更年期的植物疗法：科学与传统疗愈法真正有效的方法

这套体系是为股东服务的。

It's set up for shareholders.

这套体系是为报销机制设计的。

It's set up for reimbursement structures.

它围绕的是工作流程，而不是真正优质、连贯的临床诊疗。

It's set up for workflows, not necessarily for the excellent, connected practice of clinical medicine.

这要求我们彼此沟通，作为医生，要有足够的精力去倾听，然后运用我们的专业知识。

That requires that we talk to each other, that we, as clinicians, have the bandwidth to listen and then to apply our knowledge.

如果我们被迫只为RVU工作，那RVU到底是什么？

If we are being forced to work for RVUs and What's an RVU?

它叫相对价值单位。

It's a relative value unit.

明白了。

Okay.

光是这一点就已经够了。

Even just that.

听起来你像是在工厂里上班。

It sounds like you're working in a factory.

这就是我们时间被衡量的方式。

That is how it that is how our time is valued.

这叫相对价值单位。

It is called a relative value unit.

对。

Mhmm.

而这个标准是由一群年迈、陈旧、大多是男性、主要是外科医生组成的委员会决定的。

And it is decided by a groom full of crusty dusty, mostly male, mostly surgeons who decide

我们工作的价值，也是由他们来定的，是吧。

The relative value of our relative value of your work Yeah.

没错。

Is.

所以脑力劳动得不到应有的报酬。

So the work of the mind is not reimbursed.

不是。

No.

只有动手的活才算钱。

Only the work of the hands.

对。

Yeah.

你看，我是个外科医生，做过很多手术。

And look, I'm a surgeon, and I did a lot of procedures.

我是出于正当理由才做的。

I mean, I did them for the right reason.

相信我，我根本不是为了赚钱才给你做手术，说实话，我在诊所里其实是亏钱的。

Believe me, I wasn't making enough money to be doing surgery on you just to make trust me, I was losing money in the office.

那是另一回事了。

That's a whole other thing.

所以这个体系并不是另一回事。

So the system is it's not a whole other thing.

这其实是有关联的。

It's it's related.

整个体系根本没为医患之间的真正交流留空间，让你的医生真正了解你。

The system is not set up for people to experience each other and for your for your doctor to experience you.

我们连一点时间都没有。

Like, we just don't even have time.

我们花时间研究你的病情、思考你的状况、给你回电话、复查你的化验结果、听你讲你的故事，这些都没法从保险那里得到补偿。

So we don't get reimbursed by insurance for the amount of time that we're spending reading about this, thinking about you, calling you back, reviewing your labs, sitting and hearing your story.

我们拿的报酬，只看一天看了多少病人。

We get paid for how many people we saw that day.

这

That

根本没法让人去处理这类问题，没法深入交流，更别提发现其中的模式了。

does not lend itself to dealing with these kinds of issues and talking about stuff and recognizing patterns.

你懂的。

You know?

是的。

Yeah.

确实如此。

It just doesn't.

而且，当你去看各种医疗程序时，比如针对女性和男性做的同等手术。

And also, when you even look at procedures, procedures, if you look at equivalent procedures Women done on women versus men.

尤其是泌尿科，对吧？

Versus the equivalent procedure done on men, because we have, especially in urology, right?

我们用的是患者自身的组织。

We have autologous body parts.

阴蒂和阴茎头在功能上是对应的。

So, the clitoris is the equivalent to the head of the penis.

但同样的手术，男性能拿到的报销金额是女性的三到五倍。

So, if you look at these procedures, men are reimbursed like three to five times higher for the equivalent procedure.

我记得以前学过，因为在大公司里，医生的绩效完全看接诊人数和手术量，这才是收入来源。

I remember learning, because you know, when you work for a corporation, they are controlled by this model of as many patients that you can see in the clinical setting and do as many procedures as you can, and that's where the money is made.

他们也被同一个体系、同一个报销机制束缚着。

They are a slave to the same system, the same reimbursement system.

是的。

Yeah.

这真的让人痛心。

And it is heartbreaking.

产科护理要持续九个月。

So, nine months of care for OB.

对。

Right.

期间要跑十几趟，万一还出现并发症，得赶紧去医院。

Over a dozen visits and then, God forbid, she has some condition that needs to bring her in.

做超声检查，还有分娩，可能五分钟就完事，也可能拖上五十个小时。

Ultrasounds, you know, and then delivery, which might take five minutes, might take fifty hours.

你懂的。

You know?

你同时要照顾两位病人。

And you have two patients.

你可能会同时负责两位。

And you might yeah.

两位病人。

Have two.

你要负责两位病人。

You're responsible for two Two patients.

有时候可能是三四个，看当时有多少人。

Or maybe three or four, depending on how many there are in there.

你看看精神科的报销标准有多低。

And when you look at what the reimbursement rates were for Insanity.

但要是有人摔断腿，去看骨科医生，做个内固定手术，这可是复杂得多的 procedure，你知道的——是啊。

Versus you break your leg and you go to an orthopedic surgeon and they put a pin in it, and you know, which is a complicated procedure and, you know- Yeah.

但报销金额却差了十倍。

But the reimbursement is like 10 to one.

但你跟我说你不关心女性的生命，这可能吗？

But tell me you don't care about women's lives, you know?

我当时就想，天哪。

I was like, wow.

我干了这么久，是因为我真的喜欢这份工作。

I did it as long as I did because I loved doing it.

我特别爱我的病人。

I loved my patients so much.

后来我就累了，也老了。

And then I just got tired and old.

然后就退出了。

And did.

