with it.

與它。

Although it’s easy to see the dangers of being a high-voltage power line inspector,

雖然很容易看到作為高壓電線檢查員的危險性。

even the most harmless appearing jobs have their risks – and medicine is no exception.

即使是看起來最無害的工作也有其風險--醫學也不例外。

Dr. Jubbal, MedSchoolInsiders.com Although being a doctor may seem like a safe

Jubbal醫生，MedSchoolInsiders.com 雖然當醫生似乎是一個安全的職業，但也是一個很好的選擇。

job, there are some occupational risks that you should be aware of.

工作，有一些職業風險是你應該注意的。

I’m not just talking about carpal tunnel syndrome from charting too much or UTIs from

我說的不僅僅是由於做了太多的圖表而引起的腕管綜合症，也不僅僅是由於做了太多的圖表而引起的尿毒症。

holding your bladder too long either.

憋尿的時間也太長了。

Here are the different occupational hazards that doctors face and which specialties are

以下是醫生面臨的不同職業危險，以及哪些專業是

most susceptible to them.

最容易受其影響。

Needlesticks and other sharps injuries are some of the most common work-related injuries

針刺和其他利器傷害是一些最常見的工作相關傷害

among physicians.

在醫生中。

They often occur during procedures or medication administration when a contaminated needle,

它們往往發生在手術或用藥過程中，當一個被汙染的針頭。

scalpel, suture, or other sharp object accidentally punctures the skin.

手術刀、縫合線或其他尖銳物體意外地刺破皮膚。

The problem with these injuries is not the wound itself, but rather the risk of contracting

這些傷害的問題不在於傷口本身，而在於感染的風險。

a blood-borne illness – particularly HIV or hepatitis C.

血液傳播的疾病--特別是HIV或丙型肝炎。

The CDC estimates that approximately 385,000 needlesticks and other sharps-related injuries

疾病預防控制中心估計，大約有385,000次針刺和其他與利器有關的傷害。

occur each year; however, it is difficult to accurately estimate these numbers as many

然而，很難準確地估計這些數字，因為許多人都在為自己的行為負責。

of these incidents go unreported.

這些事件沒有得到報告。

Many people feel ashamed or embarrassed when they stick themselves and worry that disclosing

許多人在粘上自己時感到羞愧或尷尬，並擔心公開

the incident will make their peers and supervisors question their skills and competency or affect

該事件將使他們的同行和主管質疑他們的技能和能力，或影響他們的工作。

their professional development.

他們的職業發展。

Although the estimated risk of contracting a blood-borne illness after exposure to infected

儘管估計在接觸受感染的人後感染血源性疾病的風險很大，但這並不妨礙我們的工作。

blood is low, approximately 0.3% for HIV and 0.2% for HCV according to the CDC, there are

根據CDC的數據，血液中的HIV病毒和HCV病毒的感染率很低，分別約為0.3%和0.2%。

multiple factors that may increase your risk.

可能增加你風險的多種因素。

Exposure to large quantities of infected blood, exposure to blood from a patient with high

暴露於大量受感染的血液中，暴露於來自高血壓患者的血液中。

viral loads, and being stuck with a hollow-bore needle all increase your risk of infection.

病毒負荷，以及使用空心針頭都會增加你感染的風險。

That being said, there are safety precautions that further mitigate these risks such as

也就是說，有一些安全預防措施可以進一步減輕這些風險，如

wearing two pairs of gloves.

戴著兩副手套。

Doing so has been shown to reduce the volume of blood transferred by almost a factor of

這樣做已被證明可使轉移的血液量減少近1倍。

6.

6.

Despite the low likelihood of transmission and the additional precautions, however, reporting

儘管傳播的可能性很低，並採取了額外的預防措施，然而，報告

is still crucial given the lifelong consequences of an HIV or HCV diagnosis.

鑑於HIV或HCV診斷的終生後果，這一點仍然至關重要。

When these incidents occur, it is imperative that both the patient and physician are tested

當這些事件發生時，當務之急是對病人和醫生都進行測試

to determine (1) whether exposure to a blood-borne pathogen has occurred and (2) whether the

以確定(1)是否發生了血源性病原體的接觸，以及(2)是否發生了

physician should begin prophylactic treatment.

