Xu Bin looked out the window in the clinic, and on the back of the "net red", there was a tug-of-war between patients competing for doctors' time.
One day a few months ago, He Xiao set off from the fever clinic of Wuhan First Hospital after work and went to the dermatology clinic to pick up her husband Xu Bin from work.
Squeezing past the hustle and bustle of patients, she pushed open the door of the office. In front of him, a young man knelt on the ground and begged his husband to add a number. Xu Bin didn't know how to be good, He Xiao softened his heart and helped to intercede.
He Xiao is the chief nurse of the dermatology department of Wuhan First Hospital and is currently transferred to the fever clinic as the head nurse. Around 2018, more and more people were looking for her to go through the "back door", and all they asked for was to ask her husband and Deputy Chief Dermatology Physician Xu Binjia.
A more intuitive change occurred at the door of Xu Bin's office. There are long queues here almost every day, some of them grabbed the number, and some of them did not grab the number. Because of the latter, Xu Bin's lunch break was compressed from 2 hours to 30 minutes, but changlong never disappeared.
In the past, Xu Bin used Room 1 permanently, but because of its proximity to the corridor entrance, the long queues always caused congestion. His office arrangement had to be gradually moved in, and often required "mobile combat" — avoiding "lucky people", in one clinic in the morning and another in the afternoon.
Being able to grab Dr. Xu's number is like chasing a star and buying a ticket at the right price for the person who is looking for him to see a doctor.
The fiercest scramble occurred at the moment when the hospital released the number.
In 2018, the hospital still has a channel for on-site registration. Patients often sleep in the hospital hall for one night, and at four o'clock the next day, they begin to queue up to hang Xu Bin's number. After canceling the on-site release of the number, the fierce number grabbing "battlefield" moved to the line. Xu Bin's number is like a popular product in the shopping live broadcast room, always announcing "second light" at the same time as the number is released.
Hundreds of complaint letters poured into the complaint department mailbox, questioning the efficiency of the hospital's registration system. Nurses at the dermatology guidance desk are often confronted with such a question: Why do they always fail to hang up Dr. Xu's number? How exactly can I hang up?
Thus, the "speculators" appeared. Some patients imitated Xu Bin's signature and went to the medical guide desk to ask for an extra sign. Some people also pretended to be Xu Bin's relatives, saying that there were plus channels to defraud patients of trust and money.
An unconfirmed patient complaint is staggering. Some people said that if you have a VIP status in a bank with millions of deposits, you can obtain Xu Bin's number source through the "green channel service for medical treatment", and there are many people raising funds and deposits in the WeChat group formed by patients. This kind of registration method makes the complainant feel very stressed.
After 12:00 noon, the patient who had not yet called the number could not help but look at the door. Xu Bin will generally read the morning number before going to dinner, and it is normal to postpone the work of 1 hour.
An invisible web spread vigorously outside the cognition of Xu Bin and the hospital.
On the Little Red Book, netizens recorded the "meeting" and "reunion" with Xu Bin in great detail. Some netizens posted 17 times before and after the diagnosis and treatment process, got hundreds of likes and follow-up reviews, and some netizens shared the registration strategy, telling how they used the electronic clock clock with seconds to successfully register. On Weibo, "Super Talk" under the name of Xu Bin was read by 1.55 million people.
Xu Bin, at the center of the topic, presents another calm and stability that has become unfazed.
He does not understand the laws of communication, does not read the comments of netizens, and does not operate any social media. Every day at dawn, he drives across the Yangtze River, over hanshui, to the hospital, buys a cup of coffee at a coffee shop that has no customers, and puts it back in the car to save time queuing during his lunch break.
After collecting protective equipment and changing his clothes and hats at the nurses' station, he bypassed the hall and escalator, avoided possible "interceptors", and went straight to the examination room. Before the opening of the clinic, he opened the windows to clear the air and closed the curtains to reduce the irritation caused by ultraviolet rays to skin patients.
The moment he sat on the desk, he did not hesitate to start a continuous battle.
As soon as he sat down, Ye Jia, who was born after the millennium, began to cry. The last time she went to the doctor, she cried too.
