Coping with the aging of the population, the opportunities and new challenges of geriatrics.
Written by | Wang Hang
Source | "Medical Community" public account
As the director of the Department of Geriatrics and The Department of General Medicine of the Oriental Hospital Affiliated to Tongji University, Jiang Hua has not taken a day off for 10 years.
In her plan, in 2021, "be sure to take a few days off", travel or spend time with your family. But until the end of the year, her idea did not come to fruition, "the hospital encourages employees to take timely leave, and colleagues in the department work hard, but I dare not slacken off, and being on duty in the hospital or guarding the emergency department will make me more at ease." ”
Director Jiang Hua
Director Jiang Hua could not be relieved that there were more than 500 elderly patients in the Geriatrics Department, and even if it was a seemingly small health problem such as abdominal pain at night, she would consider the risks and rush from home to the hospital to deal with the doctor on duty. Her life is basically a two-point line, either in the hospital or on the way to the hospital, "rarely coming home before dark".
Under her leadership, the Department of Geriatrics of the Oriental Hospital Affiliated to Tongji University has become the core unit of the Shanghai Clinical Medical Research Center for Geriatric Diseases, and the scientific research competitiveness of the departments of Shanghai Top 3 Hospitals ranked third and fifth in 2019 and 2020. Recently, Director Jiang Hua was awarded the fourth "Shanghai Most Beautiful Female Doctor Award".
Create a platform-based department
At the age of 16, Jiang Hua was admitted to the Third Military Medical University (Army Military Medical University), and after graduating in 1986, he entered the military hospital to work in gastroenterology.
After 12 years in the doctor's position, Jiang Hua encountered her career bottleneck: "The new theories and new technologies in the field of medicine are developing very quickly, and I realize that I need to improve and need to make self-breakthroughs. ”
In 1998, Jiang Hua was admitted to the Second Military Medical University Changhai Hospital for a master's and doctoral degree, becoming a doctor of academician Li Zhaoshen, and his clinical thinking, endoscopic technology and scientific research ability were fully experienced during this period.
In 2005, Jiang Hua ushered in the first turning point in his career: he joined the Oriental Hospital Affiliated to Tongji University.
At first, she was still in the field of digestion, responsible for the early diagnosis and precise treatment of digestive system tumors such as pancreatic cancer. Later, the position of director of the department of geriatrics was vacant, and this position was one of the key disciplines for the development of the hospital, and it was necessary to be led by a person who "suffered hardships and had a big picture view".
Jiang Hua is the best candidate. She has received systematic medical education, is good at the diagnosis and treatment of geriatric diseases and digestive diseases, and her long-term military life has also allowed her to develop a personality that does not care about personal gains and losses, and has the energy, physical strength and enthusiasm to serve elderly patients.
Director Jiang Hua consulted for elderly patients
Geriatrics is a young discipline. As China enters an aging society, the discipline of geriatrics ushers in a development opportunity, which is different from specialized treatment, and also relies on specialized fields, mainly for the treatment of elderly patients with geriatric syndrome and other acute and chronic diseases.
"Geriatricians need to have an understanding of common diseases in internal medicine as a whole, and they also need to learn the latest guidelines for common chronic diseases, because the elderly are generally 'comorbid patients' with more than two diseases in one person." The available data also confirm that more than two-thirds of the elderly in China suffer from one or more chronic diseases.
Director Jiang Hua introduced that geriatrics has decades of development history abroad, and one-third of medical colleges and universities have listed geriatrics as an undergraduate compulsory course, which makes the talent reserve of the discipline fully guaranteed.
However, in China, the geriatrics department started late, and the development of the discipline was relatively slow. "A series of problems such as the lack of talent echelon and insufficient expert consensus need to be solved one by one." In addition, most geriatric departments are classified according to the disease system, and the wards inside are still called gastroenterology, cardiovascular departments, etc.
In Director Jiang Hua's view, this cannot be regarded as a real geriatric department. She believes that the first thing the elderly need is general medical services, especially in the face of "geriatric syndrome" and "comorbid patients", the specialty is far from solving the practical problems.
"There is a need for an interdisciplinary medical team and an integrated trade-off approach." In 2004, when the Department of Geriatrics was established in Dongfang Hospital, it had clearly defined the direction of discipline development of "focusing on the diagnosis and treatment of cardiovascular diseases in the elderly and featuring major health care".
