【Tomorrow at noon】

Recently, the Tianjin Municipal Health Commission, Development and Reform Commission, Medical Insurance Bureau and other seven departments have formulated the "Tianjin City Work Plan for Further Standardizing Medical Behaviors and Promoting Rational Medical Examinations".

In addition to promoting mutual recognition of test results and implementing the clinical pharmacist system to improve the prescription review and evaluation work mechanism, the "Plan" mainly focuses on focusing on the inducing excessive diagnosis and treatment. The following aspects are specific:

1. Hospitals and departments are strictly prohibited from setting indicators to doctors to induce overexamination and overmedical treatment.

2. It is not allowed to link doctors’ personal income to drug and medical examination income.

3. Use Drg to conduct a comprehensive evaluation of doctors, using technical level, difficulty coefficient, work quality, positive rate of examination results, patient satisfaction, etc. as performance appraisal indicators, so that doctors' income truly reflects their technical value.

4. Establish a hospital and doctor practice scoring system and include it in the credit evaluation system and information disclosure system.

5. Establish a mechanism for accountability and accountability for illegal and excessive medical examinations. Timely investigate and deal with illegal and irregular behaviors, warn, interview, order rectification, and report the violations. If the circumstances are serious, the relevant responsibilities will be held in accordance with the law.

6. Give full play to the role of the assessment baton and promote the "three transformations and three improvements" of public hospitals, and link government financial investment with the hospital's performance appraisal results.

It has been a long time since the curb of excessive medical treatment, but it has been thunder and rain. It was not until August 20 this year that the National Senior Officials Conference passed the "Doctor Law of the People's Republic of China", which will be implemented from March 1 next year, and the crackdown on excessive medical treatment will be truly implemented at the legal level.

In terms of prohibiting excessive medical treatment, the new "Doctor Law" adds Article 19 to the original "Practicing Physicians Law" that "Doctors should adhere to the principles of safe, effective, economical and reasonable use of drugs, and follow the guidelines for clinical application of drugs, clinical diagnosis and treatment guidelines and drug instructions" to prevent excessive use of drugs.

In addition, Article 23, Item 2 added the provisions of "complying with clinical diagnosis and treatment guidelines" and "complying with medical ethical norms" on the basis of the original "complying with technical operation standards".

Also, Article 31 added that "unnecessary examinations and treatments shall not be performed on patients" on the basis of having to make unreasonable profits. It prevents excessive medication from the perspective of safe, effective, economical and reasonable medication.

In addition, Article 1227 of the Civil Code implemented on January 1 this year also clearly prohibits excessive examinations: "Medical institutions and their medical staff shall not implement unnecessary examinations in violation of diagnosis and treatment standards."

It can be seen that excessive medical treatment is a stumbling block to building a harmonious doctor-patient relationship and even an honest society.

To be honest, over-medical care is a global problem, with certain complexity, and it is not easy to make it clear.

The main body of discussing the issue of over-medical care can only be professional doctors and laymen. Not to mention over-medical care, they may not even be clear about what to say "moderate medical care". Even professional doctors are only one thousand readers and one thousand Hamlets. Some time ago, Beijing doctor Zhang Yu publicly condemned Shanghai doctor Lu Wei for "super guideline over-medical care" for patients with tumors that had a night. In the end, the National Health Commission organized authoritative experts to conduct a discussion and found that Lu Wei's treatment basically complies with the standards and there was no problem.

Therefore, over-medicine has a certain complexity.

First of all, the definition is unclear. You can only analyze from different perspectives and then draw different definitions.

For example, from the perspective of the patient's personal interests, if the examination and treatment of the disease are given beyond the scope of diagnosis and treatment, it is all over-medical. If it is based on the perspective of medical resources, consuming the medical resources that the disease should have is also over-medical.

For example, if you have an irrelevant "cervical erosion", you will force yourself to perform cone surgery on others, or even give chemotherapy. Not only will the patient spend a huge amount of medical expenses, but it will also cause her to suffer huge pain. There is no doubt that this is over-medical.

For example, from the perspective of medical resources, if a terminally ill patient has no hope of curing and can only rely on a ventilator to maintain his vital signs, but continuing to use ventilator and a large number of drugs every day to maintain vital signs is consumed more than the medical resources that the disease should have. Although it is understandable from an emotional point of view, this should actually be excessive medical treatment.

The reasons for excessive medical treatment are also complicated.