She spoke quickly and eagerly told Xu Bin that the next day the school would arrange for the junior students to take a group file registration photo, and the acne on her face stubbornly grew longer and denser.
The square-inch-sized registration photo and the facial feature behind it were "of great significance" to her. In order to hang Xu Bin's number, she asked more than 10 students to grab the number at the same time to get this precious admission ticket. She insisted that her "condition deteriorated" as she switched to another doctor last month because she hung up Xu Bin's number.
While crying, she told her that she was preparing for the sixth level, and that test scores were a key factor in the success of the research institute. Before Xu Bin asserted, she had sorted out the vicious circle she was in: preparing for the exam made her anxious, negative emotions breed skin problems, and skin problems exacerbated psychological pressure, resulting in the preparation of exams that could not run in a positive direction.
Xu Bin never interrupted her. At the end, while explaining the next treatment plan to her, he told her, "I have also passed the graduate school, people are growing, and before they reach the most anxious time, I will pull you out of the pit."
Dr. Xu is very meticulous in his medical treatment and loves to chat with patients, so that patients have a feeling of "being flattered".
Most people sitting at the diagnostic table will at first lean against the table in a restrained manner, fold their legs, tiptoe up, and then uneasily remove their masks, hesitantly brush their hair, and finally pull out the entire face and plate.
Behind the face, there is a mixture of complicated physiological, pathological and psychological problems.
An 18-year-old patient sat silently at the diagnostic table when he was first brought to the clinic by relatives and friends. Xu Bin said lightly: "There are more people who are more serious than you, and you are nothing." ”
The patient's problems stemmed from self-perception disorders and disorders of the body's systems—plagued by severe flushing problems and gender identity disorders— and he didn't go out or speak.
After two treatments, his facial problems gradually eased and he began to receive psychiatric treatment. In the feedback from psychiatrists, Xu Bin learned that the effectiveness of facial treatment is positively contributing to the treatment of mental problems.
At a recent consultation, the young patient told Xu Bin that Xu Bin's initial understatement was important to him.
Before becoming an "internet celebrity doctor", more than half of the patients Xu Bin received were middle-aged and elderly women who were distressed by melasma. In the clinic, they will count the chores from wearing socks and washing clothes to the relationship between husband and wife, revealing the difficulties in the gap between work and life.
When online registration completely replaced offline numbering, young people almost seized all of Xu Bin's number sources.
The era of looking at faces and the proposition of looking at faces in the times make young people anxious and obsessed with finding a way out in the network.
There was once a flight attendant with the whole crew, dragging a suitcase to the doctor after landing. Xu Bin asked them to wash off all their faces and decorations before entering the consultation room. As a result, pigmentation, acne, and sensitivity problems appear on these originally bright faces. When talking to him, they unconsciously make "small movements" such as biting their nails and licking their lips.
In order to diagnose and treat them, Xu Bin studied the structure and flight principles of the aircraft, and learned that the ultraviolet rays in the stratosphere and the air supply system of the closed circulation are important culprits of the skin problems of flight attendants, and what is more difficult to resist is the anxiety of long-term high-pressure work.
Many patients share the same path and suffer from a chronic inflammatory skin disease called rosacea. The causes of this condition are mostly excessive cleaning, excessive skin care and excessive decoration.
According to online recruitment platforms and a media survey report, more than 50% of working women and nearly 60% of college students have a certain degree of "appearance anxiety".
Xu Bin's visits are slow, and the time to diagnose each patient often exceeds 10 minutes. From the moment the patient stepped into the door, Xu Bin opened two parallel actions, one is to let the other party's emotions gradually relax, and the other is to be vigilant against the subtleties of the patient's behavior.
Most of the time, his practice of "treating the face" is embedded in the huge propositions of the times and the chaotic spiritual world of individuals, and he has to fight against the spirit, emotions, and thinking of patients. As early as seven years ago, Xu Bin proposed that he hoped to go to psychiatry for further study. Although he did not make the trip, he began to teach himself applied psychology, and insisted on reading the literature related to psychology every day.
He found that the mass media and the consumer market jointly construct a standard paradigm of beauty, while the acceleration of human work rhythm, the expansion of social life, and the proliferation of beauty products have all spawned the emergence of skin problems and the evolution of facial anxiety.
