The author of this article: Chacha
Recently, a hospital announced, "In order to meet the diversified needs of patients, the hospital will continue to tap the potential, and 14 departments will expand the outpatient unit from 17 o'clock to 20 o'clock, which is convenient for patients to seek medical treatment at different peaks."
Night clinics are not unusual, and before that, hospitals have been opened everywhere.
In June last year, "Xi'an First Hospital Opens Night Clinic for Office Workers" also rushed to the hot search. In the comment area, in addition to convenient discussions, doctors also expressed their needs: how to balance working hours, pressure, how to implement subsidies, how to play the role of triaging patients...
In practice, do outpatient clinics such as dusk, night, and weekends play the expected role? What difficulties do doctors encounter in conducting outpatient clinics during their original rest time?
Can't prescribe orders, can't take medicine: doctor's "rice cooking"
According to the hospital's release, it has early night clinics, but most of them are "individual soldiers". This time, the hospital decided to launch a larger scale and more doctors to participate in the outpatient expansion service, changing the original morning and afternoon "two-stage" home visit unit to "three-stage", and the night outpatient clinic opening time is from 17 o'clock to 20 o'clock.
The staff of the relevant hospital said: "It seems that it is only extended for a few hours, but it involves the coordination and linkage of clinical departments, auxiliary diagnostic departments, pharmacy departments, billing offices, information centers, outpatient departments and other departments."
Cross-departmental transfer has always been a difficult point in opening night clinics. Because the effectiveness of doctors in outpatient clinics is inseparable from the supporting measures provided by hospitals, the absence of any link may put them in a situation of "cooking without rice".
Xu Li (pseudonym), a doctor at a tertiary hospital, said that when he was in the night clinic, the general pharmacy and auxiliary departments had already left work, and only the emergency department could do examinations and prescribe drugs, "For example, if you want to draw blood, it must be regarded as an emergency project, and patients are not willing to pay more for examinations in the usual clinic."
Therefore, she positioned herself in the night clinic as a "guide doctor", "occasionally someone came to us with a test sheet after work." If the condition is serious, we directly recommend going to the emergency department, and the general outpatient clinic cannot deal with it."
Another difficulty is "unreasonable process regulations". Li Hua (pseudonym), a sonographer in a tertiary hospital, was arranged by the department to provide special night outpatient services, and he was often troubled by how to review the application form in practice, "The hospital requires that the night time period can only do the night clinic order, such as starting the night clinic at 17:30, then the order opened at 17:20 can only make an appointment for the examination time of 8~17 o'clock during the day."
Li Hua's department handles an average of 1,000 ordinary numbers during the day and less than 10 at night. Faced with huge differences in demand, he often has to face the dissatisfaction and doubts of patients who open orders during the day but do not make appointments. In order to avoid conflict, he can only choose to do it, or the patient can find a doctor to change it to an emergency order.
The "Interim Regulations on Outpatient Quality Management of Medical Institutions" issued by the Health Commission in June last year mentioned that secondary and above medical institutions should incorporate outpatient quality management into the work system of the Medical Quality Management Committee.
Interim Regulations on Outpatient Quality Management of Medical Institutions
Source: National Health Commission
This indicates that the operation of the clinic should be standardized and systematic. To achieve homogeneity between outpatient clinics, all aspects such as auxiliary examination and testing, registration charges, drug guarantee, logistics support, and admission management need to be prepared. Lilac Garden users once shared that they felt "the oppression of the whole hospital waiting for the outpatient doctor to leave work" when they sought medical treatment at night clinics.
Source: Lilac Garden comment area
Unlike the crowds during the day, the clinic at night may encounter an empty scene.
Xu Li usually has a maximum outpatient volume of 40~50 people in half a day during the day, and in her one-year night outpatient experience, "I met 3 people at most, and I came just in my early at 5:30." There are not many patients at night, and I spend most of my time sitting in the outpatient clinic."
The convenient way to achieve such as reducing the waiting time for consultations and having more time options should be to reasonably increase the outpatient time, rather than expand indefinitely. In the case that the daytime outpatient clinic has basically met the local medical needs, Xu Li feels a waste of resources, "The outpatient clinic has been added during the day on the weekend, and the test and medicine are no problem, and patients can rest in this part of the rest time."
A few years ago, Li Hua's department once asked for 2 hours of overtime at night because of too many patients, "no one knew that everyone still crowded during the day", and the nighttime outpatient clinic lasted for a month. Costs and benefits affect how far this type of outpatient clinic can go, and the "Discussion on the Operation Model of Tertiary A Hospitals" mentioned that opening multiple departments at night requires hospitals to have sufficient sources of disease to ensure balance of income and expenditure.
If a worker wants to do a good job, he must first sharpen his tools, and the result of extending the time may be half the effort. When the system it is in doesn't work well, the pressure sinks to the doctor.
How many uses does a doctor need to be broken into?