是的，我确实经历了一次道德上的挣扎，当时决定离开传统的报销体系，因为那正是我从小接受的体系。

Yeah, I really had a, you know, we're gonna talk about this some more, but I had a moral crisis when I was like deciding to leave the traditional reimbursement system because that's what I was brought up in.

但其实刚进医学院的时候，情况还没那么糟。

But actually, at the very beginning of, like medical school, it wasn't that bad.

在住院医师阶段，我们是靠慈善体系运作的。

And in residency, we operated under a charity system.

对，没错。

Uh-huh, yeah.

我们收治所有病人。

So, we took everybody.

是的，没错。

Yes, yes.

每个病人都看。

We saw everyone.

政府当时会直接开支票，但等我当上教职时，这政策就没了。

The state would just write checks, That stopped by the time I became faculty.

是的。

Yeah.

我那时也经历过类似的情况，我们当时在转诊

I had a similar we were turning

把本可以治愈的病人拒之门外。

people away who we could cure their disease.

我们本可以治好他们的癌症。

We could cure their cancer.

他们只是早期子宫内膜癌，却因为没保险，也找不到县里或其他机构的保障，就被拒收了。

They were having stage one endometrial, turning them away because they didn't have insurance and couldn't find coverage from their county or whatever.

作为医生，签那份病历的时候，我真想死。

And I wanted to die as faculty signing off on that chart.

是的。

Yeah.

医院那边说，除非是急诊，否则我们不治。

The hospital was like, unless it's an emergency, we're not gonna

不治。

do it.

苏珊，这根本不是我们当初从医的初衷——我们是为了救治病人。

Suzanne, I That's And not why we signed up, to take care of human beings.

我们

We

而且我们牺牲了，用了它。

And we sacrificed used it.

就像，有

Like, had

她有

she had

她的癌症，要是在五年前

her cancer five years

我们本来还能治疗的

ago, we would have

在这种教学机构里，居然做这种事还脸不红心不跳的，你说离谱不离谱。

done it and not thought twice about it, you know, at a teaching institution.

对。

Yeah.

我也有过类似的经历，我觉得我们那时候是同期培训的。

I had a similar I mean, I think we trained at the same time.

我经历特别相似，因为我在医学院时一开始就在一家区立医院，什么病人都接。

I had a very similar experience because I started at a county hospital in medical school, so literally all comers.

那真是啥都碰上，太疯狂了。

And I mean, it was wild.

我从中学到了很多东西。

And I learned a ton.

我特别感谢那些病人。

I'm so grateful to those patients.

后来我去了西达赛奈医疗中心，那当然也是家大医院，处理过SARS病例。

And then I went to Cedars Sinai Medical Center, which is, sure, it's, you know, hospitals with SARS.

但那时候，我们照样来者不拒。

But also at the time, we took all comers.

我的意思是，急诊室不收病人是违法的，但即使不是急诊，我们也全收。

I mean, obviously through the emergency room, it's a federal violation not to accept But if it's not an emergency, but we took everybody.

这个培训项目之所以这么棒，原因之一是我们接触了大量经济困难或通过紧急医疗补助前来就诊的病人。

And one of the reasons it was such a great training program is that we had an enormous number of patients who were either indigent or were coming in through like emergency Medi Cal.

每一段怀孕经历都不一样。

That all Pregnancy is different.

是的。

Yes.

没错。

Yes.

怀孕期间的治疗基本都能报销，但我说的是像……

We could get anything covered in pregnancy, but I'm talking about like

妇科方面，是的。

the GYN Yeah.

妇科相关的情况全都变了。

Gynecologic It all shifted.

那段时间非常令人害怕，也很让人难过。

And that was very scary and sad.

太可怕了。

It was horrible.

简直太可怕了。

So horrible.

是啊。

Yeah.

我怀孕二十五周的时候，还是第二年的住院医师。

So when I was twenty five weeks pregnant, I was a second year resident.

我所有的朋友要么已经生了，就快生了。

And all my girlfriends had had their babies or were about to deliver.

而我那时候还在到处走动。

And I was walking around.

我姐夫和他妻子来探望我。

My brother-in-law and his wife had come to visit.

我们在加尔维斯顿。

And we're in Galveston,

而且那时候，

and it's,

你知道的，老街道，鹅卵石路。

you know, old streets, cobblestones.

我穿着小坡跟鞋走路，都快二十五周了还硬要装可爱。

And I'm walking in these cute little wedges, like trying to be cute at twenty five weeks.

一踩上马路牙子，脚踝一扭，整个人往后一栽。

And I twist my ankle stepping up on a curb, and I kind of stumbled back.

我姐夫一把把我抱住，腋下托住我，结果脚底突然一阵尖锐的刺痛，疼得我直吸气。

My brother-in-law caught me like basket caught much under the arms, and I remembered this like stabbing pain in my foot, like this sharp, like, ugh.

那脚根本不敢落地。

So I couldn't walk on it.

一点力气都不敢使。

I couldn't bear weight.

他们把我送回了家。

They bring me home.

当然，我们打了电话给那位骨科医生，他过来一看，说：八成是骨折了。

Of course, we call our friend, the orthopedic surgeon He comes over, he's like, yeah, it's probably broken.

你得马上去急诊室。

You need to go to the ER.

行。

Okay.

我疼得厉害，而且能感觉到肚子越来越紧。

I'm in a ton of pain and I can feel my tummy getting tight.

我们去了急诊，一听说我怀孕了，所有人都紧张起来。

Oh, And we go to the ED and they all freak out because I'm pregnant.

骨科医生来了，一看就说：哦，她怀孕了。

And ortho comes, and they're like, oh, she's pregnant.

