英國醫療人球事件？英國媒體如是說

既然如此，我們來看看英國媒體怎樣報導這樣的醫療事件。google找了太陽報和每日鏡報；據說這兩家報紙是所謂八卦小報－引用自wiki－且看人家八卦小報和台灣的八卦大報有何不同。

先來看鏡報；這個大標題和小標題如下，台灣媒體說的人球兩個字在哪裡？

A write pain: Schoolboy with pencil stuck in hand sent home from hospital twice

He was left in agony after he got the pencil jammed in the back of his hand while playing with school pals

A schoolboy was sent home from hospital twice – even though he had a pencil embedded in his hand.

Robbie Appleby-Socket, 13, was left in agony after he got the pencil jammed in the back of his hand while playing with school pals.

He was taken to A&E in Doncaster, South Yorkshire, but was told he would need an operation the next day.

When he returned with mum Emma they were sent home again and told to wait for a phone call to reschedule the surgery.

She took Robbie 20 miles to Pinderfields Hospital in Wakefield where they operated immediately.

He was then put on an antibiotic drip for two days in case the wound had become infected.

Emma said: “The staff at Pinderfields were amazing. They couldn’t believe the pencil had just been left in his hand and neither could I.

“Staff at Doncaster just left the pencil in and put a bandage over it and told him he would have to come back.

"I was worried he would knock it and the pencil would go even further into his hand.

“I was disgusted. He could have lost his hand if it got infected.

“It was only when I asked about infection that they gave us the antibiotics.”

A Doncaster Royal Infirmary spokesman said: “Robbie was listed for surgery the next morning and sent home with painkillers to rest and fast overnight in preparation.

“Unfortunately due to a number of very urgent cases requiring immediate trauma surgery Robbie’s operation was postponed.

"We apologised and gave him further painkillers and antibiotics.” 

接下來看看太陽報的報導，太陽報的用詞就比較強烈了，雖然圖片和內文有說＂without proper treatment TWICE＂＂Disgrace＂等字眼，還是有提到醫師too busy。同樣的，台霉說的人球這兩個字在哪邊？

Boy, 13, is left with a pencil in his hand for two days - after docs turn him away twice

A BOY was left with a pencil stuck in his hand for TWO days - after a hospital sent him home without proper treatment TWICE.

Robbie Appleby-Socket, 13, was in agony when turned away and told to take mild painkillers at home by docs too busy to end his ordeal. His livid mum Emma Appleby fears the teen could have lost his hand if she had not taken him to another hospital 20 miles away.

The pencil became stuck in the 13-year-old's hand during a playfight at his school in Doncaster, South Yorkshire, on Wednesday afternoon last week. Staff at Doncaster Royal Infirmary's (DRI's) A&E saw Robbie but told him he would have to return the following morning for an op.He was sent away with the pencil still embedded in his hand - with just a bandage for protection.

When Robbie and his mum returned last Thursday, they were told he would have to go home again and wait for a phone call over the weekend. Robbie's horrendous 48-hour ordeal finally came to an end when he was treated in Pinderfields Hospital, Wakefield, West Yorkshire last Friday afternoon.

Emma, 33, said: "The staff at Doncaster Royal Infirmary (DRI) just left the pencil in and put a bandage over it and told him he would have to come back.

"I couldn't believe it. I was disgusted. He could've lost his hand. I was worried he would knock the pencil and it would go in even further.

"They asked me if I had paracetamol at home, which I did, so they sent us away.

"I was so shocked they didn't even think about the idea that Robbie could have rolled onto his hand while he slept and injured it even more.

"I didn't sleep a wink, I kept getting up to check on Robbie in case he was in pain."

Emma was even more staggered when she returned the following day.She said: "I was absolutely outraged. Robbie was there with that pencil still in his hand, and it was starting to look sore around the point of the pencil.