A young patient, after treatment the skin has improved. Recalling the scene of the first time he consulted Xu Bin, he was so excited that the corners of his eyes were moist.
Long-term unremitting study, forced memory of various drug instructions and multi-disciplinary collaboration that participated in the consultation of the whole hospital for two years have allowed him to dabble in the "internal, external, gynecological and pediatric" departments. In the most relaxed and witty tone possible, he will learn the patient's allergy history, menstrual condition, daily routine, genetic and past medical history, and dig deeper and more accurate roots of the disease tree behind the facial problems.
Humorous and powerful language is his commonly used weapon - "informal beauty salon is a strategic partner of the dermatology department of the hospital" "Many difficult diseases have been solved by us, and we are afraid of rosacea.".
He hopes that like a builder, he will help patients complete the psychological construction from self-loathing to self-pleasing, and not become the "patient" of this society because of the annoyance of skin diseases.
Xu Bin is one of the first doctors to arrive at the department almost every day, and when night falls, his consultation room is often the last to end the diagnosis and treatment.
Xu Bin said that this is like rushing to an exam, one minute early, you can start answering questions one minute earlier.
The test paper in front of him was not difficult, but the amount of questions was very large. He does not look down on every seemingly simple question, trying to maintain a higher accuracy rate.
Every morning, Xu Bin would come to the hospital at 7:30 a.m. to prepare for treatment.
In the examination room, he tried to answer carefully, and when he left the examination room, he still repeatedly pondered whether each answer was really accurate.
In this path of improving medical skills, Xu Bin is no longer the backbone of the department of drinking, smoking, and loving to eat betel nuts, and gradually surrenders his personal time and the outside world.
When a patient mentions an area where he lives in Wuhan, he will be curious to ask, does it belong to Wuhan? He doesn't know many of Wuhan's newly booming place names, relies on navigation every day to drive home, and is not aware of the changing traffic pattern between Wuhan and surrounding cities.
In the 12 years since their marriage, he and his wife have traveled together only twice, and he has maintained a sparse number of meetings with his parents in Changsha. Two elderly people, one had a stroke, one underwent a malignant tumor resection operation, he often worried about it, but he had no time to care for it. Together with the urinary tract stones in his body, he also had to resign himself to it and did not go to review it for a long time.
Once he began to receive treatment, he would not drink water, get up, or go to the toilet for five to six consecutive hours, and he would naturally quit the past thunderous lunch break, the habit of drinking a lot of water, and the love of playing table tennis.
He would instill in every patient who came almost like a star chaser his simple skincare philosophy: moisturizing, sunscreen, and maintaining emotional stability. But some patients questioned him, how come and go are these kinds of prescriptions?
A few years ago, a patient who bought a number source through a "scalper" was very angry with his prescription, "I spent 1200 yuan to buy the number, you will prescribe me dozens of pieces of medicine?" ”
Xu Bin adheres to such a simple but effective small prescription, always choosing microneedle cupping and bloodletting treatment that can be implemented for 100 yuan, such as red and yellow light, so it is favored and respected by more young patients.
Dr. Xu prescribes the patient.
In the 1970s, wuhan first hospital, as the first public hospital in Hubei Province, moved to Shiyan, Hubei Province, to support the construction of the third line at the call of the state.
Among the more than a dozen people who remained in Wuhan was a dermatologist, Sun Zengzheng. Wearing a white coat, he knocked on the gong in front of the hospital and shouted to let the public know that "there is still a doctor here, and the dermatology department of a hospital is still seeing a doctor!" ”
Hundreds of patients were "shouted" and waited in long lines for consultation. Under a large tree in the hospital playground, Sun Zengzheng set up a table, picked up a pen and paper and began to diagnose and treat.
Today, the dermatology department of the "second venture" has become the largest dermatology specialty in the country, and the big tree that Sun Zengzheng once sat in is still quietly standing in front of the hospital's Traditional Chinese medicine department.
Every day, Xu Bin commutes to and from work passing by this big tree. This big tree became a metaphor for his relationship with patients - to see a doctor like Sun Zengzheng's predecessors.