醫生應開始預防性治療。

Surgical specialties are often at higher risk for these types of injuries due to their regular

外科專業由於其經常性的工作，往往在這些類型的傷害上有更高的風險。

exposure to bodily fluids and the use of sharp tools during surgery.

暴露於體液和在手術中使用鋒利的工具。

According to one study examining resident physicians, there was approximately twice

根據一項對住院醫生的研究，大約有兩倍的

the number of needlestick injuries involving surgical residents as there were with non-surgical

涉及外科住院醫師的針刺傷害數量與非外科住院醫師的數量相同。

residents at about one needlestick injury per year for each surgical resident.

每位外科住院醫師每年大約有一次針刺傷。

Emergency medicine physicians also tend to be at higher risk for sharps injuries or exposure

急診科醫生也往往有較高的利器傷害或暴露的風險

to blood-borne illnesses given their regular exposure to blood and other bodily fluids.

鑑於他們經常接觸血液和其他體液，他們對血源性疾病很敏感。

They also perform a variety of procedures involving needles and other sharp tools including

他們還進行各種涉及針頭和其他鋒利工具的手術，包括

central line placement and chest tubes, among others.

中心靜脈置管和胸管，等等。

Exposure to pathogens through the air or respiratory droplets is another common occupational hazard

通過空氣或呼吸道飛沫接觸病原體是另一種常見的職業危害。

for physicians.

為醫生服務。

This has been of particular concern as of late due to the coronavirus pandemic.

由於冠狀病毒的大流行，最近這一點特別值得關注。

Despite taking proper precautions, many physicians were still exposed to the virus and became

儘管採取了適當的預防措施，許多醫生仍然接觸到病毒，併成為

sick themselves – some even losing their lives due to the disease.

自己生病--有些人甚至因為這個疾病而失去生命。

Even before COVID-19; however, there has always been a risk of contracting an airborne illness

即使在COVID-19之前，也一直存在著感染空氣傳播疾病的風險。

for physicians.

為醫生服務。

This includes more common pathogens like flu and other respiratory viruses as well as more

這包括更常見的病原體，如流感和其他呼吸道病毒，以及更多的

dangerous pathogens such as tuberculosis and bacterial meningitis – both of which may

危險的病原體，如結核病和細菌性腦膜炎--兩者都可能

be transmitted through respiratory droplets when a patient coughs or sneezes.

當病人咳嗽或打噴嚏時，可通過呼吸道飛沫傳播。

Because physicians in most specialties regularly interact with patients, most physicians are

因為大多數專科的醫生都經常與病人互動，所以大多數醫生都是

also susceptible to exposure to airborne pathogens.

也很容易接觸到空氣中的病原體。

That being said, some specialties are at higher risk than others.

也就是說，有些專業的風險比其他專業高。

To start, front-line specialties such as family medicine, pediatrics, emergency medicine,

首先，一線專業，如家庭醫學、兒科、急救醫學。

and internal medicine are at higher risk given the fact that they are the first point of

由於他們是第一個接觸到的人，內科醫生面臨的風險更高。

contact for patients.

為病人聯繫。

Other specialties at high risk for exposure to airborne pathogens are critical care, anesthesiology,

其他接觸空氣傳播病原體風險較高的專業是重症監護、麻醉學。

and pulmonology as they regularly work with patients’ airways and perform a variety

他們經常與病人的呼吸道打交道，並進行各種各樣的工作。

of procedures, such as endotracheal intubation, where they must be near the patient’s face.

的程序，如氣管插管，他們必須靠近病人的臉。

Ear, nose, and throat doctors and ophthalmologists are also at higher risk for airborne exposures

耳鼻喉科醫生和眼科醫生接觸空氣的風險也較高

for this same reason.