After taking over the post of director in 2010, Jiang Hua expanded the scope of diagnosis and treatment of geriatric diseases on this basis and proposed the goal of building a "platform department".
Department morning meeting
She explained: "We have coordinated the professional forces of various departments and formed a multidisciplinary medical team to carry out disease, psychology, rehabilitation, nutrition and other work. It is equivalent to integrating the resources of the whole hospital to build a platform to provide the most convenient medical services for elderly patients. ”
Under the guidance of this department construction model and concept, in Dongfang Hospital, Director Jiang Hua spent less than 10 years to build the Geriatrics Department into the core unit of the Shanghai Geriatric Disease Clinical Medical Research Center, and the scientific research competitiveness ranked among the top three hospitals in Shanghai in 2019.
The Geriatrics Department will usher in a good opportunity for development
In the process of department development, Director Jiang Hua also encountered a very real problem: difficulty in generating income.
She remembers that at the beginning of the establishment of the department, there were only 24 beds, less than ten doctors, and most of the two or three hundred patients were home nursing, and they needed to do comprehensive assessment, physical examination, nursing and other work on a regular basis.
Comprehensive geriatric assessment is one of the most important skills of geriatric physicians, in addition to assessing the diseases of the elderly themselves, it also includes function, cognition, mental state and social environment, etc., and the assessment itself is indispensable compared with the specialized technology, but the fee is much lower.
In addition, geriatric doctors in the treatment, for the drug choice is more in the "subtraction" to reduce the risk of multiple medication, coupled with the hospital's actual medical expenses are higher, bed turnover time and other reasons, most hospitals in the opening of geriatric departments, the first to face the risk of loss.
This has caused certain limitations to the development of the department, especially when forming an interdisciplinary medical team, it is difficult to attract outstanding talents in various fields, and the geriatrics department has long belonged to the fringe department of the hospital.
Director Jiang Hua gave a speech
When communicating with other hospitals, Director Jiang Hua also found that in addition to insufficient investment in hardware, most hospitals lack soft incentives such as doctor title evaluation and academic qualification promotion in the department of geriatrics, and "the gap between market demand and actual investment is getting bigger and bigger."
But she also believes that the geriatrics department will usher in a good opportunity for development. On November 24, the "Opinions of the CPC Central Committee and the State Council on Strengthening the Work of Aging in the New Era" was released, and the geriatric department has become an important part of the geriatric medical service network, and the "Opinions" proposed to strengthen the construction of geriatric departments in comprehensive hospitals, and the proportion of geriatric departments in secondary and above general hospitals will reach more than 60% in 2025.
In terms of building geriatrics, Shanghai is at the forefront of the country. By the end of 2018, 93 of the 105 secondary and above general hospitals in Shanghai had opened geriatrics departments, accounting for 89%.
In the "14th Five-Year Plan for the Development of Shanghai's Aging Cause", Shanghai has put forward higher requirements: it will promote the establishment of geriatric departments in general hospitals of grade II and above, traditional Chinese medicine hospitals, and hospitals of integrated traditional Chinese and Western medicine, and form a network of geriatric medical services led by the Municipal Geriatrics Center, with the Geriatrics Department of the General Hospital as the backbone, the grass-roots medical and health institutions as the basis, and the relevant teaching and scientific research institutions as the support.
In practical work, Director Jiang Hua also felt the support from the hospital.
In order to promote the development of the department, Dongfang Hospital has put forward a series of incentive measures in health education, preventive health care, disease diagnosis and treatment and subject research, which ensures the enthusiasm of medical staff and provides services for elderly patients in a more targeted manner.
The hospital introduces "robot disinfection" facilities, cooperates with cleaners, nurses, etc. to comprehensively disinfect wards to prevent cross-infection of the elderly; provide convenience for the elderly to register, pay, and use smart devices, and provide accompanying medical services for the elderly with special needs; create elderly-friendly wards to consider the needs of the elderly from many aspects such as equipment, temperature, and air quality.
Ward environment
Director Jiang Hua believes that there is still much that can be done around the development of geriatrics. "Improving hardware and enriching talents is the first step, improving the construction of the system is the long-term solution, from inside the hospital to outside the hospital, we should establish the concept of serving the elderly."
Occupational well-being
Unlike other departments in hospitals, geriatrics focuses on healthcare services such as functional assessment and rehabilitation.
