太棒了！FreeWare(自由軟體)萬歲~

在越南時，范草雲是一名擁有優異文字能力的記者，後來，她來到台灣從事幫傭工作，每天負責打掃三間透天厝、為幾十個人做飯洗衣。她讀著以越南文寫成的《四方報》潸然落淚。被僱主解僱後，范草雲開始逃亡生涯，在桃園龜山的森林裡，致電張正請求他持續寄這份報紙給她，《四方報》是越南勞工撫慰疲憊心靈的精神食糧。

為甚麼逃跑？張正說，范草雲對於超過負荷的工作並不以為苦，只是被僱主解僱後，藍領移工別無選擇，只能被遣送回國。來台灣賺錢的目的尚未達成，只好選擇逃跑。至今，有兩萬多名的移工行蹤不明，他們不偷不搶卻必須日夜恐慌於警察的盤查。《四方報》為這些逃跑移工開闢專欄，讓他們得以抒發「不得不逃跑」的理由與心情。

《四方報》致力於追求與維護藍領移工在台灣的基本人權。他們曾經撰寫「沒有服務，何來服務費」的專題，指出仲介向移工收取服務費的不合理。文章一出，有幾名比較大膽的泰籍移工便拿著報紙向仲介據理力爭，丟失的權益在《四方報》的協助與自己的親身努力下，索討回來。除此之外，諸如基本工資調漲、取消外籍配偶財力證明等有關移工權益的議題都是《四方報》所關心的。

這份報紙剛柔並濟，除了嚴肅的人權問題，更多的是體現移工自身的情感價值。越南幫傭陳氏桃除了打掃做菜，當她的雙手握住畫筆，更可揮灑出一幅幅關於家鄉、關於愛情、關於勞動的美麗圖畫。《四方報》提供了移工以文字或圖畫紀錄生活的平台，有人用不嫻熟的中文寫下對僱主的感激之情，有人畫蛋糕祝福在越南的妹妹生日快樂，有人寫情詩，有人將自己失敗的婚姻化作文字……越南配偶與勞工豐饒的情感躍然紙上。

為了避免成為「一座越南民族沙文主義的堡壘」，除了外配外勞的議題，《四方報》收錄許多如同志、跨性別與原住民等弱勢團體的相關報導，因為「弱勢集結起來比較有力量」，樂生療養院就曾躍上《四方報》的版面，在台灣的越南人，從此與台灣本身的弱勢族群有了連結。

張正於獨立媒體《立報》當了十幾年的記者，接過三、四封讀者迴響，《四方報》發行之後，他一天接到三、四十封利用衛生紙、月曆紙、各種廢紙書寫的信件，熱情的來信證明《四方報》成立的價值。「動員讀者一起關心公共議題」是張正身為媒體工作者十幾年來的願望，這個願望在《四方報》成立後有了具體的實踐。《四方報》成為一個「練習發聲的場域」，讓移工有勇氣在異地爭取權益，紓解情緒。

「證明他們是人」是張正，也是許多外籍勞工權益工作者的信念之一。《四方報》立基於台灣對外勞權益的漠視，張正半開玩笑地說「希望這份報紙趕快倒掉」因為當外勞終於能夠得到平等尊嚴的對待，又或者有其他報刊挺身為他們爭取權益時，這份報紙就算是功成身退。因為除了越南與泰國，還有柬埔寨，還有更多為台灣奉獻勞力的異鄉客，渴求一份屬於自己的刊物。

延伸閱讀：
BỐN PHƯƠNG 越文四方報 Bao Bon Phuong
สี่ฝั่ง 泰文四方報

圖說一：＜四方報＞主編張正。

圖說二：來自馬祖的讀者以中文寫下來台灣的心情。（翻拍自越文＜四方報＞第二十五期第二十五版）

圖說三：讀者圖文並茂的投稿。（翻拍自越文＜四方報＞第二十五期第二十六版）

多關心在周遭的每個人

什麼都是政治陰謀！你真的很惡極~~

可惡的政府！置入行銷、讓費公帑

諷刺和令人驚恐的畫面！

到現在還有這種事情存在...苗栗縣政府真的很會拆古蹟，毀良田~

June 28, 2010 — The fear of being sued for medical malpractice is pervasive, leading 91% of physicians across all specialty lines to practice defensive medicine — ordering more tests and procedures than necessary to protect themselves from lawsuits — a new study finds.

A survey by researchers from Mount Sinai School of Medicine, New York City, also found that the same overwhelming percentage of physicians believe that tort reform measures to provide better protections against unwarranted malpractice suits are needed before any significant decrease in the ordering of unnecessary medical tests can be achieved.

Investigators questioned 2416 physicians from a variety of practice and specialty backgrounds in a survey conducted between June 25, 2009, and October 31, 2009. Their findings were published today in the June 28 issue of the Archives of Internal Medicine.