也是出於這個原因。

Lastly, infectious disease physicians would also fall into this category as they work

最後，傳染病醫生也屬於這個類別，因為他們的工作是

closely with patients with diseases that are transmissible through air and respiratory

密切關注可通過空氣和呼吸道傳播的疾病患者。

droplets such as tuberculosis and bacterial meningitis, to name a few.

諸如結核病和細菌性腦膜炎等飛沫，僅舉幾例。

For some specialties, radiation exposure is another occupational hazard.

對於一些專業，輻射暴露是另一種職業危害。

The x-rays, CT scans, and other imaging studies that doctors use to help diagnose patients

醫生用來幫助診斷病人的X射線、CT掃描和其他成像研究

use ionizing radiation to produce images of the body.

使用電離輻射來產生身體的影像。

Although these tests use small doses of radiation and are unlikely to cause any damage in the

儘管這些測試使用小劑量的輻射，並且不太可能對人體造成任何損害。

short term, long-term repeated exposure has the potential to cause cumulative damage to

短時間內，長期重複接觸有可能造成累積性損害。

DNA and subsequent adverse effects -– most notable of which is the increased risk of

DNA和隨後的不利影響--其中最值得注意的是增加的風險。

cancer.

癌症。

An increasingly common tool for physicians and surgeons is the fluoroscope.

醫生和外科醫生的一個越來越常見的工具是熒光鏡。

These x-ray devices allow doctors to see into patients’ bodies in real-time to help guide

這些X射線設備使醫生能夠實時看到病人的身體，以幫助指導

procedures.

程序。

The downside, however, is that they expose the physicians to small doses of radiation.

然而，其缺點是它們使醫生暴露在小劑量的輻射中。

There are precautions that physicians take to minimize radiation exposure including wearing

醫生們採取了一些預防措施，以儘量減少輻射暴露，包括佩戴

lead vests to protect against radiation, maintaining appropriate distances to minimize exposure,

鉛背心以防止輻射，保持適當的距離以儘量減少暴露。

and keeping exposure times to a minimum.

並將曝光時間保持在最低限度。

Physicians that use these tools will typically also wear dosimeter badges which monitor their

使用這些工具的醫生通常也會佩戴劑量計徽章，以監測他們的情況。

exposure to ionizing radiation over time to ensure they are well within safe levels.

隨著時間的推移，對電離輻射的暴露，以確保它們遠在安全水準之內。

Although research largely suggests that the risk of an adverse health effect from radiation

儘管研究大多表明，輻射對健康產生不利影響的風險

is low for physicians, regularly being exposed to even low levels of radiation is likely

對於醫生來說，經常暴露在即使是低水平的輻射中也可能是

more harmful than not being exposed to radiation.

比不接觸輻射更有害。

According to the Cleveland Clinic, as of 2012, there have been nine reported cases of left-sided

根據克利夫蘭診所的數據，截至2012年，已經有9個報告的左旋肉鹼病例。

brain or head and neck tumors in interventional cardiologists which may suggest an increased

介入性心臟病專家的腦部或頭頸部腫瘤，這可能表明，增加了

risk of brain tumors in doctors who use fluoroscopy.

使用透視的醫生有患腦瘤的風險。

Studies have also demonstrated an increase in chromosomal abnormalities in interventionalists,

研究還表明，干預者的染色體異常情況有所增加。

compared with non-interventionists.

與非干預者相比。

The specialties most at risk for radiation exposure are diagnostic radiology, cardiology,

輻射風險最大的專業是放射診斷學、心臟病學。

interventional radiology, interventional cardiology, and certain surgical specialties due to the

介入放射學、介入心臟病學和某些外科專業，因為

use of real-time imaging in procedures.

在程序中使用實時成像。

Other occupational risks that we often don’t consider are neck pain, back pain, and other

我們經常不考慮的其他職業風險是頸部疼痛、背部疼痛和其他

musculoskeletal injuries.

肌肉骨骼傷害。

These issues are especially common among surgeons due to the long hours spent standing and the

這些問題在外科醫生中特別常見，因為他們要花很長時間站立和

tendency to shift to poor, ergonomically limited positions to ensure proper exposure and accessibility

傾向於轉移到惡劣的、符合人體工程學的有限位置，以確保適當的暴露和可及性

to the area of interest.

