(Long article warning, 3700 words)
This article is pure fiction, speculation, and imagination, so don't read it if you don't like it.
This paper imagines a plan out of thin air, that is, the most ideal medical reform plan, in order to deduce the internal reasons why it is difficult to see a doctor and expensive to see a doctor, and explore the deep logic of the doctor-patient relationship. Originally, there was another content, that is, the deduction of the worst medical reform plan, and the two were compared, but only the previous one was written, and it was almost 4,000 words, and the worst plan had to be omitted. The following is the text.
Under the condition that the state's financial resources allow, fully consider the demands of patients and medical staff, and in line with the principle that life and health are priceless and medical resources are shared by the whole people, the state and all levels of finance will bear all kinds of expenses of the hospital, and patients will be treated free of charge. The details of the scheme are as follows:
1. The wages of medical staff, hospital handymen, hospital utilities, equipment purchases, medicines and testing supplies, etc., are all paid by the treasury.
The outpatient building and inpatient building of the hospital are constructed by financial appropriation.
2. All outpatient and inpatient services are free of charge, no registration fee, no bed fee, no injection fee, no drug operation fee, and all miscellaneous expenses are also banned, including the cost of ambulance transfer of patients, including the parking fee for patients to come to the hospital, etc.
There is no geographical restriction on the free policy, and all Chinese residents can receive free medical treatment in any hospital in China.
3. Medical staff shoulder the heavy responsibility of saving lives and helping the wounded, and their right to normal rest must be guaranteed, and hospitals must not force medical staff to work overtime.
Discipline leaders and experts must take a certain amount of time to sit for consultation while taking care of scientific research tasks.
4. The hospital shall not refuse patients for any reason, shall not perfunctory patients, and shall not be less than 10 minutes for each patient's consultation, observation and doctor-patient communication, and the time for difficult patients may be appropriately extended. The side effects of the prescribed drugs and injections should be clearly explained, and efforts should be made to relieve patients' doubts and dispel patients' worries.
5. In order to protect patients' right to seek medical treatment and not to be treated coldly and harshly, a complaint system is established. The medical staff who received a complaint from the patient will be deducted 20% of the bonus of the month after verification, and the bonus will be reduced to zero after being complained about 5 times and all of them have been verified. Medical staff who receive pennants and other commendations from patients will receive a 20% bonus for the month after verifying the situation.
Medical staff who have been subject to more than 30 complaints during the year will be disqualified.
I feel that this program is close to the ideal state, and there are two highlights for patients: everything is free, and if you are not satisfied, you can complain. There are also two bright spots for medical care: the treatment is guaranteed, there is no need to earn their own wages, there is no need to work overtime, they should get off work, and they will rest on holidays.
But what is the effect of the implementation of this plan, please see the effect deduction below. It is just speculation and imagination, in order to explain the problem in as little space as possible, doctors and others have a lot of words, and they also say that what should not be said is not that they lack the heart, but that the text needs it.
Boss Wang, the owner of a small supermarket who is barely middle-class, felt unwell after an argument with his family, so he went to the best hospital in the city for treatment.
It's crowded like a bazaar. There are long queues in waiting rooms, medicine pick-up desks, and at the doors or windows of various functional departments. Fortunately, there was an information desk and a medical guide, so Boss Wang found a medical guide who looked capable.
Doctor: Actually, you don't have to come to us for this disease, you can be treated by a general hospital.
Wang: There is a stipulation that hospitals are not allowed to refuse patients for any reason.
Guide: Okay. No online registration?
Wang: No, I'm not familiar with the operation on the Internet, so I rushed here in a hurry. I registered on the spot.
Guide: Where to queue up for registration. Do you hang that doctor?
Wang: Director Zhang, I heard that he was a well-known expert, so I went to him for medical treatment.
Doctor: Director Zhang's appointment has been scheduled for three months, and you can sign up for him if you are willing to wait.
Wang: What? Is it so exaggerated? Why is this happening?
Doctor: Director Zhang is a discipline leader with scientific research tasks, and only comes to sit for half a day on Tuesdays and Thursdays. I can see a maximum of 10 patients in half a day, and sometimes only four or five patients, and there are so many people who hang up that I can only look in the back row.
Wang: Why is it so inefficient that it takes half a day to see four or five patients?
Medical guide: The plan stipulates that there should be full communication with the patient, the side effects of the drug injection should be clearly explained, and the patient's doubts should be relieved. If you think about it, this is equivalent to a medical science education for patients, and it is not easy to be able to popularize science within a few hours, and also let patients understand and not have doubts in their hearts.
Wang: Then we should pay more attention to efficiency, right?
Doctor: Everything is for the satisfaction of patients, doctors don't need to pursue efficiency now, because the treatment is financially guaranteed, doctors just need to make patients satisfied, don't complain about him.
Wang: Okay, what about the other experts? What about the numbers of ordinary doctors?
Doctor: There are many appointments from specialists, and you must wait a few days, at least a month. Ordinary doctors, just wait three or five days.