对。

Right.

于是他们赶紧把胎心监护仪搬了过来。

You know, like, so they get the monitor.

我开始宫缩了。

I'm contracting.

明白吗？

Okay?

当然了。

Of course.

他们问我：你疼得厉害吗？

And they're like, are you in pain?

我当时太害怕了，不敢说到底有多疼，怕他们觉得我是想骗药或者爱抱怨。

And I was too scared to tell anyone how much I was hurting because I thought they would label me as a drug seeker or whiny.

天哪。

Woah.

你觉得是因为你当住院医时的经历，看到别人怎么对待那些说疼的女性吗？

Just because of do you think that was because of your own experiences as a resident and how people treated women coming in with pain?

而且，我们那时候被教导说，要尽量压低自己的症状。

And, like, we were taught, you need to minimize your symptoms.

天哪。

Wow.

是的。

Yeah.

我当时真是吓坏了。

I was I had a Oh my god.

我的脚趾骨断成了两截。

Groan in my foot that had snapped in two.

疼痛太剧烈了，我都早产了。

The pain was so severe, I was in preterm labor.

天哪。

Oh my god.

可我太害怕承认了，怕被人说成是想骗药的。

And was too scared to admit it because I was worried I would get labeled as a drug seeker.

但这其实也是医学培训的一部分。

But that's also like medical training too.

我的意思是，随着职业生涯推进，我觉得……说实话，我也说不准。

I mean, I think, you know, as we get further into our careers I don't know.

我以前就挺爱反思的，但现在更爱想了。

I've just gotten more inter I was always introspective, but I'm very introspective now.

现在有更多时间去琢磨这些事。

I have more time to do it.

我开始回想我们当年经历的那些事，因为我没意识到，我们俩的经历居然这么相似。

And I think about the stuff that we subjected ourselves to, because I didn't realize we were that parallel.

我整个住院医师期间都怀着孕，硬扛着，就怕别人觉得我怀孕了就偷懒、拖后腿，还因为怀孕多排了班，诸如此类。

Parallel because I was pregnant my whole residency also and sucked it up so hard because I didn't want people to feel like she got pregnant and she got lazy, and she didn't carry her weight, and we're taking more call because she got pregnant, you know, and whatever.

我那时候真是个怀孕的实习医生。

And I was like, oh my god, I was a pregnant intern.

晚上你得一个人撑完整个医院，你知道的，整个院区都得你管。

At night, you would have to cover the whole house, right, the whole hospital.

我身上挂着四个呼叫器，天知道我是怎么把白大褂穿不掉的。

So I had four pagers on my, I don't even know how I had my, how my scrubs weren't falling off.

熬夜撑着。

Staying up.

我们那时候看起来

We looked

像个笑话，对吧？

like a clown, right?

手术服都勒在身上。

The scrubs are tied up here.

我负责妇科肿瘤的呼叫。

I had the GYN onc pager.

我还管急诊室。

I had the emergency room.

产房和分娩也归我。

I had labor and delivery.

病房那边也是我。

I had the floor.

你还记得那些超大的老式超声波机器吗？

And we had those old remember those humongous, huge ultrasound machines?

是啊。

Oh, yeah.

我当时还得自己推着它们，一路从走廊推过去。

And we were like, I'm pushing those, and I'm pushing it down the hall.

我当时就想，天啊，坐骨神经痛要来了。

And I'm like, oh my god, sciatica.

这简直太离谱了。

And I mean, the hell?

正常孕妇根本不会干这种事，任何和孕妇一起工作的人都不会让她这么做。

No normal pregnant woman would do this, and nobody else who worked with a pregnant woman would let her do it.

但他们都没事。

They were fine.

那时候我只是个实习医生。

I was the intern.

她在做她的本职工作。

She's doing her job.

我是真的从来没抱怨过。

I mean, I would never have complained.

这太离谱了。

It's so crazy.

这太离谱了。

It's so crazy.

这完全不正常。

It's so not normal.

是啊。

Yeah.

我也不太明白。

I don't know.

然后呢，你想想，如果你是个有同理心的人，你的第一反应肯定是：我绝不会让别人经历这种事。

And then, you know, then you come out, and of course, you're like, if you're an empathic person, your response would be like, I would never subject anybody else to that.

但人都是人啊。

But people are people.

他们就说，我都能做到。

And they're like, I did it.

她怎么就不行呢？

Why can't she do it?

是啊。

Yeah.

他们就是这样对待病人和同事的。

That's how they treat their patients and their colleagues.

没错。

That's Yeah.

这不太好。

It's not good.

我挺担心的。

I worry.

不行。

No.

当一位女性终于感受到……我在诊所里见过这种情况，当然，在旧体系下我也经历过不少美好的时刻。

What do you see when a woman finally feels, and I've experienced this in my clinic, certainly I had wonderful moments under the old system.

是的，当然。

Yeah, of course.

你知道的。

You know?

对。

Yeah.

当然。

Of course.

我只是觉得，到最后情况越来越糟了。

I just, you know, it was getting so bad at the end.

道德上的伤害，行政负担，你知道的，那些文书工作，跟保险公司扯皮，医院还不断招人来告诉我该怎么做，根本感觉不到自己在做最好的医疗。后来我离开那个体系，转去建立新的系统时，根本不知道该怎么开一家诊所。

The moral injury, the administrative burden, you know, the paperwork, the fighting with insurance companies, more people being hired to tell me what to do at the hospital I was at and just not feeling like this was the best medicine I And could then leaving that system and going into building a new system, I didn't know how to open a medical practice.

我一辈子都是给人打工的。

I'd always been employed my whole life.