In a discussion at the Lilac Garden Forum, 84.5% of the people voted for measures such as adding weekends, holidays, and night outpatient departments, etc., and chose to "not support it, increase the burden on doctors".
Source: Lilac Garden Forum
The White Paper on the Practice Status of Chinese Physicians released in 2018 shows that the average weekly working hours are 51.05 hours for doctors in tertiary hospitals, 51.13 hours for doctors in secondary hospitals, and 48.24 hours for doctors in primary hospitals, all exceeding the daily working hours stipulated in the standard working hour system by no more than 8 hours and the average weekly working hours not exceeding 40 hours.
Clinic visits are opened during breaks, allowing doctors' working hours to be extended again. Wang Fang (pseudonym), a respiratory doctor at a tertiary hospital, needs to see more than 30 patients in the morning, and often sees 12:30 or 1:00, "there is no limit to the number of outpatient clinics during the day, and we are already overworking."
In terms of work content, for example, an attending doctor has to undertake the tasks of outpatient clinics, managing patients, and possibly teaching hospitals to take students on a daily basis. In the inflexible time, Xu Li sometimes encounters night shifts and night clinics coming continuously, "when you are really tired, change the duty time, but you can't always change with others, or because there are not enough people." When it comes to personnel additions, she often gets feedback that "hiring too many people is to share the money, everyone insists".
Apart from working hours and pressure to "break a doctor into several to use", there is no uniform implementation plan for performance subsidies for this type of outpatient clinic.
Xu Li has not seen the rumored 1,000 yuan subsidy in nearly a year, and she feels that the subsidy that cannot be implemented is an inevitable by-product of the small number of night outpatient visits, "It's not overtime pay, this part of the money hospital doesn't care, Corey has to earn it himself."
Li Xiaohong (pseudonym), a doctor at the second-class hospital, left a message on the Lilac Garden forum, he has been working for almost 20 years, Corey has always been open 365x24 hours, night doctors often receive hundreds of patients a night, and the night shift fee is only 50 yuan,
Li Hua initially felt that the performance appraisal method brought by paying for the evening time must not be the same as the regular outpatient clinic, "after all, it takes up the evening time". In fact, the two options for compensatory rest and subsidies in front of him are "come two hours in the morning and late, there is no money, or a subsidy of 15 yuan an hour, and nothing else."
This made him feel that he was like a kind of mandatory overtime in the night clinic, and the resistance in his heart came from "the overall working time, personnel allocation, corresponding treatment, involving the safety of going home from work at night, and how to solve the rest place for people who cannot go home and other work problems have not been solved", he said that "if it can be solved, the hospital will not close 24 hours a day in the future".
Clinic clinics are opened during breaks, and need to be discussed on a case-by-case basis
Before opening the night clinic, Li Hua encountered many "fake emergency rooms" at night because of work, "such as complaining of 33 weeks of pregnancy and requesting examinations." More is better than less, and these will also go through the emergency process."
Source: National Health Commission
Some hospitals also need to accept emergency patients referred from the surrounding area, and doctors are always in a busy phase. Night clinics provide an idea for alleviating scarce emergency resources. But to really achieve the effect of triaging patients, it is necessary to do a lot of publicity for patients, "The hospital has made special videos, such as introducing the location of night clinics and day clinics." But many people still can't figure out whether to go to the emergency department or the outpatient clinic."
In addition, the situation in night clinics varies greatly from department to department. Compared with Shennei, pediatrics and other departments, Xu Li of the Department of Nephrology encountered more situations without patients, or oolong scenes, "The patient came at night, but found that he needed to take a morning urine test, and cursed and left."
Xu Li's hospital has allowed almost all departments to open night clinics, and the result is that doctors in some departments have nowhere to make and waste the original rest time, in this regard, Xu Li feels that it is necessary to reasonably open departments according to local conditions for optimization, "For example, if the purpose is to serve office workers, then open night clinics for diseases that are easier for office workers, and do not open all departments together."
Another thing to consider is how to avoid exacerbating the siphon effect of large hospitals due to such outpatient visits.
Liu Ming (pseudonym), a physician of intensive care medicine, left a message on the Lilac Garden forum, suggesting that the outpatient clinic be cancelled by the tertiary hospital, and the outpatient clinic should only be reserved for community hospitals and secondary hospitals, "If the patient needs to be treated in a tertiary hospital due to his condition, he needs to prove the opening of the lower-level hospital or establish a shared Internet to upload the patient's situation, and then conduct the treatment at the higher-level hospital." Originally, it was necessary to have graded diagnosis and treatment, why are the tertiary outpatient clinics opening more and more, and the number of grassroots outpatients becoming fewer and fewer?"
Xu Li and Li Hua work in third-class hospitals, and their use of senior expert resources may be a group of patients who can be treated in lower-level hospitals, "There will be some people in the heart to see high blood pressure at night, in fact, community hospitals can also solve it."
Curator: Y^OH, carollero | Executive Producer: gyouza
Source: Visual China
What do you think about the normalization of night clinics in hospitals?