"Geriatrics must take into account the characteristics of the elderly." Director Jiang Hua introduced that the elderly become very fragile after aging, the ability to cope with diseases is very poor, even small factors such as influenza may become the "last straw" that overwhelms them, and medical treatment is also prone to iatrogenic complications and other issues.
Director Jiang Hua participated in the rounds
In view of the characteristics of the elderly, a particularly strong medical intervention may kill the patient. "For the elderly, medical treatment is only part of it, and medical treatment suitable for the elderly must be a whole, continuous medical treatment, including the whole process inside and outside the hospital."
Based on this, Director Jiang Hua does not advocate that the geriatric department has done too many examinations, but pays more attention to prevention and solving practical problems. The department has set up a health management team to establish a health file for each elderly patient, record every physical examination, dispensing and other contents, and follow up regularly.
In the practice of the Department of Geriatrics of Dongfang Hospital, patients will first do a comprehensive assessment of the elderly after admission, and for the elderly, pay special attention to the detailed inquiry, record the patient's family and social support system, and even help understand the life background, life experience, and problems of home care of the elderly patients.
For the elderly with weak social support systems, hospitals have tried their best to solve the long-term care problems of these elderly people by working with social workers, nursing homes, and community hospitals to establish a referral medical model.
In addition to his work in the Department of Geriatrics, Jiang Hua is also a member of the Party Committee of Dongfang Hospital, the director of the Second Department of Medical Affairs and the Department of General Medicine, and the director of the General Medicine Residential Training Base.
With multiple titles, Director Jiang Hua also felt "several times the pressure", and when carrying out practical work, the 15 female doctors and dozens of nurses in the department are often a team with multiple responsibilities.
Director Jiang Hua and department doctors
As one of the designated medical institutions of Shanghai Municipal Health Bureau, the Oriental Hospital Affiliated to Tongji University has undertaken the medical security task of a series of major conferences and important activities held in Shanghai.
World Expo, APEC, SCO Summit, CICA Summit, G20 Summit, CIIE... Whenever there is a major medical security task, Director Jiang Hua's team will always participate in it, cooperate with the hospital to organize, participate in and successfully complete.
"These jobs are related to foreign-related medical care, representing the image of the country, our team does not dare to slack off a little, and every job must be done well." Based on its excellent comprehensive support capabilities, the Shanghai Municipal Health Commission also entrusted the important health care tasks of the BRICS New Development Bank to Dongfang Hospital.
In addition, Director Jiang Hua also serves as a professor and graduate tutor of Tongji University, and one day a week, she participates in undergraduate education and MBBS international student classes in English, and has trained 2 general doctors, more than a dozen masters and hundreds of residential training physicians.
Director Jiang Hua has 20 days of public leave every year, but she has never used it. Even when she's busy, she feels "happy every day." "My team and I are serving the elderly, doing medical security for diplomacy, and sending talents for general medicine, and the profession has given me too much sense of gain."
Expert Profiles
Jiang Hua
Member of the Party Committee of Shanghai Dongfang Hospital
Director of the Second Department of Medical Affairs, Geriatrics and Director of General Practice
Ph.D. Chief Physician Professor Doctoral Supervisor
University of Nebraska Medical Center School of Medicine
Honorary Professor of Family Medicine
Vice President of Family Doctor Branch of China Geriatric Health Care Association
Member of the Standing Committee of the General Medicine Branch of the Cross-Strait Medical and Health Exchange Association
Member of the General Medicine Branch of the Chinese Medical Association
Member of the Geriatric Gastroenterology Group of the Geriatrics Branch of the Chinese Medical Association
Member of the General Practitioners Branch of the Chinese Medical Doctor Association
Member of the Anti-Aging Branch of the Chinese Society of Gerontology and Geriatrics
Chairman-elect of the General Medicine Branch of Shanghai Medical Association
Vice President of General Practice Branch of Shanghai Medical Doctor Association
Member of the Geriatrics Branch of Shanghai Medical Association
Chairman of the Geriatric Medicine Committee of Shanghai Pudong New Area Medical Association
"Medical Reference Newspaper General Medicine and Precision Health Communication Special Issue"
Executive Editor-
Member of the Editorial Board of the Journal of Geriatrics and Health care
Source: Medical community
Editor-in-charge: Wang Hang
Proofreader: Zang Hengjia
Plate making: Xue Jiao