"They didn't even check the wound. It was only when I asked about infection that they gave us some antibiotics.
"We've still not heard from them so as far as they know Robbie still has the pencil in his hand.
"The staff at Pinderfields Hospital in Wakefield were amazing. They couldn't believe that the pencil had just been left in his hand."

Robbie was kept awake during his 90-minute op in Wakefield, watching docs remove the pencil on a TV monitor. He has been left with a five-inch scar and has not yet returned to school. Emma said of the freak accident which led to the injury: "From what he's told me, he was play-fighting with a friend at home time.

"Robbie punched out at him and unfortunately the friend had a pencil in his hand so Robbie had punched the pencil - which then got stuck in his hand.

"He was in a lot of pain obviously. He was very pale and looked like he was going to faint."
A DRI spokesman yesterday apologised to Robbie for his ordeal.

He added: "Robbie was seen by the A&E team, who were concerned and asked an orthopaedic surgeon to assess him.

"Robbie was then listed for surgery the next morning. Unfortunately, due to a number of very urgent cases requiring immediate trauma surgery, Robbie's operation was postponed."

英國醫療人球事件？台灣媒體如是說

先來看看台灣媒體的報導；Nownews和蘋果兩家媒體都說是被醫院當人球，甚至Nownews還用踢這個動詞。

蘋果日報表示：

6吋鉛筆插入手　男童被醫院當人球

2012年11月16日16:20    

英國13歲男童索克特(Robbie Appleby-Socket)，日前在學校跟同學嬉鬧時，被六吋長(約16公分)的尖鉛筆插入手背，痛入心扉，媽媽立即送他到醫院求醫，心想只是取出鉛筆的小手術，應該不是太難，但院方卻告訴他們明天再回來做手術。

離譜的是，母子倆隔天再到醫院時，院方又說沒有相關就診紀錄，又再安排他隔天做手術。手背插着鉛筆等2天，媽媽無法忍受兒子還要再受苦，也怕傷口感染產生其他問題，飛車帶他到較遠的醫院求助，醫生立即替他取出鉛筆。

Nownews 表示：

英男童手遭16公分鉛筆刺入　醫院踢人球：明天再來！

 林依伶 2012年11月16日 17:59  國際中心／綜合報導

英國一名13歲男童索克特(Robbie Appleby-Socket)在學校和同學打鬧，不料手背竟遭一支6吋長（約16公分）的木鉛筆狠狠插入手背，痛到受不了。索克特的媽媽連忙將兒子送醫急救，但沒想到院方卻要他們「明天再來」，母子倆傻眼無助。

據外媒報導，索克特的右手背被一支筆頭削得尖銳的木鉛筆刺入，母親心疼送兒子到醫院，心想只是要取出鉛筆，非動什麼大手術應該很快就能處理，沒想到院方給了止痛藥後，要求手仍插著鉛筆的索克特先回家，明天再來動手術。

更誇張的是，隔天索克特挨痛護著受傷的手到醫院看診，院方竟回答：「無相關就診紀錄」，要男童另預約時間才能動手術。索克特的母親再也無法忍受兒子深受皮肉之苦，更擔心傷口感染引發其他症狀，開車到32公里外的另一間醫院就診，當地醫生二話不說動刀替索克特取出鉛筆。 

美國華盛頓州的急診醫師們對州政府提出控告!! Washington Docs Sue State over ED Visit Limits

美國的老人和窮人醫療保險制度


前篇文章簡介了一下美國的老窮殘醫療保險；Medicaid主要是由州政府承辦，對於窮人的醫療補助。


接下來是最近的新聞Washington Docs Sue State over ED Visit Limits

ref: http://www.medpagetoday.com/EmergencyMedicine/EmergencyMedicine/28826

主要是說州政府面臨預算赤字危機，決議要從州政府主辦的醫療補助Medicaid著手，減少支出。官方發現有部分民眾濫用了急診，造成整體支出上升；於是限制使用Medicaid的窮人們每年以＂非緊急病情＂到急診看診的給付次數為三次。