"Physicians feel they are vulnerable to malpractice lawsuits even when they practice competently within the standard of care," said Tara Bishop, MD, associate, Division of General Internal Medicine at Mount Sinai School of Medicine, and coauthor of the study, in a news release. "The study shows that an overwhelming majority of physicians support tort reform to decrease malpractice lawsuits and that unnecessary testing, a contributor to rising healthcare costs, will not decrease without it."

Physicians were asked to rate their level of agreement to 2 statements:

• "Doctors order more tests and procedures than patients need to protect themselves against malpractice suits," and
• "Unnecessary use of diagnostic tests will not decrease without protections for physicians against unwarranted malpractice suits."

There were no statistically significant differences between sex, geographic location, specialty category, or type of practice. The largest difference was that 92.6% of male physicians said they practice defensive medicine vs 86.5% of female physicians.

Although physicians in relatively low-risk specialties such as general internal medicine and pediatrics are much less likely to be sued for malpractice than obstetric/gynecologic specialists and emergency physicians, their fear is just as real, Dr. Bishop asserted in an interview with Medscape Medical News. "There's just a visceral response to the word 'malpractice,' " she said. "The entire medical community worries about being pulled into a lawsuit."

Determining the true costs of defensive medicine may be impossible because so many factors go into decisions about ordering tests, Dr. Bishop noted. Malpractice fears play a large role, but so does a desire to be thorough and careful. In a fee-for-service system that often rewards overuse, it is difficult to say how large a part defensive medicine plays in the decision to order a test.

A 2003 study by the US Department of Health and Human Services estimated the cost of defensive medicine at $60 billion a year, but the American Medical Association pegs it at $200 billion. A 2008 study by PricewaterhouseCoopers' Health Research Institute calculated the cost of defensive medicine at $210 billion per year, or 10% of all healthcare spending.

The new Mt. Sinai study coincides with several earlier surveys about how prevalent defensive medicine is. Some of the findings of those studies follow here.

• Ninety percent of physicians said they practice defensive medicine, according to a poll published in April by Jackson Healthcare, a medical staffing and information technology company. About three quarters of physicians surveyed said defensive medicine decreases patient access to healthcare and will exacerbate the growing physician shortage.
• A 2008 study by the Massachusetts Medical Society found that 83% of its physicians practice defensive medicine at a cost of at least $1.4 billion a year in that state alone. More than 20% of x-rays, computed tomography scans, magnetic resonance images, and ultrasounds; 18% of laboratory tests; 28% of specialty referrals; and 13% of hospital admissions were ordered for defensive purposes.
• A survey of 824 Pennsylvania physicians, published in 2005 in the Journal of the American Medical Association, found that 93% admit to risk-aversion tactics such as overordering tests, abandoning high-risk procedures, and avoiding the sickest of patients.

"We practice maximalist medicine to avoid missing any problem our clinical judgment tells us may be extremely remote," said Alan C. Woodward, MD, an emergency physician and past president of the Massachusetts Medical Society, to Medscape Medical News. Defensive medicine is rampant because "the threat of being sued is pervasive, and doctors simply don't trust the legal system."

In an invited commentary accompanying the Mt. Sinai study, Sen. Orrin G. Hatch (R-UT) acknowledged that consensus on Capitol Hill about tort reform "has been an elusive commodity" because of division and partisanship. "It is my hope that, as the American people see more evidence that they are paying for redundant and unuseful medical procedures, they will demand in larger numbers that real reforms be enacted to address this problem," Sen. Hatch writes. "That is what makes studies like the one by Bishop, et al., so important."

Arch Intern Med. 2010:170:1081-1084.

[CLOSE WINDOW]

Authors and Disclosures

Journalist

Mark Crane, BA

Freelance medical writer, Brick, New Jersey

Disclosure: Mark Crane has disclosed no relevant financial relationships.

防衛性醫療~~

真是太扯了！

Google Docs推出OCR文字辨識功能，可自動擷取、轉換PDF、圖片中的文字！

最近「Google文件」推出了一個新的功能，只要我們在上傳PDF文件檔或圖片時，若勾選「 將 PDF 檔案或圖片檔案中的文字轉換為Google 文件」功能的話，在上傳之後，會自動將PDF或圖片中可以辨識的文字擷取出來，並記錄在Google文件中讓我們進一步做編輯。

初步測試，以軟體編製的PDF文件中的文字可以正常抓得到，而且還可支援中文文字辨識，正確率還不錯。不過部分圖片中的文字就無法順利擷取，可能得再多試試看不同樣本。儘管如此，還是相當方便！如果有需要將PDF轉成一般文件來繼續編輯的話，可以上傳到Google Docs網站來試試看。