"More medical care" is in the fifty groups of 500 doctors. A survey was conducted on this issue and found that more than 90% of doctors believed that there were three main reasons:

1. Over-medical treatment is related to doctors’ performance appraisal and salary mechanisms.

A doctor Wang told me about something about their subject.

Their department received a postoperative pancreatic leak patient. He had an operation in a hospital in Hong Kong. The patient told Dr. Wang that when he was hospitalized in Hong Kong, the doctor had a very good attitude and answered his questions seriously during rounds every day, which was very touching. He felt that the doctor in Hong Kong was the real angel in white. In contrast, the mainland doctor was a turtle-eyed man. He was stunned until he was discharged from the hospital and checked out. There was a "consultation service fee" of more than 300,000 yuan on the bill, which was charged according to the round time. After the complications of "pancreatic leak" after surgery occurred, the Hong Kong doctor referred him back to a hospital in Beijing for one month. In the final bill of the Beijing hospital, none of them was the cost of the doctor's consultation service.

In other words, in China, whether in the system or people's concepts, hospitals are regarded as a public service institution. Doctors should provide knowledge and technical services for free. Only consumables such as medicines and devices can "zero bonus" or charge a symbolic fee.

In fact, hospitals have long been responsible for their own profits and losses, and there is not much actual financial support. If hospitals want to make profits, they can only make money from drugs and devices. Therefore, more patients are collected, more examinations, more medicines, and more surgery have become a way to increase income.

What you can't imagine is that over-medical caused by the interests of doctors is generally believed that only Chinese doctors use medicine, examinations, and surgery are profit-driven, but it is not. The same is true in foreign countries. For example, in the United States, half of cesarean section, one-quarter of hysterectomy, and one-fifth of pacemaker surgery are unnecessary. Over-medical is a global phenomenon. As long as the doctor's income is linked to the labor he has paid, this phenomenon cannot be avoided. Because this has nothing to do with the professional ethics of doctors, but is closely related to the design of salary plans.

In other words, the problem of over-medical care is not a problem of doctors’ professional ethics, but a problem of professional positioning. In essence, those who earn four yuan and 40,000 yuan are businessmen. They only have the difference in their ability to make money, and have not changed the fact that business is not traitorous. Therefore, if you want to completely avoid excessive medical care, the only way is to eliminate market behavior, so that doctors are just doctors, not businessmen.

Now, the official no longer avoids talking about the issue of excessive medical care, which shows that some irrationality of the medical system has been seen. There will definitely be some changes in the future, but the process of change will definitely be accompanied by controversy. For example, increasing the cost of doctors' outpatient clinics, surgery, and rounds, and increasing the sunshine income of doctors, there will definitely be people complaining. But water does not hinder the stone, and the final direction will definitely be better.

2. Over-medical definitions and boundaries are very blurred.

Because over-medical treatment is difficult to define. Although many diseases in my country have standardized diagnosis and treatment guidelines, everyone's situation is different. When a patient has special circumstances, the doctor cannot ignore it, so there may be some adjustment plans. These attempts to explore beyond the diagnosis and treatment guidelines have become a vague area of ​​whether it is over-medical.

For example, a patient with advanced cancer has used all known treatment plans in China, but it is still ineffective. The patient learned that a foreign pharmaceutical company was conducting clinical trials of a new drug at that time. It is said that the efficacy is good, but the drug has not yet been launched. The patient particularly wants to get this drug for treatment. At this time, the doctor gave the patient a guide to use medicine. Is it considered overt treatment?

Let’s take a look at the incident in Shanghai Lu Wei and Beijing Zhang Yu. After this incident caused heated discussion among netizens, there was a message with the most likes on Weibo of a report: “Investigate carefully! You can’t cold the hearts of the doctors, nor the hearts of the patients!”

I have to say that it is thought-provoking.

3. Excessive medical treatment is related to the collapse of trust in doctors and patients and the increase in conflicts between doctors and patients.

Over the years, the accumulation and intensification of medical disputes and conflicts have led to a certain degree of preventive medical measures taken to avoid medical risks and litigation risks.

For example, if one of the 10,000 fingertips has a numbness and acupuncture-like pain may not necessarily be a myocardial infarction. Wouldn’t the electrocardiogram be done? What if one of the 10,000 is a myocardial infarction, is it a misdiagnosis or misdiagnosis, a quack doctor kills his life, and all the blame for taking human life?