而華盛頓的急診醫師們提出抗議，根據聯邦法律EMTALA－據說這法案另外暱稱是反拋棄病人法－急診醫師們必須不論病人有沒有錢都要提供醫療照顧。如今州政府決定限縮給付，可是急診醫師又不能把病人趕走，那錢要找誰去要？


有沒有覺得跟台灣情形很像~~


其實有幾點可以觀察討論
1.州政府有提出配套措施和事前／事後排除條款
2.美國的EMTALA法案對急診室的影響
3.關於急診室是否被濫用，政府vs.急診醫師的態度，美國和台灣的看法是否不同？

Washington Docs Sue State over ED Visit Limits

Emergency physicians in Washington are suing that state's health department over a new law that limits the number of "nonemergency" emergency department visits that Medicaid will cover.

華盛頓的急診醫師們對於州政府的衛生主管單位提出控告；因為一項新的法律，限縮了使用窮人醫療補助 (Medicaid) 的民眾，在＂非緊急病況＂卻跑去急診看病的就醫給付次數。

The Washington State Health Care Authority recently notified Medicaid beneficiaries that starting Oct. 1, Medicaid will pay for no more than three nonemergency visits to emergency departments annually per beneficiary.

華盛頓州保健管理署最近通知了窮人醫療補助 (Medicaid) 的保戶，表示從10月1日開始，沒有＂緊急病情`"卻跑去急診看病，每年將只給付三次這樣的就醫費用。

Limiting emergency room visits is illegal, according to the lawsuit, which was filed by the Washington branch of the American College of Emergency Physicians (ACEP).

美國急診醫學會的華盛頓分部提出異議，表示根據相關的訴訟判決結果，限縮人民的急診就醫是違法的。

Washington's new law also would reclassify 700 diagnoses as "nonemergent" conditions,including chest pain, abdominal pain,miscarriage, and breathing problems, but ACEP is arguing that many of the codes represent true medical emergencies and should be covered by Medicaid, no matter how many times the patient has visited an ED during the year.

華盛頓州新的法律同時對於700項疾病診斷碼重新歸類為＂非緊急病況＂，包括了：胸痛、腹痛、流產、呼吸問題。但是美國急診醫學會反駁說很多疾病診斷碼事實上是代表了＂真正緊急的病況＂，應該包含在窮人醫療補助 (Medicaid) 的給付範圍，不應該限制病人每年的急診就醫次數。

"This list of nonemergent diagnoses puts patients in danger and unfairly targets the poor and those in most need of care," said Stephen Anderson, MD, president of the Washington Chapter of the ACEP, in a press release.

美國急診醫學會華盛頓分部的主席Stephen Anderson發布新聞稿表示：這份＂非緊急病況＂清單針對了那些最需要醫療補助的貧困民眾，不但不公平，甚至是導致他們處在危險之下。

The Health Care Authority spent nearly $98 million last year on 327,965 emergency department (ED) visits for Medicaid patients, according to a Sept. 22 press release.

根據9月22號發布的新聞，去年使用窮人醫療補助 (Medicaid)的民眾，總共有32萬7千9百6十5人次的急診就醫，同時花費了保健管理署將近98萬美元(編按：將近3億台幣)。

The three-visit plan is estimated to save the state $35 million a year.
The plan stems from a directive in the state's 2011-2013 budget that directed the Health Care Authority to find ways to cut unnecessary ED visits to save money.

這項＂三次就診限制計畫＂預估每年替州政府省下35萬美元(編按：約1億台幣)。這項計劃是根據2011-2013年的州政府預算要求，命令保健管理署找出辦法減少不必要的急診就醫來節省支出。

"This is a realistic strategy to change clients' behavior and improve patient care as well as assure taxpayers that we are addressing the state's continuing financial crisis," Doug Porter, director of the Washington Health Care Authority, said in the press release."Nonemergency issues and chronic conditions should be treated by a primary care provider, not by an expensive visit to hospital emergency rooms."