到感興趣的領域。

A 2020 study published in JAMA monitored the ergonomics of fifty-three surgeons from 12

2020年發表在《美國醫學會雜誌》上的一項研究監測了來自12個國家的53名外科醫生的工效學情況。

different specialties while performing surgery.

在進行手術時，不同的專業。

They found that surgeons spent an average of 65% of procedure time in high-risk neck

他們發現，外科醫生在高風險的頸部平均花費65%的手術時間。

positions, 30% in high-risk torso positions, and 11% in high-risk shoulder positions.

在高風險的軀幹位置有30%，在高風險的肩部位置有11%。

Other factors that contributed to increased time spent in high-risk positions included

導致在高風險崗位上停留時間增加的其他因素包括

longer case lengths, increased years in practice, and use of surgical loupes and headlights.

病例長度較長，從業年限增加，以及使用手術用放大鏡和頭燈。

Additionally, a 2017 study of ENT residents found that 82% of residents experienced some

此外，2017年一項針對耳鼻喉科居民的研究發現，82%的居民經歷了一些

form of musculoskeletal pain, 16% reported having to scrub out of ongoing operating procedures

肌肉骨骼疼痛的形式，16%的人報告說不得不取消正在進行的操作程序。

due to musculoskeletal symptoms, and 6% reported missing work due to their symptoms.

由於肌肉骨骼症狀，6%的人報告由於他們的症狀而錯過了工作。

Lastly, a 2020 study surveying 685 orthopedic surgeons across 27 different states, found

最後，2020年的一項研究調查了27個不同州的685名骨科醫生，發現

that approximately 60% of respondents reported neck pain and approximately 23% reported issues

約60%的受訪者報告了頸部疼痛，約23%的人報告了問題

with cervical radiculopathy.

患有頸椎病的人。

Of those surveyed, only six surgeons reported receiving ergonomic evaluations.

在被調查者中，只有6名外科醫生報告說接受了人體工程學評估。

Surgeons aren’t the only physicians at risk for musculoskeletal issues either.

外科醫生也不是唯一面臨肌肉骨骼問題風險的醫生。

Any specialty that requires long hours standing or sitting at a computer also has the potential

任何需要長時間站立或坐在電腦前的專業也有可能

for back pain, neck pain, and other musculoskeletal issues.

用於治療背部疼痛、頸部疼痛和其他肌肉骨骼問題。

Gastroenterologists, for instance, have been shown to have high incidences of back and

例如，腸胃科醫生已被證明有很高的背部和腹部疼痛的發生率。

neck issues as well as elbow, wrist, and hand injuries.

頸部問題以及肘部、腕部和手部受傷。

This is thought to be a result of the long hours spent performing scopes and endoscopic

這被認為是由於長時間進行鏡檢和內窺鏡檢查的結果。

ultrasounds and the repetitive motions associated with them.

超音波和與之相關的重複性動作。

Studies examining the prevalence of musculoskeletal pain and injuries among GI doctors range from

對消化科醫生中肌肉骨骼疼痛和損傷的發生率進行的研究，範圍從

29% all the way up to 89%.

29%一直到89%。

Although there is a lot of variation between studies, it is clear that many GI physicians

雖然不同的研究之間有很大的差異，但很明顯，許多消化科醫生

are being affected by this, which is problematic given that injury and pain can lead to loss

這是有問題的，因為受傷和疼痛可能導致損失。

of productivity and shorten a physician’s career.

的生產力，並縮短醫生的職業生涯。

No matter what specialty you choose, it’s important that you remain cognizant of your

無論你選擇什麼專業，重要的是你要保持對自己的認知。

posture and movement patterns to minimize the risk of developing issues down the road.

姿勢和運動模式，以儘量減少今後出現問題的風險。

Daily stretching and regular exercise are also great ways to prevent musculoskeletal

日常拉伸和定期鍛鍊也是預防肌肉骨骼的好方法。

issues and improve your overall health.