At 1:00 p.m., Xu Bin changed his clothes and went to eat in a hurry.
However, the title of "net red doctor" obtained unexpectedly undoubtedly contradicts Xu Bin.
He has his "ambitions". Around 2017, Xu Bin served as the responsible doctor in the dermatology inpatient ward. It was a very different world from the clinic. Acne and pigmentation are complex, but they are rarely life or death. In inpatient wards, systemic lupus erythematosus, drug eruptions, and erythroderma are all tricky and dangerous.
There was a moment when the young doctor was stunned in the face of the patient who had no breath, and Xu Bin quickly made up the position and launched rescue.
He likes to deal with difficult diseases, and when he encounters serious skin diseases, he can't help but sigh "here comes a big guy". Now, he is trapped in the eyes of many peers in the eyes of "small diseases" and common diseases, and rarely has the opportunity to practice surgery.
The timing of his visits has also changed as a result of these patients. Two years ago, his expert scheduling was added to Saturday and Sunday, behind which is the enthusiastic demand of many young office workers and college patients.
The couple had a quick lunch in the clean area, a rare time of the day to laugh.
His wife, He Xiao, has her concerns. Irrational patients often take Xu Bin's prescriptions and ask other doctors to copy them all.
After receiving treatment, a young female patient took the prescription prescribed by other doctors and insisted on asking Xu Bin to see if it was appropriate. She did not accept Xu Bin's suggestion that "we should trust other doctors", and only left satisfactorily after the prescription was affirmed by Xu Bin.
From the perspective of his peers, He Xiao believes that Xu Bin's medical career is getting narrower and narrower. She is worried that the encounter of "Internet celebrities" has encroached on her husband's time to write a thesis on a project and hindered his promotion.
In the broader scene of medical treatment and treatment, doctors generally face a similar time dilemma -
According to the "2020 Statistical Communiqué on the Development of China's Health and Health Undertakings" issued by the National Health Commission, in 2020, the number of diagnoses and treatments in primary medical institutions reached 4.44 billion, the number of hospital admissions exceeded 100 million, and about 70% of the time of grass-roots doctors were spent on work every week, with an average working day of more than 9 hours, even on rest days, it took an average of nearly 5 hours to work.
Yin Ling, who lives in Jiangxia District, Far Eastern District, Wuhan, has been treated by Xu Bin for 11 consecutive months. On the day of each visit, she needs to leave at six o'clock in the morning and switch between the intercity railway and the subway.
But more often than not, she simply can't successfully grab the line number. A few months ago, she began experimenting with the hospital's Internet hospital, continuing to follow up every two weeks online. With this supplement option, she can not only continue the treatment by a trusted doctor, but also eliminate the time cost of number snatching, rushing, and waiting.
The time for offline consultation is limited, and the hospital encourages patients who "need but do not need" to come to the hospital to consult online.
When the Internet hospital was just opened for online consultation, a large group of children sitting on the sofa appeared at the other end of the video connected by Xu Bin, asking him about skin problems one by one.
At the other end of the video, there are still rich life and work scenes: university cafeterias, school dormitories, company corridors, noisy streets, restaurants, trains, and even in the back seats of electric cars.
When each video is connected, the other party can't help but shout: "Dr. Xu, I finally see you!" "Some of them have been unable to grab a number for four consecutive months and eventually turned to the line, while others have been out of town and have taken this as the best way to continue treatment."
Dr. Xu Bin who received treatment at the Internet Hospital.
Xu Bin will inquire about the local climate conditions of patients in Zhuhai to accurately prescribe medicines; he will encourage Xiangyang patients who are also medical staff to strengthen their determination to treat and give local dermatologists the same trust; he will instruct 17-year-old Chengdu patients who are infusing fluids in the hospital to "first overcome the cold and then solve the facial problem together."
A Jingzhou university student could not open the video due to the conflict between the registration time and the class, and did not want to miss the consultation, so he could only turn off the video camera and slowly respond to Xu Bin's questions with text.