華盛頓州保健管理署主席Doug Porter在新聞稿中表示：＂這是個很實際的方案，一方面可以藉由改變受保民眾的就醫行為，同時增進病人照顧；甚至對廣大納稅人來說，這代表我們有努力在解決州政府越來越嚴重的財政危機＂。不緊急的問題和慢性疾病應該在基層醫療照護(Primary care provider)接受治療，不應該去花費昂貴的醫院急診就醫＂

The state is working with providers to develop alternatives, including opening up walk-in primary care clinics located near the hospitals and lining up case managers to work with EDs to find the right care for nonemergency patients, according to the press release

新聞稿同時表示，州政府目前與基層醫療照護單位合作發展替代方案，包括在醫院附近開設＂不需要預約可以直接看診＂的基層醫療診所；和招募個案管理師與急診醫師們合作研究出非緊急病患的正確照護方式。

The limit wouldn't apply to children who are in the foster system or living with relatives or other caregivers. Nor will it apply to patients brought in by ambulance,police, or emergency medical technicians; visits for mental health diagnoses or for clients seeking detoxification services; or for visits that result in inpatient admission, emergency surgery, or admission for observation.

這項限縮的政策，不會影響下列幾類病人：寄養系統、由親戚照顧、或是其他託育的兒童；經由救護車、警察、EMT送醫的病患；精神疾患或是戒毒酒癮戒斷患者；或是就醫診斷後需要住院、需要留院觀察、需要緊急手術的病患。

In addition to harming patients, the physicians argue in their suit, the limits will harm physicians. ED physicians must provide care under the federal Emergency Medical Treatment and Active Labor Act (EMTALA) regardless of coverage rules, and will be penalized under the new law because they won't be paid for treating Medicaid beneficiaries who've exhausted their three-visit limit.

醫生們在提出的抗告中爭論，這項限縮政策除了對病患有害，也對醫生有害。根據聯邦法規《緊急醫療勞動法》(EMTALA)，不論病人是持有哪種保險、或是完全沒有保險，急診醫師都必須提供醫療服務；但是卻受到新的限縮政策懲罰，因為州政府對於超過三次就醫限制的窮人醫療補助 (Medicaid) 病患不支付醫療費用。

"Physicians also will suffer harm in that patients are likely to unnecessarily delay treatment, there by exacerbating the risks and costs of treatment and interfering with the patient-physician relationship," ACEP said in the lawsuit.

美國急診醫學會同時在訴訟中提到：＂這項政策讓病人容易遭受不必要的醫療延誤，因此增加治療上的風險和花費，影響了醫病關係，這樣的改變讓醫師受到危害＂

Washington Medicaid's chief medical officer, Jeffery Thompson, MD, said that 97% of Medicaid clients don't exceed emergency room visits in a given year, but that a "small number who exceed that limit are responsible for scores of visits," mostly for chronic conditions and pain complaints that result in a prescription for narcotic painkillers, he said in a prepared statement.

華盛頓窮人醫療補助 (Medicaid) 的首席醫療官Jeffery Thompson在準備好的聲明中表示：根據統計，97%的窮人醫療補助 (Medicaid) 保戶每年急診就醫次數不會過多；但是少部分的病患急診利用次數卻特別特別多，才造成整體就診人次上升。大部分都是慢性疾病和需要麻醉類管制止痛藥品處方的疼痛病況。

Washington's Medicaid office is working with a number of other states interested in developing similar policies, and if Washington state's policy goes into effect, other states may follow suit, Anderson said.