問題並改善你的整體健康。

Start now by stretching your finger over the like button and subscribing to Med School

現在就開始吧，把你的手指伸到喜歡的按鈕上，訂閱《醫學院》。

Insiders.

內部人士。

We have a number of videos to help you stay healthy on your path to becoming a doctor

我們有一些視頻可以幫助你在成為醫生的道路上保持健康

from study strategies, to sleep, to mental health and everything in between.

從學習策略，到睡眠，到心理健康，以及兩者之間的一切。

We’d love to be a part of your journey to becoming a happy and healthy future doctor.

我們很願意成為你成為一個快樂和健康的未來醫生的旅程的一部分。

Physically combative patients are another occupational hazard for some specialties – particularly

身體上有爭鬥的病人是某些專業的另一個職業危險--特別是

for psychiatrists and emergency medicine physicians.

為精神病學家和急診科醫生。

In psychiatry, you are regularly treating patients with behavioral health issues including

在精神病學中，你經常治療有行為健康問題的病人，包括

anger management problems, personality disorders, and even homicidal ideation.

憤怒管理問題，人格障礙，甚至殺人的想法。

Although not all patients with mental illness are dangerous, the nature of these patient

雖然不是所有的精神疾病患者都是危險的，但這些患者的性質

populations does increase the risk for psychiatrists, which can be seen in the fact that psychiatrists

人口確實增加了精神病醫生的風險，這可以從以下事實中看出：精神病醫生

are the most common victims of physician homicide.

是醫生凶殺案最常見的受害者。

Emergency medicine physicians are also at higher risk of encountering physically combative

急診科醫生遇到肢體衝突的風險也更高。

patients for several reasons.

由於幾個原因，病人的情況很不樂觀。

To start, there are a lot of strong emotions that come along with emergencies as these

首先，有很多強烈的情緒伴隨著緊急情況的發生，因為這些

situations are often incredibly stressful for the patients and families, as well as

對病人和家屬來說，這種情況往往是令人難以置信的壓力，同時也是對病人和家屬的壓力。

for the medical staff.

為醫務人員。

Anytime strong emotions get involved, people often experience less control over their actions

任何時候，只要涉及到強烈的情緒，人們往往會對自己的行為產生較少的控制力。

leading them to say and do things that they normally would not.

導致他們說和做他們通常不會做的事情。

In addition, common presentations including intoxication, hypoxia, stroke, and infection

此外，常見的表現包括中毒、缺氧、中風和感染。

can lead to altered mental status and agitation.

可導致精神狀態改變和躁動。

As a result, patients experiencing these conditions may unknowingly lash out against the physician

是以，遇到這些情況的病人可能會在不知不覺中對醫生進行抨擊。

due to their altered mental status.

由於他們的精神狀態改變了。

It is also common for EM physicians to encounter patients who are malingering, or in other

對於EM醫生來說，遇到裝病的病人也很常見，或者在其他方面

words, trying to abuse the hospital system for their own gain.

話說，為了自己的利益，試圖濫用醫院系統。

As an example, patients who are addicted to narcotics will often feign illnesses to receive

例如，對麻醉品成癮的病人往往會假裝生病，以獲得

pain medications.

止痛藥。

Although various prescription monitoring programs exist to help physicians detect drug-seeking

儘管存在各種處方監測計劃，以幫助醫生髮現尋求藥物的情況

behavior, these patients tend to become aggressive towards providers when they don’t get what

行為，這些病人在沒有得到他們想要的東西時，往往會對服務提供者產生攻擊性。

they want.

他們想要的。

I discuss these issues in more detail in my Why I Didn’t…

我在《為什麼我沒有》中更詳細地討論了這些問題。

Emergency Medicine video on my second channel Kevin Jubbal, M.D.

我的第二個頻道上的急診醫學視頻 Kevin Jubbal, M.D.

– link in the description.

- 描述中的鏈接。

Substance abuse is another surprisingly common issue among physicians.