我带着听诊器过去，他们给我一间屋子，我挂上病历本，

I showed up with my stethoscope, and they gave me a room, and I stuck a chart,

你知道的，

you know?

没错，

Right.

然后我就开始上班了。

And I went to work.

对，

Right.

于是我干脆找了一本《新手开诊所指南》来学。

And so I literally like got the idiot's guide to opening a medical practice.

我真的完全不懂这些规矩。

Like, I didn't know the rules.

比如，我们要不要交税？

Like, do we charge taxes?

我得先注册公司，还有

How do you, I had to incorporate and

所有这些手续。

do all

这事儿。

this stuff.

但我们决定按服务收费，结果挺适合我们的。

But we decided to do fee for service, and that worked for us.

但这是我职业生涯中第一次，除了以前在产妇床边守着的时候，现在我完全用自己的时间，单独和病人聊天，能有一整个小时陪她，真正了解她的目标、需求和想法。

But like for the first time in my career, other than sitting bedside with someone in labor, right, when I was on my own time and just visiting with a patient, I had a whole hour to spend with a patient and really get to know her and really understand her goals, her needs, her wants.

就在开业第一个月，我就意识到，我从来没这么 consistently 感觉这么好过。

And I just, within the first month of practice, I just realized I never felt that good consistently.

是的。

Yeah.

你知道，并不是每个人都有好结果。

You know, not everybody had a happy outcome.

很多幸存者会来找我，因为他们无处可去，而我也不能解决每个人的具体问题。

A lot of survivors would come to me because they had nowhere to go, and I, you know, couldn't fix everyone's exact problem.

但我能送他们一份时间的礼物。

But I could give them the gift of time.

是的。

Mhmm.

还能把我的心意给他们，不再感到分裂，不用在家庭和工作之间做选择。

And give them the gift of my heart and not feel so fractured and having to choose my family over my work.

没错。

Yep.

那真的特别神奇。

And it was just unbelievably magical.

对你来说，这种经历是什么样的？

Like, what's that been like for you?

天哪。

Oh my god.

你这话说到我心坎里了。

Exactly what you're saying.

我的压力真的大到不行，你说的‘破碎’这个词特别戳中我。

I mean, that word fracture really resonates with me because my stress level was so high.

现在想想，胸口都隐隐发闷。

Like, I'm thinking about it now, and it's like, gives me a little bit of chest pain.

就像在各个房间之间不停地跑，一听到她哭，就知道得马上过去，她需要我。

Just like running from room to room or knowing like, oh my god, I'm running over because she's crying, and she needs me.

我这时候根本走不开。

I cannot walk out right now.

手都搭在门把上了，可你知道屋里还有三个房间等着你，这时候真正的难题才冒出来。

I can't be like, you know, or your hand's on the door and you know there's three rooms full, and now that's when the real question emerges.

然后你就只能在心里喊：天啊，这可怎么办？

And you're just like, oh my god, what?

不行，我真的做不到。

No, I can't.

我完全不再有那种感觉了。

I don't feel that at all anymore.

但特别有意思的是，我记得刚起步的时候，我离开了在比佛利山庄一家做了二十多年、规模很大、名气很高的诊所，那时候病人多得不得了，什么都能做，我们还特别以什么都能接为荣。

But it's really interesting because I remember initially when I started, so I left a twenty plus year career in a very large prestige practice here in Beverly Hills where we had very high volume and did everything and prided ourselves on doing everything.

但对我来说，那真的不是我想要的生活。

And it just, for me, I just, it wasn't it wasn't me.

那不是我该做的事，也不是我想做的事。

It wasn't what I needed to do or what I wanted to do.

我只想多花点时间在病人身上。

I wanted to spend the time.

而且我总是迟到。

And I was always running late.

即使刚开始新诊所的时候，我还紧张得不行，天哪，真担心啊。

And even when I started the new practice, I remember being nervous like, oh my god.

我的意思是，我们怎么才能把45个号都排满呢？

I mean, how am I gonna, are we gonna fill 45?

天哪。

Oh my god.

根本不是那么回事，你得放松下来。

It's like so not It's so not You just sit back.

你只要坐着听，就能把该知道的信息全听全了，甚至更多。

You sit back and listen, and you get all the information you need and more.

你才能真正地跟对方建立联系。

You get to really engage.

说实话，我觉得我对自己的病人已经够了解了。

I really knew my patients, I think, pretty well considering.

我有很多病人跟着我几十年，我接生的孩子长大后又成了我的病人，一家几代人都找我看病。

And I had patients for decades who stayed with me, and children I delivered who then became my patients, you know, multi generation families.

我确实在和他们建立连接，但这个过程其实让我付出了巨大的代价。

I was connecting, but I was doing it at a big, actually a really huge cost to myself.

是的，我也是。

Yeah, me too.

因为我一直在付出、付出、付出，根本没时间放松、好好想想。

Because I was giving, giving, giving, and I had no time to, like, relax and think.

而且我总觉得压力巨大，生怕出错。

And also, I felt, like, so pressured that I'm gonna make a mistake.

我怕因为时间不够，不小心害了人。

I'm gonna harm somebody unintentionally because I don't have enough time.

那时候我真的快疯了。

It was just, I was so insane.

现在回头想想，我都想不通自己是怎么撑那么久的。

And looking back on it, I don't know how I did it as long as I did.

但我得说，一开始我特别紧张。

But I will say I was initially nervous.

我怎么能做得到呢？

Like, how can I do this?

一年过去了，我刚完成执业的第一年。

A year in, I just completed my first year of my practice.

这整个过程真的特别有成就感。

It has just been enormously gratifying.