美國急診醫學會華盛頓分部主席Anderson表示，華盛頓窮人醫療補助 (Medicaid) 當局正在和其他有興趣的州合作發展類似政策；如果華盛頓州的政策開始生效，其他州可能也會跟進。

美國的老人和窮人醫療保險制度

剛好在Medpage Today上面看到一則醫學新聞，所以google了一下美國的醫療保險制度。

簡單來說分為Medicare和Medicaid，前者是對於老人和部份殘障人士的醫療保險；後者是對於經濟弱勢者、孕婦、嬰兒的醫療保險。

ref: http://www.medicare.gov/Publications/Pubs/pdf/11306_C.pdf

• 聯邦醫療保險 (Medicare)

聯邦醫療保險 (Medicare) 是為 65 歲或以上人士、不足 65 歲但患有某種殘障的人士，及患有永久性腎臟衰竭（也稱「末期腎病」）的任何年齡的人士提供的健康保險。您必須是合法進入美國並且在美國已經居住了五年才有資格獲得聯邦醫療保險。

• 州醫療輔助 (Medicaid)

州醫療輔助 (Medicaid) 是為收入和資產有限的某些人士和家庭提供的健康保險。計算您收入和資產（如銀行帳戶或可以兌換為現金的其他各項資產）的規則通常視您居住在哪一個州而定。其資格也可能由下列因素決定，即您的年齡及您是否懷孕；您是否失明或有其他傷障；以及您是否是美國公民或合法進入美國境内的移民。如果生產和分娩孩子的婦女擁有州醫療輔助保險，則她的嬰兒無需申請也可獲得長達一年的保險。


即使您不能確定您是否符合資格，假如您的收入有限，以及您或您的某個家庭成員需要健康護理，您也應當申請州醫療輔助，讓您州裡的合格社會工作者審查您的狀況。

擁有州醫療輔助的人士可能還會得到療養院護理等服務的保險。視您所在州的規則，您可能需要為某些醫療服務支付小部份的費用（共付費）。如果您同時擁有獲得聯邦醫療保險和州醫療輔助的資格，您大部份健康護理費用都會得到承保。

ref: http://www.ba.ncku.edu.tw/yong/HE/Global/US%20national%20health%20policy/HCR_Before/m&m/new_page_1.htm

• 政府(窮人)醫療保險(Medicaid)簡介 

政府醫療保險是為窮人提供醫療健康服務最大保險. 在聯邦政府的指導下, 各州制定自己的合格標准, 保險程度, 內容等等, 因此各州政府醫療保險內容不等.

Medicaid是美國政府針對一般貧窮的居民(Resident)或公民所提供的一種健康保險。不同於老人健保，Medicaid是由美國聯邦政府與州政府合辦的，而由州政府全權經理。它是在1965年立法通過，但由於是各州政府自行經理，故不像老人健保﹝Medicare﹞有特定的標準，誰符合Medicaid是由各州自行決定，故有時候，某人在甲州的經濟狀況無法讓他申請到窮人醫療補助，但搬到了乙州，卻可以同樣的條件而取得。

至1999年為止，全美約有三千六佰萬的人民在這種保險下受益他們包括嬰兒、小孩、孕婦、殘障人士及老人。他們有一個共同條件─就是符合〝窮人〞的經濟水平，在這一方面，各州的標準不一，但基本上，若年收入低於聯邦政府所設定的貧窮線(Poverty level)百分之133%以下，應該是沒有太大困難取得健保補助。

但對於健保所涵蓋的範圍，患者的自付額， 處方藥給付方面，也因各州的貧富不同而有差別，但基本上是聊勝於無。

讀報心得：「更正-修訂公費流感抗病毒藥劑擴大使用範圍」 角色錯亂政策搖擺的健保局和疾管局

實在是不得不繼續抱怨…相信很多人都有同感：拜託疾管局不要繼續亂搞了！
一個抗病毒藥物－克流感－的使用標準，從下面的圖可以發現，兩個月內變動了四次。到底克流感是＂防疫物資＂還是＂治療藥物＂？疾病管制局的角色是著重在疾病疫情還是疾病治療？

先講重點好了…底下太落落長；＂得到流行性感冒，並不一定要吃克流感！大部分身體健康的民眾，得到流感，都會自己好＂


然後我們要記得：健保不給付克流感，克流感並不是治療流感的必要藥物。多休息不要熬夜或日夜顛倒、維持正常飲食補充體力、不要抽菸喝酒…健康的生活型態維持免疫力才是對抗流感最好的武器！


