷êè çðåíèÿ áåçîïàñíîñòè áîëüíîãî -óñòàâøèé àíåñòåçèîëîã ïîñëå 8 ÷àñîâ íåïðåðûâíîé ðàáîòû íå åñòü õîðîøî. |
#52
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Äà è âðÿä ëè áû êîëëåãà çàãëÿíóë íà ýòîò ôîðóì, åñëè áû îáùàÿ àíåñòåçèÿ ïðîâîäèëàñü äîñòàòî÷íî ñïîðî è íèêàêèõ çàäåðæåê áû íå áûëî (ïîòîìó ÷òî èçíà÷àëüíî èíòåðåñ áûë íå â óëó÷øåíèè êà÷åñòâà àíåñòåçèîëîãè÷åñêîé ïîìîùè, à â óëó÷øåíèè ýôôåêòèâíîñòè). Òàê ÷òî áûëî áû ëó÷øå ïðîñòî ñîáðàòüñÿ ñ êîëëåãàìè ïî îïåðàöèîííîé è îòêðûòî âûÿñíèòü, â ÷¸ì ïðîáëåìà (pàçâå ÷òî íèêòî è ïðåäñòàâëåíèÿ íå èìååò î ðåãèîíàðíîé, íî äàæå è ýòî íå îáúÿñíÿåò ãðîìàäíûå ïåðåðûâû ìåæäó îïåðàöèÿìè (ïî ñëîâàì õèðóðãà)) è êàê å¸ ìîæíî ðåøèòü (õîòÿ, ñóäÿ ïî ïîñòàì, ýòî äëÿ íåãî íèêàêèì ñåêðåòîì íå ÿâëÿåòñÿ ![]() Äà, à â ñîñåäíåì çàâåäåíèè, ãäå àíåñòåçèîëîãè òàê óäàðíî ðàáîòàþò, ÷òî èõ ñïîäâèãëî? Êñòàòè, åñëè õèðóðã "çàÿâèò" îïðåäåë¸ííûé âèä àíåñòåçèè, ïàöèåíò íà ýòî ñîãëàñåí, äàííûé âèä àíåñòåçèè ÿâëÿåòñÿ îäíîé èç îïöèé , è íåò ïðîòèâîïîêàçàíèé, òî ëè÷íî ÿ ñîâåðøåííî ñïîêîéíî ýòî ñäåëàþ áåç ëèøíèõ âîïðîñîâ, òê ïðåäïî÷òåíèå õèðóðãà ÿâëÿåòñÿ îäíîé èç ñîñòàâëÿþùèõ ìîåãî âûáîðà (åñòåñòâåííî, íå ñàìîé ãëàâíîé, íî ëåãèòèìíîé). |
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#53
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2. Åùå ðàç ïîâòîðþñü, ìû íå çíàåì âñþ îáñòàíîâêó â ýòîé êëèíèêå: êàê ñòðîÿòñÿ âçàèìîîòíîøåíèÿ ìåæäó õèðóðãàìè, àíåñòåçèîëîãàìè, àäìèíèñòðàöèåé. Âîçìîæíî, ïðîäâèæåíèå èíèöèàòèâû ñâåðõó - ýòî åäèíñòâåííûé "ñïîñîá" îáùåíèÿ ìåæäó êîëëåãàìè (õîòü ýòî è íå ëó÷øèé ñïîñîá). Íî îïÿòü æå - íå íàì ñóäèòü. Âîçìîæíî, àâòîð õî÷åò ïðèäòè íà òàêóþ âñòðå÷ó õîðîøî ïîäãîòîâëåííûì, ÷òîáû íå ñåñòü â ëóæó â ñëó÷àå êàâåðçíûõ âîïðîñîâ.  êîíöå êîíöîâ, îí çàøåë â ðàçäåë "Àíåñòåçèîëîãèÿ" èìåííî çà èíôîðìàöèåé, à íå çà ñîâåòàìè, êàê ðåîðãàíèçîâàòü ëå÷åáíûé ïðîöåññ. 3. Íå çíàåì, è äóìàþ, ÷òî íå óçíàåì. Ýòî êîììåð÷åñêàÿ òàéíà. ![]() 4. Àíàëîãè÷íî. Íî òîëüêî â òîì ñëó÷àå, êîãäà íåò ïðîòèâîïîêàçàíèé. Íî îáùàòüñÿ ñ õèðóðãîì, êîòîðûé èìååò íåêîòîðîå ïðåäñòàâëåíèå î âîïðîñå, áîëåå ïðèÿòíî è ïðîäóêòèâíî, ÷åì ñ òåì, êîòîðûé "÷òî-òî ãäå-òî ñëûøàë". |