The human body is a complex system, composed of 37 trillion cells, which is not like the black doctor in a short video, which is like the one who uses to repair the air conditioner. The master who repairs the air conditioner thinks that when he repairs it, he knows that it is broken. The air conditioner can be broken so much that it affects the function. There are only a few places that can be broken. Is it worth 100? If it really doesn't work, you can try it. Can people do it?

For the sake of the patient's health and safety, even if the doctor does not want to give you excessive medical treatment, he can only give you excessive medical treatment!

In our era, people often no longer believe in authority. With the various medical chaos that public opinion selectively reported, many patients do not trust doctors. The cost of patients is high. Is it necessary to treat the disease or to make rebates for the treatment? The treatment effect is not good, is it complicated, is the doctor's level not high, or is it because of not giving red envelopes? Is it full of doubts and my heart is full of doubts.

A doctor told them about something in their hospital.

The Department of Gastroenterology admitted a patient who complained about gastric discomfort. The doctor considered that gastritis was likely to be high, but he still suggested that the patient have gastroscopy. However, the patient was afraid of being uncomfortable, so he did not do it at that time and went home to take medicine to observe. As a result, a month later, the patient was diagnosed with gastric cancer and his family came to make trouble, thinking that the hospital missed the diagnosis. In the end, the hospital lost money to make the matter worse. Since then, their hospital stipulated that all people who see gastric diseases must have routine gastroscopy and tissue biopsy. In fact, most patients have ordinary gastritis, but in this way, they have to spend more money on gastroscopy and suffer the pain of examination. Who is the case with such excessive medical treatment?

Let me say more here. In some news about doctor-patient conflicts, many times the hospital makes concessions and loses money. It seems that the patient has won, but the one who suffers in the end is actually more patients.

4. Over-medicine is related to patients' over-the-top understanding and expectations of diseases, medical care, and medicine.

Take a cold as an example. Many people take antibiotics when they feel uncomfortable, and even ask doctors to give injections. In fact, a cold is a viral infection. After a week, it will slowly heal itself. But how many people can do this? Especially when it comes to children, parents are even more uneasy.

For patients, they only care about the correct result. Regardless of the correct process, as long as the disease is cured, they are not very concerned about whether certain examinations and treatments are unnecessary. Many patients come and complain that they are uncomfortable. The doctor will conduct the examination according to the procedure and the results are fine. The patient requests a refund, because if the examination is not sick, it is vain and excessive medical treatment. This argument is ridiculous, just like if the exam fails, it will not be in vain!

Some patients guide doctors to over-medical care. Some patients ask doctors to use the best medicine for examinations when visiting the hospital, as well as those who have to have surgery (such as cesarean section), and some families require patients who are hopeless to treat. Even abroad, there are many excessive medical disputes. For example, in Canada, many lawsuits that many doctors require to remove ventilators every year but their families refuse. Because the government provides medical resources in Canada and the government pays salaries, doctors have the requirement to save medical resources and save costs.

It’s all about excessive medical treatment!

Frankly speaking, requiring highly accurate diagnosis and treatment is a requirement of the current law. The pot of misdiagnosis, misdiagnosis, and mistreatment are also established within the scope of large-scale examinations and full-coverage treatment. Income is humane, and losses are about the market. Can hospitals survive without surplus grain?

The problem of excessive medical care requires treatment, but the material basis determines the superstructure. If you want to cure it, the overall cost of medical insurance will be increased at this stage. If the source of medical insurance payment income is insufficient and the medical insurance fund pool is insufficient, it will definitely be oppressed to the hospital. The ultimate reflection will inevitably be the doctor's large order for diagnosis and treatment, and the patient will be borne in the end.

Therefore, by increasing the water level of the medical insurance fund pool, making this cake bigger while increasing the doctor’s income, and cutting the cake well, the medical reform will be successful!

The National Health Commission reported the results of investigations on 38 medical research integrity cases

On December 2, the National Health Commission reproduced the investigation and handling results of medical research integrity cases recently reported by some medical institutions, including 38 cases, involving academic misconduct such as writing and submission, tampering with data, buying and selling papers, and punishment measures include canceling professional title promotion, fines, suspension of application for graduate supervisors, administrative warnings, etc. According to statistics, 32 cases were from hospitals in Shandong, 5 cases were from hospitals in Jiangsu, and 1 case was from hospitals in Guangxi Zhuang Autonomous Region.
Chapter completed!