年底的时候，好多病人带着满满的感激来找我，说是我改变了他们的生活，因为我有足够的时间仔细安排检查，发现了那些以前没空关注的问题。

And I can't tell you, you know, the end of the year, I had a lot of patients come in with a lot of gratitude, telling me how I changed their lives because I had more time to thoughtfully order those labs and pick up on things that I wouldn't have had time to address.

我接受的培训很传统，说别做那些你没法根据结果采取行动的检查。

I was taught very old school, don't do labs that you can't act on results with.

对。

Mhmm.

即使我知道接下来该怎么做，每当有人问我：‘我能在这儿做个体检吗？’

So even if I knew what the path forward would be, I really, when somebody would say to me, hey, can I just do my, you know, blood test here?

我都会心里一紧，心想：天啊，这又得多出一堆事要处理，说实话。

I'd be like, cringing because I thought, oh my god, because this is gonna be more stuff I'm gonna have to address, honestly.

而且，我真的没时间应付这些。

And again, I just didn't have the time.

我现在有的是时间。

I have all the time in the world.

他们会做身体成分分析。

They get on the body composition.

我给他们做全套血液检查。

I do their labs.

我会深入分析血脂谱，比如加上脂蛋白(a)。

I do a deeper dive into lipid pro I mean, just by adding lipo little a

脂蛋白(a)。

LP little a.

没错。

Yep.

载脂蛋白B。

Apo b.

载脂蛋白B。

Apo b.

我真没法跟你形容，光看体成分数据，天哪，简直太震撼了。

I cannot tell you between that and body composition, looking at Oh my god.

他们的体脂、内脏脂肪和肌肉含量，这简直是颠覆性的改变。

Their fat, their visceral fat, and their muscle, it is a game changer.

这能帮人规划未来三十年的人生，意义重大。

It's a game changer in helping someone plan the next thirty years of their life.

以前在洛杉矶，大家可能觉得我就是专治更年期的医生。

Because I think people knew me here in LA as like, you know, she does menopause.

我写过一本书。

She wrote this book.

我在社交媒体上露面什么的。

She's, you know, on social media, whatever.

但其实我做的远不止激素治疗。

But it's not really just the hormones.

当然，激素确实是其中一部分。

I mean, sure, it's the hormones.

是的

Yeah.

但关键在于，现在就是那个关键时刻——无论你具体是谁。

But it is not it's that this is the moment in time, whether you're and I'm thinking about specific people.

不管你今年47岁还是69岁，只要你来找我，我们都能为你做点什么。

Whether you're 47 or you're 69, whatever moment in time you come to me, there is something that we can do for you.

对

Mhmm.

我看到的效果非常显著。

And I'm seeing massive results.

这些女性都是能力超强、事业有成、非常成熟的人。

These are women who are really, really high functioning, successful, sophisticated people.

她们以前到处奔波，却得不到任何帮助，怎么也找不到原因。

And they were running all over town, getting no help, couldn't figure it out.

她们所需要的，其实只是坐下来，把事情说出来。

All they needed was that, being able to sit, tell their story.

我们可以慢慢理清它。

We can unwind it.

也正是在那时，一些深藏的秘密才会浮出水面——他们从未对任何人提起过，比如曾经遭受过虐待、有药物依赖、正在努力改善饮食问题，还有许多其他影响身心健康的重大问题，他们一直瞒着别人。

That's also when some of the secrets come out, things that they never told anybody, that they had a history of abuse, that they have a substance problem, that they are trying to work on their eating, that they have all this stuff that has big consequences, mental health and physical health consequences, that they're not telling people.

你不可能一进门就直接说：‘我有饮食失调史，现在特别担心我的骨密度。’

Because you're not gonna walk in and say, Hey, have a history of an eating disorder, and I'm really worried about my bone density.

对啊。

Right.

谁会这么开口呢？

Who says that?

他们不会。

They don't.

但你知道吗？

But you know what?

只要你花上几个小时陪他们，他们就会感到安心。

You spend a couple hours with people, they feel safe.

是的

Yeah.

向别人敞开心扉。

To open up to people.

你才能真正地解决问题。

You can do the real work.

你觉得我们国家目前对大多数患者的医疗交付方式有问题吗？

Do you think that the way we deliver healthcare in this country for most patients is broken?

是的。

Yeah.

这根本不像人该有的体验。

It's just not human.

缺乏人情味。

It's not human scale.

太不近人情了。

It's not human size.

这对任何一个普通人来说都不像人该经历的。

It's not human for any of the humans.

你和我都是普通人。

You and I are humans.

你打算怎么改？

How would you fix it?

我的想法是直接推倒重来。

I mean, I'd blow it up.

我一向都是这么做的。

That's what I do.

我觉得我们需要

I think we need

帮助，因为这问题一直悄悄蔓延，我们都亲身经历了这种变化。

help Because get it's it been insidious, and we've lived through the change.

对吧？

Right?

是啊。

Oh, yeah.

我们都看在眼里。

We've watched it.

我们都看在眼里。

We've watched it.

我觉得我们一直处在一种缓慢的崩塌中。

We've been, I think, in a slow mo implosion.

我认为最关键的是，医生们。

I think the most, and Doctor.

迈克在社交媒体上发过一张图，他是个特别受欢迎的医学教育者。

Mike had put this graph up, super popular medical educator on social media.

他是全科医生。

He's a family medicine doc.

他贴出的那张图我见过好多次，讲的是医生收入随时间的变化，但增长速度赶不上生活成本的上涨。

And he put the graph up that I've seen multiple times when you look at physician payment over time, which has grown under the cost of living.

对吧？

Yeah, Right?