如果還有空，再記住一個要點：流感和普通感冒，並沒有辦法從症狀百分之百區分。

疾管局一變再變的克流感使用標準

從底下幾次修訂的紀錄可以看到，疾病管制局對於克流感這種抗病毒藥物的支付標準，短短兩個月內變動了四次。一下子發燒48小時可以用，一次子說不行；一下子說只有同住家人可以，一下子又說朋友同事都行。到底疾病管制局是受到怎樣的影響作了這些變動？是投書打電話抗議的民眾很多嗎？

過年前有學弟在急診，跟病患言語爭執，病患說她兒子先來我們醫院急診，醫生沒有開克流感給他，後來去到其他醫院，其他醫院就開了克流感；現在她也是類似症狀，要來我們醫院要求克流感。學弟說＂妳現在不像類流感症狀，不符合克流感使用標準＂…為了這個病患，花了應該有十幾分鐘，最後還是讓她退掛。

昨天負責類流感門診看診，一個年輕的小姐發燒喉嚨痛來掛號。她說她覺得自己也是流感，因為過年時候同樣症狀來掛急診，急診醫師開了克流感給她，她吃了一天就好了，就沒有繼續吃藥，然後剩下三天的克流感…

為什麼有這種亂象？拜託疾病管制局和衛生署好好想看看，到底整個流感防疫和衛生政策是什麼，要怎麼對民眾和媒體宣導。

疾病管制局致醫界通函第092號 1/21號 關於公費克流感早期規定

「公費流感抗病毒藥劑使用對象適度放寬，籲請醫師提高警覺，及時給予用藥治療」(疾病管制局致醫界通函第094號) 1/27號 第一次修訂

「公費流感抗病毒藥劑使用對象放寬期限，延長至今(100)年3月31日」(疾病管制局致醫界通函第096號) 2/17號 第二次修訂

「修訂公費流感抗病毒藥劑擴大使用範圍」(疾病管制局致醫界通函第097號) 3/2號 第三次修訂

「更正-修訂公費流感抗病毒藥劑擴大使用範圍」(疾病管制局致醫界通函第098號) 3/4號第四次修訂

話說從頭的克流感發放

首先感謝疾病管制局或是衛生署不知道哪個單位的誰，把克流感這樣的藥物列為防疫物資另外編列預算由政府採購，不占用到全民健康保險原本的額度…否則一個成本約八百到一千的克流感，一定是健保財務嚴重的負擔。

劉揆：擴大使用克流感以公務預算支應，不列健保總額內 ←link

行政院長劉兆玄今（24）日表示，行政院在防疫諮詢小組建議下，會擴大使用克流感，費用由公務預算支應，不列在健保總額以內 

上面這一段，希望中部某大醫院的陳醫師有看到，克流感是另外公務預算買的，請不要再叫得到流感的護士小姐去健保局要求退費了！
link: 中部某大醫院陳醫師打電話到大話新聞抗議

而前一波新流感疫情減緩後(2010年的年初)，疾病管制局也就順勢縮減克流感的公費支應，所以一般得到流感沒有併發症的民眾，要吃克流感，也是得自費！

所以克流感在去年的年初年中之間，又回復到只給付給流感併發重症的病人。其他得到流感沒有併發症的病患，請＂自費＂…


爾後，流感疫情又逐漸升溫，所以增加了＂重大傷病高危險群＂、和＂有危險徵候的類流感病患＂；不過這個危險徵候的認定實在是非常寬鬆，怎樣算是胸悶呼吸急促？誰感冒發燒咳嗽不會胸口悶呼吸急促的？發燒超過48小時也很常見。其實這樣寬鬆的標準，也反映了流感診斷困難和克流感使用時機仍有爭議。

