Old girl operated on why HIV testing?
Ocean News Time: 2011-01-08 Source: Guangzhou Daily Author: Lu Wenjie

 
 

 

 
 
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● health officials in Guangdong Province: your doctor is the source of abuse of prescription inspection and large.

● "Tort Liability Act" clearly states: Patients can sue over hospital check behavior, but "over-inspection" but no details of how to define

● medical staff cry foul: over-inspection, the main sticking point is to avoid risks

Cut one appendix, a lot of examination items: hepatitis A, hepatitis B, hepatitis C, as well as blood, urine, stool, blood coagulation examination and biochemical tests, they can even inspection AIDS! In recent years over the country checking on reports of patients with common experience. Deputy Director of Health Department of Guangdong Province, Liao Xinbo that your doctor is to check the performance of the most prominent high cost and large prescription drug prices due to high.

However, many medical personnel in an interview with reporters shouting wrong, they said the project is in the hospital most of the inspection the Ministry of Health disease diagnostic and treatment practices, and if there is excessive examination, mainly in order to "protect themselves", to avoid the patient sued the future the possibility of the hospital, had to do in advance, "the siege" of the inspection.

Medical guidance / Southern Hospital Director of Medical Service Customer Service Center Macro

Guangzhou First People's Hospital, Radiology, Vice-Ren Wumei

Text / correspondent Wu Jianpeng reporter Lu Wenjie, Xu Jing

Patient question:

A minor operation, why check the hundreds?

One-year-old girl swallowed a curved needle, surgery removed to the hospital, the hospital made for girls preoperative examination, the patient to see their parents get a single check, check, including 217 items, check with the AIDS surprising! This is the year in Guangzhou City, one patient complaints, and such incidents are frequently reported across the country. Hangzhou, a girl to the hospital for appendicitis, hospital check out the list let her parents surprise: hepatitis A, hepatitis B, hepatitis C, as well as blood, urine routine, stool routine HIV testing ... ... of course.

Patients just do a minor surgery, and why at every turn to check hundreds of items? Some appear to have no relationship and disease inspection items also appear in the check list, such as cutting the appendix to check the hepatitis B and AIDS. Others see the cold, to the second hospital, the doctor prescriptions in actually read: blood test, and recommends an MRI head. This allows patients can not help but wonder - doctors are not asking for more money, so quick to open a lot of checks?

Hospital response:

Check the doctor needs primarily by treatment

In this regard, specializing in medical disputes Customer Service Center of Nanfang Hospital Director Medical Service, said Wang, a correct view of the hospital patients are listed first checklist, do not check each item as a separate branch of the checks. For example, examination of blood is a separate project, but which will contain dozens of branch projects, including the WBC count, the total number of red blood cells, hemoglobin, platelet distribution width. This branch of dozens of projects as long as the data analysis to do a blood test can be completed, charges fees according to collect a blood test can not be considered done dozens of checks. Therefore, the first admission of patients to do hundreds of inspection items, which is the sum of all branches of the project together, does not mean is to check hundreds of items.

Second, many patients see the hospital check the contents listed in a variety of easy to think that hospitals do the inspection himself. Made in the macro, not patients feel more content inspection to be an "oversized check." For example, some young people do not understand why an operation to check blood sugar, but many people are not suffering from symptoms of type Ⅱ diabetes, if glucose before surgery did not find to be complications of postoperative wound unhealed. Wang said at the hospital check out the single most were issued in accordance with Chinese Medical diagnosis and treatment of diseases specifications.

"If in some cases suspected of excessive examination, the doctor issued these checks out of self-protection, to avoid risk." Wang said in the current medical malpractice practice "burden of proof", the patient sued the hospital if the hospital to prove that he did wrong . Why cut an appendectomy HIV testing should it? This is because blood transfusion or surgical incision itself may be infected, which may be infected with viral hepatitis, AIDS and syphilis. If the hospital before surgery did not do this check in the future come back in patients infected with HIV is to find the hospital infection in surgical procedures, hospital fair hearing to one hundred.

Expert analysis:

Hospital patients do not have confidence the market

"Over-check is there, but not the mainstream medical profession, most doctors are for the sake of the patient." An unnamed hospital executives said. It is understood that check the existence of the hospital over the following several reasons:

First, the Government very little financial investment in hospitals, hospital self-financing, over the market. Health of Guangdong Province in 2010 budget expenditure 609,722,600 yuan, but assigned to small hospitals. Such as the Southern Hospital in 2010, only 0.3% of the expenditure from the financial allocation, the Guangdong Provincial People's Hospital of the financial allocation of the total income ratio is very small. Most hospitals in Guangdong Branch to implement two-tier budgeting hospital, some hospitals in order to maintain fiscal balance, the indicators will be the year "pressure" to the departments, departments are pushed to the doctors, led some doctors to open up a small check for the department profit .