没错。

Yeah.

再看看行政开支。

And then you look at administrative costs.

简直离谱。

It's insane.

简直像火箭一样直冲云霄。

And literally, it is like a skyrocket that has gone.

医疗费用上涨，根本是因为管理医疗的成本飙升。

Like, basically healthcare costs have increased because of the cost of administrating healthcare,

是的。

Yeah.

而我们的医疗效果

And our outcomes

都不是真正提供医疗服务的临床医生。

are not clinicians who are delivering the healthcare.

而我们的医疗结果

And the outcomes

以产科为例，孕产妇死亡率呢？

I mean, OB specifically, maternal mortality?

我们已经倒退了。

We've ground.

没错。

Yes.

在很多方面，我们都在倒退。

We've lost ground in so many areas.

我亲眼看着它改变了医疗的运作方式，这真的

And I've watched it reshape the way medicine is practiced, which is really

让我感到害怕。

scary to me.

说说看。

Tell me.

说说看。

Tell me.

你对这方面的研究有什么看法？

Like, what what are your impressions about how they've been it's been researched?

首先，我们以前是能治疗那些可以治愈的癌症的。

Well, one, that we used to take care of curable cancers.

以前所有来看病的患者，我们都会尽力治疗，但现在时间太紧了，根本做不到。

We used to take care of these things for all the patients who walked in, but really being so hamstrung by the time constraints.

就像管理层一直在催你，一天要看完三四十个病人，还得拿满五个星级评分，对吧？

So like this administrator breathing down your neck, not only to see thirty, forty patients in one day, but to get all five stars for Yeah, exactly.

没错。

Every Right.

所以我们的薪酬——

So our pay- And

然后他们告诉我们能做什么、不能做什么——结果连基本的诊疗都做不了。

then they tell us what we can and can't do- Was getting deed.

去照顾这些病人。

To take care of these patients.

而且

And the

病人很沮丧，因为保险不报销。

patient is frustrated because insurance won't cover.

你知道，他们带着各种不同的保险计划来看病，但长期以来，我们根本没法提前知道他们的保险到底能覆盖哪些项目——现在倒是好一点了。

You know, they're all coming in on multiple different insurance plans, and there was no method for a long time, there's a better one now, of me being, have any idea of what their insurance is going to cover.

对。

Right.

你明白吧？

You know?

再看看前置授权的申请量，简直爆炸式增长，这根本就是一套专门用来拖垮病人和医生的系统。

And then if you look at the rate of prior authorizations and how that has skyrocketed, I mean, it is a racket built to destroy patients and their clinicians trying to take care of it.

百分之百。

A 100%.

那又怎样？

So?

没错。

Yeah.

他们就是不愿意花你投入的那些钱。

I mean, they don't wanna spend the money that you invested.

那现在谁在医疗行业赚钱？

So who's making money in healthcare right now?

是保险公司。

The insurance companies.

保险公司是这样，顺便说一句，医院也在大把大把地亏钱。

The insurance I mean, the hospitals are losing money hand over fist too, by the way.

是的，你说到

Yes, you're There's

人们对这个有很多误解。

a lot of misconception about that.

是的。

Yeah.

人们收到的账单简直离谱，连一片泰诺都要八十美元之类的。

I mean, people are getting these crazy, crazy bills, and like, their Tylenol is $80 whatever.

但其实医院也扛不住保险体系带来的重压。

But that's because the hospital cannot bear it under the weight of the insurance system either.

药房福利管理公司，本质上都是保险公司旗下的，它们定价格、决定哪些药能报，这简直就是垄断联盟。

So, the pharmacy benefit managers, which are essentially owned by the insurance companies, which are setting the rates and telling you whether or not this medication will be covered, This is like a freaking cartel, man.

这就是个垄断联盟。

It's a cartel.

我觉得另一点是，当人们管这叫‘医疗’的时候，其实根本不是医疗。

And I think the other thing is when people call it a health care, that's not health care.

这叫医疗保险。

It's health insurance.

我的意思是，保险的存在是为了以防万一，比如你突发心脏病、被诊断出癌症，或者遭遇车祸。

I mean, it's there for, god forbid, you end up with a heart attack or cancer diagnosis or a car accident.

你确实需要有保险。

You need to be insured.

我想人们得明白，我们买健康保险，就是为了防止遇到重大意外时破产。

Believe I mean, people I need to am be aware that our health insurance is to keep us from going bankrupt if something catastrophic happens.

但我不确定我们的听众是否知道，在美国，导致破产的首要原因是什么。

But I don't know if our listeners understand the one cause of bankruptcy in The United States

是医疗费用。

Is medical.

是天价医疗账单。

Is medical bills.

对。

Yeah.

这种头号原因在欧洲根本不存在。

The number one cause of this does not exist in Europe.

在加拿大，这种情况根本不存在。

This does not exist in Canada.

说到道德创伤，我们其实已经卷入其中了，这根本不对。

Talk about moral injury and then we're Then involved in It's wrong.

本集《Unpaused》由Alloy Health赞助播出。

This episode of Unpaused is brought to you by Alloy Health.

我们经常聊荷尔蒙如何影响情绪和精力，但它们对皮肤的影响同样重大。

We talk a lot about hormones affecting mood and energy, but they also play a major role in your skin.

胶原蛋白、保湿、弹性，都离不开它。

Collagen, hydration, elasticity.

到了中年，荷尔蒙水平开始变化，皮肤也会跟着变。

And in midlife, when hormone levels start to shift, your skin changes too.

我最早是通过一位当皮肤科医生的密友听说Alloy的。

I first heard about Alloy through a close friend who is a dermatologist.