#54
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Îòíîñèòåëüíî íåîáõîäèìîñòè ìûòüÿ ïîëà â îïåðàöèîííîé. ß, êàê óáåæäåííûé "çàïàäíèê" ñêëîíåí äîâåðÿòü â ýòîì âîïðîñå îïûòó è ñòàíäàðòàì ïðàêòèêè öèâèëèçîâàííîãî çäðàâîîõðàíåíèÿ. Îáû÷íî òàêèå âîïðîñû êåì-òî êîãäà-òî ïðîðàáîòàíû è çàáûòû. Îòñóòñòâèå ýâèäåíñà 1 óðîâíÿ â ýòîì âîïðîñå îáîçíà÷àåò òîëüêî îòñóòñòâèå ýíòóçèàçìà â îòíîøåíèè îïðîâåðæåíèÿ ýòèõ îáùåïðèíÿòûõ ñòàíäàðòîâ.
Áûëà, êàæåòñÿ, çàáàâíàÿ ñòàòüÿ â BMJ - ñîâåðøåííî ñåðü¸çíî, ïî âñåì ïðèíöèïàì ïûòàëèñü äîêàçàòü, ÷òî ïðè ïðûæêàõ èç ñàìîë¸òà íàäî ðàñêðûâàòü ïàðàøþò. Ê ñîæàëåíèþ, íèêàêèõ ðàíäîìèçèðîâàííûõ èññëåäîâàíèé ïðîâåäåíî íå áûëî. Òàê ÷òî - ýòî âñåãî ëèøü êàòåãîðèÿ Ñ - ìíåíèå ýêñïåðòîâ. |
#55
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#56
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#57
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Êîëëåãè, âàñ âñåõ ãîðàçäî ïðèÿòíåå ÷èòàòü, êîãäà íå èäóò áåñêîíå÷íûå ïîïûòêè âûÿñíèòü "ó êîãî äëèííåå", íó à åñëè èçìåðèòü íå óäàåòñÿ, òî îäíîçíà÷íî "òîëùå", ïîñêîëüêó ýòî common practiñe, à äåìîêðàòèè êîå-ãäå íåò.
Ñàì ôàêò, ÷òî ãäå-òî 100% êàêèõ ëèáî âìåøàòåëüñòâ ïðîèçâîäèòñÿ îäíèì ìåòîäîì íàñòîðàæèâàåò. Êàê ìèíèìóì íåäîñòàòêîì èíäèâèäóàëüíîãî ïîäõîäà ê ïàöèåíòó. Íå âèæó íè÷åãî ïðåäîñóäèòåëüíîãî â òîì, ÷òî àäìèíèñòðàòîð íà îñíîâàíèè ôàêòîâ ïðåäëîæèò "êîå-÷òî ïîìåíÿòü â êîíñåðâàòîðèè". Áîëåå òîãî, ìíå â ïîäîáíîé ñèòóàöèè áûëî áû ñòûäíî, ÷òî ýòî íå ÿ ïðèøåë â àäìèíèñòðàöèþ ñ ïðåäëîæåíèåì ïåðåìåí è çàïðîñîì íà íåîáõîäèìîå â äàííîì ñëó÷àå îáó÷åíèå/ïåðåîáîðóäîâàíèå. |
#58
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Öèòàòà:
![]() ![]() Íó à íàñ÷¸ò âñåãî îñòàëüíîãî - òî íè÷åãî óäèâèòåëüíîãî â òîì, ÷òî íàøà ñïåöèàëüíîñòü â Ðîññèè íå öåíèòñÿ íè õèðóðãàìè, íè ïàöèåíòàìè! Åñëè ñàìè àíåñòåçèîëîãè ñîâåðøåííî ñåðü¸çíî ñ÷èòàþò, ÷òî ëþáîé õèðóðã ìîæåò èì äèêòîâàòü, ÷òî è êàê äåëàòü, ïðè ýòîì äàæå íå óäîñóæèâøèñü ñ íèìè ïîãîâîðèòü, à äåéñòâóÿ "÷åðåç ãîëîâó" (îòêðîâåííî äåìîíñòðèðóÿ íåóâàæåíèå ê êîëëåãàì è ñîâåðøåííî íåïðîôåññèîíàëüíîå ïîâåäåíèå). Êàêàÿ òðîãàòåëüíàÿ çàùèòà! Ëè÷íî ÿ ñåáÿ êàê ñïåöèàëèñòà-ïðîôåññèîíàëà âåñüìà óâàæàþ è âåñüìà îòêðûòà äëÿ îáñóæäåíèÿ ñ õèðóðãàìè ëþáîé ïðîáëåìû è íàõîæäåíèÿ ïóòåé å¸ ðåøåíèÿ, òóò óæ ìîæíî è ñ ïðèâëå÷åíèåì àäìèíèñòðàöèè, åñëè åñòü òàêàÿ íåîáõîäèìîñòü, íî èìåííî ïîýòîìó è íå ïîçâîëþ ìíå íè÷åãî äèêòîâàòü (òàê æå, êàê íå áóäó äèêòîâàòü è õèðóðãó, ÷òî è êàê åìó äåëàòü). Çàòî ìîãó ó÷åñòü âñå ïîæåëàíèÿ! Ïðîôåññèîíàëèçì åù¸ è â òîì, ÷òîáû öåíèòü è óìåòü ðàçãîâàðèâàòü ñî ñâîèìè êîëëåãàìè (ëþáûìè), à íå äàâèòü íà íèõ. |
#59
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Òàøà, Âû çà íèõ ïåðåæèâàåòå, êàê çà ðîäíûõ ! Ýòî æå ôîðóì, íàø êîëëåãà äîêòîð îáðàòèëñÿ ñî âïîëíå êîíêðåòíûì âîïðîñîì, äëÿ òîãî, ÷òîáû óñëûøàòü êîìïåòåíòíîå ìíåíèå. Íàøà çàäà÷à ïîïûòàòüñÿ äàòü ãðàìîòíûé îòâåò, íåçàâèñèìî îò òîãî, êàê ýòà èíôîðìàöèÿ áóäåò èñïîëüçîâàíà. Íå ïðèíèìàéòå Âû ýòó äèñêóññèþ áëèçêî ê ñåðäöó. Íà ôîðóì ÐÌÑ ÷àñòî îáðàùàþòñÿ ïàöèåíòû, êîòîðûå õîòÿò óñëûøàòü ìíåíèå àëüòåðíàòèâíîå îò òîãî, ÷òî èì ãîâîðÿò èõ âðà÷è, ìû âåäü íå îòêàçûâàåì èì ñ ïîñûëîì íà òî, ÷òî äîêòîðà âñåãäà âñå äåëàþò ïðàâèëüíî è âñåãäà êîìïåòåíòíû.
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#60
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À äàâàéòå íå ÷èòàòü ìåæäó ñòðîê. È äåëàòü âûâîäû ñîãëàñíî òàì óâèäåííîìó.
Öèòàòà:
Öèòàòà:
Åùå ðàç, âñåãäà ïðèÿòíî êîãäà äåëÿòñÿ èíôîðìàöèåé, êîãäà îáñóæäàþò ïðåäñòàâëåííóþ èíôîðìàöèþ. Íî îáùåíèå â ñòèëå "Oh, my God! How you dare? It's so ugly! Don't you see this?" íàâîäèò íà ãðóñòíûå ðàçìûøëåíèÿ. |