Xu Bin did not cut off the consultation. He carefully examined the facial photos sent by the other party, and then sent a text message to the other party: "You can study with peace of mind, I will prescribe you medicine." ”
One patient's mobile phone network was not good, the sound was very small, Xu Bin supported the armrest of the seat the whole time, half lifted his body and leaned towards the speaker, without the slightest impatience.
A computer, a camera, can not only continue treatment by a trusted doctor, but also remove the time of number snatching, running, and waiting.
Plus, plus, plus are the dilemmas that Xu Bin faces every day in reality. For the Dermatology Department of Wuhan First Hospital, the source is always a rare resource where supply and demand are difficult to balance.
Adjacent to the old large-scale comprehensive tertiary first-class hospital, which was once the first street of the national small commodity market, at the beginning of the establishment of the outpatient building, the daily reception volume was designed to be 2,000-3,000 people, but now it is loaded with nearly 10,000 patients per day.
By 2003, the hospital had more than 1 million outpatient visits, of which one-third came from dermatology. Today, the annual outpatient volume of dermatology alone has reached 1.2 million, which is the sum of the annual outpatient volume of some top three hospitals.
The turning point occurred in 2020, when the epidemic was raging, and the battle for time between doctors and patients began to break.
In March 2020, Wuhan was in the "sealing and control" management stage, patient travel was blocked, Wuhan First Hospital and Tencent cooperated to start construction, and six months later, the Internet Hospital was officially launched, becoming the first batch of hospitals with Internet licenses in China and the first Tencent smart medical joint innovation base in The country.
In 2020, the Internet Hospital of Wuhan First Hospital was officially launched.
An online and offline integrated consultation service has emerged, and patients only need to open WeChat to complete the whole process of medical treatment such as appointment registration, video diagnosis and treatment, prescription, medical records, payment and medicine collection.
Looking at the affected area can prescribe the right prescription, and dermatology has the advantage of the Internet. Doctors can guide difficult patients offline through Internet hospitals, and guide patients who take drugs for follow-up consultation or examination online, ensuring the needs of medical services for patients while reducing the risk of personnel gathering and cross-infection.
For Xu Bin, the day of the online consultation is the only day he can sit down with his wife and eat with peace of mind every week. Other times, his wife would buy lunch and wait for him in the car, or simply eat a bowl of rice noodles or nibble on a bun.
When receiving the consultation online, the auxiliary doctor will conduct a pre-consultation before the doctor's consultation, guide the patient to fill in the summary of the condition, upload the picture of the affected area, and then assist the patient to pay the fee, take the medicine, and view the medication guidance according to the electronic prescription issued by the doctor after the diagnosis. This consultation mode saves doctors 3-4 minutes of time per consultation. This seemingly tiny few minutes is a golden time with a multiplier effect on a hospital and an industry.
A popular department has led more departments to join the Internet practice, and a "net red doctor" has attracted more doctors to borrow "pocket hospital" to do science popularization and "cloud free clinic".
In August 2020, two administrative districts in Wuhan were designated as medium-risk areas due to a number of positive cases of new crown, and lockdown measures were implemented to allow Wuhan people to face the epidemic again.
During the extraordinary period, the number of patients received by Wuhan First Hospital plummeted, and the number of visits per day at least was less than 1,000. At this time, the number of visits received by Internet hospitals exceeded for the first time, with more than 1,700 visits a day at most.
As of October 21, 2021, Wuhan First Hospital Internet Hospital has opened 42 online departments, 734 online doctors and pharmacists, the average daily outpatient volume has reached more than 600 person-times, the total number of online consultations has reached 271446 person-times, the total number of prescriptions issued has 147809, and the total number of drugs distributed is 84246, of which 57.1% are provinces and regions outside Wuhan City, and the farthest is delivered to Malaysia.
In the country, as of June 2021, there are more than 1,600 Internet hospitals, and under the connection of WeChat, the electronic health card has covered 21 provincial-level administrative regions and more than 2,400 hospitals.
In the future, Internet hospitals may become a new choice for more people.
(The names of the patients in this article are pseudonyms)
Issue 4000
Written by | Geng Ga Dolma Photography | Flying messenger edit | summer
Co-produced | Tencent News Tencent official public number Tencent Health