她告诉我，市面上真正能应对荷尔蒙引起的皮肤问题的产品少之又少。

She shared how few products truly address hormonal skin changes.

当我了解到Alloy的方案是基于激素科学和生理机制时，我就决定亲自试试。

Once I understood that Alloys approach is rooted in hormone science and physiology, I decided to try it myself.

它彻底改变了我对这个年龄段护肤方式的看法。

It changed the way I think about how skincare is at this stage of life.

Alloy的M4系列包括M4面霜、M4精华液和M4眼霜。

Alloys M4 line includes the M4 face cream, M4 face serum, and M4 eye cream.

这些是处方级配方，含有雌三醇——这是身体自然停止分泌的黄金标准激素，且有临床研究支持。

These are prescription strength formulas made with estriol, the gold standard hormone your body stops producing naturally, and they are backed by clinical research.

女性们都在寻找更光滑、更紧致、肤色更明亮均匀的肌肤效果。

Women are seeking smoother looking skin, improved firmness, and a brighter, more even tone.

如果皮肤变了，你的护肤方式也该跟着调整。

If your skin is changing, your skin care should change too.

使用Alloy，你可以在线问诊医生，获得专业指导，产品还会直接送到你家。

With Alloy, you consult with a doctor and receive expert guidance and have your treatment delivered right to your door.

访问myalloy.com，使用优惠码MCH20。

Head to myalloy.com and use code MCH20.

输入代码 MCH20，首单立减 20 美元。

That's MCH20 to get $20 off your first order.

母亲节快到了。

Mother's Day is coming.

如果你还在纠结送什么，我来帮你简单说清楚。

And if you're stuck on what to get, let me make this very simple for you.

两个字，Jenny Bird。

Two words, Jenny Bird.

如果你想送一份真正走心的礼物，Jenny Bird 就是你的首选。

If you want something that actually feels thoughtful, Jenny Bird is your one stop shop.

从耳环、手链到刻字项链，他们什么都有。

They have everything from earrings to bracelets to personalized monogram necklaces.

你可以挑一件真正像她的东西，而不是临时随便买的一个。

So you could choose something that genuinely feels like her, not something you grabbed at the last minute.

我有一对他们的银色亚麻圆环耳环，特别百搭，简单又精致，我超喜欢。

I have a pair of their silver linen hoop earrings, and I love how easily they go with everything, effortless and polished.

这正是它这么省心的原因。

And here's what makes this an easy option.

这些是她真正会戴的饰品。

These are the pieces she's actually going to wear.

戴上几秒钟就能整个人看起来精致不少。

The ones she can throw on in seconds and instantly feel more put together.

发货特别快，你完全不用担心赶不上时间。

They ship fast, so you're not stressing about timing.

到了之后，美得让人惊喜。

And when it arrives, beautiful.

一到家门口，就已经像一份完整的礼物了。

It already feels like a complete gift the second it hits your doorstep.

今年母亲节，别再为送什么发愁了。

So this Mother's Day, don't complicate or stress out about what to get.

直接选Jenny Bird就对了。

Just go with Ginny Bird.

这是一份有心意的礼物，而且是她每次都会穿的永恒单品。

It's a meaningful gift and a timeless piece she'll reach for every time.

访问 ginnybird.com，下单首单可享八折优惠，结账时输入代码 UNPAUSED 即可。

You can get 20% off your first order with Ginny Bird by visiting ginnybird.com and use the code UNPAUSED at checkout.

明白了。

Okay.

我有个25岁的孩子，还在我保险上，每月多付9块钱，这个我也买了。

So I have a 25 year old who is on my insurance for another $9.00 I got that too.

我都没算在内，因为我们是全家一起用。

I'm not counting because we are.

我每个月光保费就快花两千块了。

And, I mean, I'm spending almost $2,000 a month on the premium.

但这钱花得并不值，我和她根本用不上这些服务。

That doesn't mean that it's paying for anything that I need or she needs.

今年我有次特别顺利的经历，最后不得不临时找了个替代方案。

I had a fabulous experience this year where I ended up having to get whatever.

我得去做另一侧乳房的活检，好在一切正常。

I had to get a biopsy on my other breast, and everything's okay.

但这次我自付了三千美元，而我还在不断交保费。

But I was $3,000 out of pocket, and I'm paying my premiums.

这可是医生建议的检查。

And this was a recommend.

我又不是在做啥实验性治疗。

I wasn't doing some experimental procedure.

就是他们发现有点异常，

It was like, hey, we saw something abnormal.

所以建议做个活检。

We need to biopsy it.

结果还得我自己掏钱。

No, I gotta pay for that.

你的免赔额到了，就得自己承担。

You got your deductible.

你有这么多问题。

You got all these things.

这太离谱了。

It's insane.

那我觉得该怎么解决呢？

So how do I think it needs to be fixed?

我觉得这些东西应该取消。

I think that needs to go away.

我觉得应该有个公平的环境。

I think there needs to be a level playing field.

我觉得每个人都应该享有全民医疗。

I think there needs to be national healthcare for people.

一切都会完美吗？

Will it all be fabulous?

也许不会。

Maybe not.

但总比什么都没有强。

But it'll be something.

总比人们负担不起、又不符合州或联邦保险资格要好。

It's better than people not being able to afford, not not qualifying for, you know, state or federal insurance.

结果他们没法管理自己的慢性病。

So then they're not taking care of their chronic diseases.

他们甚至开始患上慢性病。

They're developing chronic diseases.

他们根本得不到任何医疗。

They don't have any access.

最后只能跑去急诊室处理慢性病问题。

And now they're showing up to the emergency room for their chronic disease management.