Second, because the hospital over the market, competition in the market at all levels need to expand the size of the hospital, updating equipment, huh the "arms race." Equipment must be used to buy back a large number of input charges for medical services need to "return to the" checklist so hard to open more fully to avoid.

Third, the growing tension between doctors and patients, according to statistics of the People's Court of Guangdong Province in 2004, has 387 medical malpractice, 2008 up to 645. As tensions between doctors and patients, doctors out of self-protection, sometimes in order to avoid misdiagnosis and reduce disputes, the doctor had more checks, as far as possible with more advanced equipment and a large enclosed check to make their diagnosis have a more adequate basis.

Experts teach Way: Check means to you is not good

July 2010 from the implementation of the "Tort Liability Act" stipulates that patients can sue the hospital over inspections. However, due to lack of appropriate judicial interpretation, the definition of over-inspection is still a problem. For patients, lack of appropriate medical knowledge is difficult to know what diseases they do check. To this end, our doctor used to check the daily means of an interview with Guangzhou First People's Hospital Department of Radiology Vice Renwu Mei. Wu Mei introduction, a variety of commonly used examination methods have their respective advantages, each with advantages and disadvantages, not the more expensive the better.

X-ray plain film:

X-rays are used to make conventional means of routine physical examination is an important method for diagnosis of diseases of bone lesions with good results. However, when the gonads to do X-rays, X-ray of the thyroid and other highly sensitive areas should focus on protection. If not necessary, accompanied by family members try not to do X-ray examination of patients, pregnant women, children most need to guard against X-ray examination.

CT:

In general, CT of all organic diseases can be checked, especially for large density difference between organic lesions can check them out and make a diagnosis. But the most suitable for CT examination of the disease is brain disease, in which the tumor, hemorrhage and infarction and other diseases check the best, then such as the liver, spleen, pancreas, kidney, prostate and other parts of the tumor, breast, thyroid and other parts of Masses can also be displayed and to make the diagnosis; again is of pleural, lung, heart cavity tumor, spine, spinal cord, pelvis, gall bladder, uterus and other parts of the mass inspection.

But for small lesions, especially lesions less than 6 mm, CT is hard to detect. In addition, CT of diffuse inflammation and degeneration of some of the inspection lesions less effective, such as hepatitis and CT examination of little value.

MR:

Magnetic resonance imaging (MRI) examination of the strengths is the soft tissue sensitivity, because of the synovial tissue, blood vessels, nerves, muscles, tendons, ligaments and hyaline cartilage of the high resolution. MRI can be done to avoid the X-ray damage, but more expensive.

B-:

B-more applicable to the liver, gallbladder kidney, bladder, uterus, ovaries and other organs lesions. B-clinical examination has become the most common method of biliary disease can be diagnosed with gallstones, cholecystitis, cancer, parasites, and the differential diagnosis of jaundice patients have a higher diagnostic accuracy.

However, B-also has its limitations difficult to overcome, it penetrates weak, on the bone, air and other hard to reach deep, so the gas containing organs such as lung, gastrointestinal and other difficult to detect, the diagnosis of adult brain are more X ray, CT inferior. Of about 1 cm tumor difficult to find.

Medical knowledge, then you know

Preoperative routine

Check what?

General trauma surgery, before surgery "routine" to check blood, urine, stool, and coagulation.

Blood, including hemoglobin, red blood cell count reflects the degree of anemia and anemia in patients with nature, but also as the basis for the need of blood transfusion; white blood cell count increased, the majority of infectious and inflammatory process is a normal phenomenon; white blood cell count decreased, often by the chloramphenicol and other drugs or radioactive substances caused by x lines. In addition platelet count and bleeding and clotting time determination of routine examination before surgery is essential.

Urine, including urine volume, specific gravity, color, acid-base reactions, urinary protein, urine testing and microscopic examination. Bleeding in patients with hemorrhagic shock caused by a doctor to be based on urine output, urine specific gravity changes to guide fluid replacement.

At the same time, patients also need to check ECG before surgery, electrolytes, renal function, liver function and blood sugar. Furthermore, since the procedure may need blood transfusion, to do the virus family (hepatitis B, hepatitis C, syphilis, AIDS) examination.