而到了今年這一波春節流感疫情，整個克流感發放標準大變動，簡直可說是在＂灑藥＂了；原本明白條文規定＂必須發燒超過38度＂也拿掉，變成＂民眾說有發燒就是有發燒＂、＂民眾說有接觸就是有接觸＂。


當然流感的確是有不典型表現，不見得每個人都會發高燒超過38度；況起身體自己有調節體溫機制，體溫高起來的時間常常不是在醫院被量到；再說快速篩檢的敏感度很低，幾乎可以說有一半的人得到流感，也沒辦法從快速篩檢檢查出來。


如果真要達到＂一個都不漏、所有的流感病患都吃到克流感＂，那就是必得像現在這樣，病人說了－有發燒有接觸流感病人－就算是、醫生說了－像是流感－就是類流感。當然在流感流行的高峰期，這樣子大規模發放，只要有所謂類流感症狀幾乎就會給克流感(感冒會呼吸急促胸悶發燒超過48小時是很容易的)，命中流感的比率是很高的，雖然也造成很多不必要的濫用。但是在流感疫情衰退後，所謂的類流感症狀，實際上是流感病毒感染造成的病人，就會大幅減少；如同最上面所說的，流感和普通感冒，其實沒有辦法從症狀完全區分，換句話說，就算是普通感冒，也是會造成類流感症狀－跟流感很類似的症狀。這時候如果拿相同標準去發放克流感，造成的濫用會更多！

克流感是防疫物資或者治療必須用藥？

站在民眾角度想想看，為什麼發燒喉嚨痛頭痛肌肉痠痛，可不可以吃克流感、有沒有需要吃克流感，會因為一日之差或者去到不同醫院，而有不同結果？


如果說，得到流感就要吃克流感，那為什麼號稱包山包海、醫師認為有需要就會給付的全民健康保險，竟然不給付克流感？


一個流感有兩種治療－吃克流感和不吃克流感
一個克流感有兩種拿法－去公費配置醫院或者自費買
對民眾來說＂我已經有交健保了，為什麼克流感還要我自費一千塊錢？＂
這樣的抱怨很常在新聞上看到，大部分的民眾都不了解克流感是疾病管制局另外預算公費購買的，並不屬於健保給付項目(我也是後來才知道)。


或許這是因為推行施打流感疫苗沒有達到預期效果，在面臨流感疫情爆發時候，拿＂大量發放克流感＂當作減緩疫情的方式；而疾病管制局和衛生主管單位沒有對民眾講清楚＂克流感到底是防疫用還是治療用＂；只見新聞媒體上都是宣導大家有感冒症狀不要輕忽趕快就醫，請去醫院拿公費克流感，診所醫師也請多轉病人去醫院。


疾管局沒有告訴大家定這些規定的理由是什麼，擅自增加或者縮減使用標準；同時宣布方式又是在少數的管道；很多醫生要看新聞媒體才知道，甚至有時候有偷偷的把某些項目增減。不但有陷醫生於不義之嫌，也讓民眾無所適從。


的確，在二月底三月初之後，在急診篩檢出的流感病患少了很多，疾病管制局發布新聞稿也說明疫情趨緩，可能是得力於疾管局放寬克流感使用標準的政策；可是副作用是什麼？

克流感抗藥性 新增3例 ← link

流行性感冒，從很久以前就有了！可是克流感長期來不被重視，在我還是資淺住院醫師的時候，遇到流感病人，也只是說＂回家多休息靠抵抗力恢復＂；其中一個重要原因是＂克流感對於所謂舊型流感幾乎沒有效了！＂，抗藥性高達八到九成。而目前流行的所謂新流感H1N1，對於克流感的抗藥性還很低，所以克流感又被拿起來重視，而實際上治療也真的有效。但是抗藥性問題已經慢慢浮現，或許等克流感對付新流感已經沒有效的時候，這樣的亂象也會解除吧！希望在那之前的今年年底，流感又要開始流行時候(現在疫情慢慢退燒了，也來不及修正了)，疾管局和衛生署能夠記取現在的各種經驗，做更好的應變。