这正在夺走他们的生命。

And it's costing them their lives.

不仅掏空了他们的积蓄，也让我们花了很多钱——有人中风走进来，我们总得救。

It's costing them their finances, and it's costing us a lot of money because someone walks in having that stroke, we're gonna treat them.

所以现在花的钱比当初早点治疗多太多了。

So now it's costing a ton more money than if we just would have treated them.

在那些有全民医疗的国家，有些人是有能力投资自己健康的。

And there are gonna be people, like in other countries where there's national healthcare, who have the means to invest in their health.

这公平吗？

And is it fair?

现实就是如此。

It's the way it is.

他们会去找像你我这样的医生，体验也完全不同。

And they will seek doctors like you and I and have a different experience.

我觉得这种影响会慢慢扩散开来。

And I think there's a trickle down.

我常跟我的病人说，因为这事我跟你提过好多次。

One of the things that I say to my patients, you know, because I called you a lot about this.

从道德和伦理上讲，离开这个体系对我而言是个极其艰难的决定，原因也完全一样。

It was a very, very hard decision for me to make ethically and morally to leave the system behind as well for the exact same reasons.

当我们讨论保险之外的其他选择时，很多人会强烈反对，他们认为医疗应该是社会化的，是每个人应得的权利，而不是一种商品。

And so when we talk about alternatives to insurance, there's a lot of pushback from people who believe in socialized medicine or that healthcare should be a right and not something.

那你怎么回应这种观点呢？

How do you respond to that?

我觉得他们说得对。

I think they're right.

医疗确实应该是一项权利。

I think it is a right.

它不应该是少数人的特权。

And I think it shouldn't be a privilege.

那些有能力负担自己想要的医疗服务的人，也理应拥有这样的权利。

I think people who have the privilege to afford the care that they want to access should have that right as well.

这些人的影响力往往很大，他们的行为方式，包括在政策层面，都会产生广泛影响。

And these are people often that are influential, and that can also have big impacts out in the world in the ways that they are, including in policy.

但现实是，我们为什么非要把事情非黑即白地对立起来呢？

But the reality is, why are we either or ing everything?

为什么 everything 都非黑即白？

Why is everything so binary?

我们得有不止一种方式来做这件事，这非常重要。

It's very important that we have more than one way to do this.

我也觉得这确实是一项权利。

And I do think that it is a right.

但问题是，别人并不了解你我今天是怎么走到这一步的，对吧？

But the other thing is that people don't understand how you and I got here, right?

我的医学教育是自己掏钱供的。

I self funded my medical education.

我也是。

Same.

我的债务大概有五十万美元，全都是贷款。

My debt was probably half 1,000,000 in premium, you know, just in my loans.

你不能要求医生牺牲十年甚至更久的青春和未来，结果出来后却没人管他们。

So you can't ask doctors to sacrifice a decade or more of their life plus their financial future, and then come out and not be cared for.

这根本不是以人为本的体系。

It's not a human system.

我们没人说，当初学医是为了发财。

I don't think any of us are saying like, I didn't go into medicine to get rich.

喂，有人在吗？

Okay, hello?

我那些想发财的朋友，早就实现目标了，很久以前就做到了。

Friends of mine who wanted to get rich already did that, like a long time ago.

是的。

Yeah.

我在这儿不是为了钱。

That's not why I'm here.

我怀孕的时候每周干八十个小时，可不是因为钱是我唯一在乎的东西。

I didn't work eighty hours a week while I was pregnant because all I care about is money.

如果大家能明白，我们为了成为医生、为了坚持当医生，付出了多少，就会明白我们其实是一条心的。

And I feel like if people understood what it took for us to become physicians and then to stay physicians, they would understand that we're on the same side.

这种分裂背后，其实是有人故意想让我们继续对立。

This is also, this polarization is coming from forces that want us to stay divided.

如果我们能团结起来，就会看清问题真正的根源在哪里。

Because if we all united, then we would all recognize where the problem really is.

问题不在谁在提供医疗、谁在接受医疗。

And it's not who's delivering healthcare and who's receiving it.

而在于医疗是怎么被运作的，谁在背后掌控这一切。

It's how the healthcare is getting delivered and who's controlling that.

这情况确实很复杂。

It's a complex situation.

但我相信问题是可以解决的。现在正是个特别的时刻，因为大家开始用更创新、更积极的方式思考，社交媒体也把患者和医生前所未有地联结在了一起。

I do think it's solvable, and I think right now we're in an interesting time because people are thinking more creatively, people are thinking in a more positively disruptive way, and I do think that social media has brought patients and clinicians together in a very powerful way.

是的。

Yeah.

我加入了好几个医生的线上社群，感觉很多人要么已经离开了传统医疗体系，要么想走却走不了，因为背负着贷款或合同束缚。

I am a member of several physician groups online, and it just seems to me that a lot are leaving traditional medicine, to leave traditional medicine, or can't leave because they're tied down by loans or contracts and whatever.

你觉得...

What do you

该怎么劝他们呢？

say to them?

其实我觉得未来十年里，美国的医生缺口大概会达到8.6万人左右。

Well, I mean, we are looking at, I think, a deficit of something like 86,000 physicians in The United States in the next like ten years.

这是个非常严重的问题。

That's a huge problem.

真正在提供医疗服务的人是谁？

Who's delivering care?

对吧？

Right?

我们之前也一直在反复聊，这套现行体系是怎么同时伤害到患者和医生的。

And we've been talking endlessly about how the system is really injuring the patients and the clinicians.

那他们当然会选择离开了。

So, of course, they're leaving.