藥物濫用是醫生中另一個令人驚訝的常見問題。

According to the American Addiction Centers, approximately 10-15% of physicians will develop

根據美國成癮中心的數據，大約有10-15%的醫生會患上

a problem with substance abuse during their careers.

在他們的職業生涯中，有濫用藥物的問題。

The type of substance abuse; however, often varies between specialties.

然而，藥物濫用的類型在不同的專科之間往往是不同的。

Among anesthesiologists, for instance, the most commonly abused substances are opioids.

例如，在麻醉師中，最常被濫用的物質是阿片類藥物。

This is thought to be a result of their proximity to large quantities of highly addictive drugs,

這被認為是他們接近大量高成癮性毒品的結果。

the relative ease at which they can divert small quantities of these drugs for personal

他們可以相對容易地將少量的這些藥物轉用於個人用途。

use, the high-stress environment in which they work, and the continuous exposure to

他們在工作中的高壓力環境，以及持續接觸到的

these drugs in the workplace which can promote substance abuse.

在工作場所使用這些藥物，會促進藥物濫用。

Although the exact prevalence of substance abuse among anesthesiologists is not known, 

儘管麻醉師中藥物濫用的確切流行率並不清楚。

between 1991 and 2001, four out of five U.S. anesthesiology residency programs reported

在1991年至2001年期間，美國五分之四的麻醉學住院醫師項目報告說

experiences with impaired residents, and one in five reported at least one pretreatment

有障礙的居民的經歷，五分之一的人報告說至少有一次治療前的

fatality.

致命。

This is especially concerning given that substance abuse increases your risk of suicide and anesthesiologists

鑑於藥物濫用會增加你的自殺風險和麻醉師的自殺風險，這一點尤其令人擔憂。

are known to have some of the highest rates of suicide out of any medical specialty.

眾所周知，在任何醫療專業中，自殺率是最高的。

Anesthesiologists are not the only physicians with substance abuse issues.

麻醉師並不是唯一有藥物濫用問題的醫生。

According to the American Addiction Centers, male surgeons are over two times as likely

根據美國癮君子中心的數據，男性外科醫生的可能性超過2倍

to experience alcohol dependence or abuse than the general population and female physicians

與普通人群相比，女性醫生經歷酒精依賴或濫用的可能性更大。

are over four times as likely.

是四倍以上的可能性。

In addition, a 2014 study of emergency medicine physicians treated by a Physician Health Program

此外，2014年對接受醫生健康計劃治療的急診科醫生進行了一項研究

showed that nearly half were treated for alcohol abuse, 38% for opioid abuse, and almost 10%

顯示，近一半的人因酗酒而接受治療，38%的人因濫用阿片類藥物而接受治療，還有近10%的人因酗酒而接受治療。

for stimulant abuse.

濫用興奮劑的人。

Lastly, sleep deprivation is another common workplace hazard that is present across a

最後，睡眠不足是另一個常見的工作場所危險，它存在於整個工作場所。

variety of specialties.

各種各樣的專業。

It’s common knowledge that many physicians work long and unpredictable hours – especially

眾所周知，許多醫生的工作時間長且不可預測--尤其是

during training.

訓練期間。

It’s so common in fact that it is pretty much expected that you will experience many

事實上，這種情況非常普遍，以至於幾乎可以預見，你會經歷許多

sleepless nights on your path to becoming a physician.

在你成為一名醫生的道路上，不眠之夜。

That being said, sleep deprivation, both acute and chronic, can have significant negative

也就是說，睡眠不足，無論是急性的還是慢性的，都會有很大的負面影響。

effects on a physician’s health.

對醫生健康的影響。

Acute sleep deprivation has been shown to decrease cognitive function, attention, and

急性睡眠剝奪已被證明會降低認知功能、注意力和注意力。

memory – all of which can negatively affect a physician’s performance.

記憶 - 所有這些都會對醫生的工作表現產生負面影響。

Additionally, driving when sleep deprived has been compared to driving intoxicated and

此外，在睡眠不足的情況下開車被比作醉酒駕駛和

can greatly increase your risk of getting into an accident.

會大大增加你發生事故的風險。