Wang: Why is this happening? I have been to your hospital in the past, and although there are quite a lot of patients, not as many as now.
Doctor: We wonder too. But since the free of charge, there have been more patients all of a sudden, not only in our hospital, but also in various hospitals. In the past, I basically chose not to go to the hospital for minor illnesses that I could go to the hospital, but now I basically choose to go. In this way, there are more patients.
After the implementation of the plan, doctors are afraid of complaints, and communication with patients increases, and the speed of seeing patients is slow.
If you think about it, if the number of patients increases, the speed of medical treatment becomes slower, and naturally it becomes overcrowded.
Wang: There is no reason to wait for a few months, even the number of an ordinary doctor has to wait, how can you see a doctor?
Doctor: You don't know why, I'll tell you. It sounds like you have to wait in line for days, but it's actually not that exaggerated, because many of the numbers are empty.
Wang: What do you mean by empty number?
Doctor: Someone registered, thought the waiting time was long, turned around and went to another hospital, and his number became empty. We sometimes encounter hundreds of empty numbers a day. Because there is no charge for registration, some patients register the number of ten hospitals at the same time, which one has a short waiting time to go to which, and the other nine hospitals have one more empty number.
So, you can come to the waiting room every day and wait, maybe there are empty numbers in front of you, and you will be able to get up smoothly. But this method is not safe, and it is better that you also hang up the number of several hospitals.
Boss Wang was very depressed and helpless, so after thinking about it, he had to leave the big hospital and come to his district hospital.
There are quite a lot of people in the district hospital, but there are not as many as the big hospitals, and I waited for an hour, and finally I was almost there, but it was time to get off work. The doctor stopped going to eat, and if he wanted to see a doctor, he had to wait until he went to work in the afternoon.
Boss Wang also went out to have some dinner himself, and finally sat down opposite the doctor at about 3 o'clock in the afternoon.
After some consultation and a simple examination, the doctor said, "Your illness is not a big problem, I will prescribe some medicine, then some injections, and go to your community hospital for injections." ”
Boss Wang said: "But I want to be hospitalized, even if it is for two or three days." ”
Doctor: I'm afraid of your complaints, if you really want to stay, I'll give you a hospitalization certificate, but you can't go to the inpatient department, there is no bed.
Wang: Why are there so many tight beds?
Doctor: You want to be hospitalized when you are so sick, and there are many people who think the same way as you, so the beds are tight.
Wang: I'm in a special situation, I'm having a fight with my family, I'm depressed and irritable, and I want to be hospitalized for a few days, and if I'm hospitalized, they'll be anxious, you know.
Doctor: I naturally understand that there are reasons for people who want to be hospitalized. Our district has abundant finances, generous allocation to the hospital, the food of the sick number is good and cheap, the old aunt who opened a shop outside the door is not sick and wants to be hospitalized, her home is far away, and she does not have to run away in the morning and evening, and she eats three meals a day and spends less money.
Wang: Is there any other way?
Doctor: Yes, you go to the "Patient's Home Office" and beg them to see if they can find you a bed.
Wang: What kind of institution is this?
Doctor: Now that the hospital is in drought and flood, many people have come in through connections. But these people don't know how to see a doctor, can't give injections, and don't want to look at the door to cut flowers and plants, so the hospital set up this office for them, saying that they are afraid that doctors will please patients and admit patients who should not be hospitalized into the hospital, resulting in a shortage of beds, so they will set aside 1/3 of the beds to be managed by the "patient home" for the critically ill patients who really need it. It might be useful for you to look for them.
Wang: Is it really useful?
Doctor: It depends on your ability, the benefits of dessert and cigarette lighting may be useful.
Wang: Well, forget it, I don't want to beg them when you say that. I went to our community hospital, where there was an inpatient unit.
The next day, Boss Wang walked around his supermarket and came to the nearby community hospital, where there are few doctors, but there is no need to register, just sit on the bench in the corridor and line up.
It's just that the benches are full of people, mostly Weng Yuan in their seventies and eighties, they all seem to know each other, and while waiting for the doctor's treatment, the parents are chattering nonsense.
Boss Wang didn't have a place to sit, just walked around the corridor. I saw an old woman enter a female doctor's office, and as soon as she sat down, she rolled up her sleeves.
The female doctor measured her blood pressure and said, "The blood pressure is still a little high, but it's not a big problem, just continue to take those medicines." ”
The old lady said: Okay, okay, it doesn't matter if it's high or low, anyway, I come to measure my blood pressure once a day, and it is my livelihood, otherwise it will be annoying to be bored at home. It's good to come to you, they're all acquaintances. You don't know, my granddaughter is about to turn 30 and is not looking for a boyfriend, do you have the right person to introduce?
Female Doctor: Auntie, I'm going to the bathroom.
Old woman: You go, you go, I'll wait for you here, I'm fine anyway.
It's been more than ten minutes, and the old lady is still nagging in the consultation room, and Weng Yuan, who is waiting outside the door, is not in a hurry, and gathers to chat casually.
After waiting for an hour, Boss Wang couldn't help it, he didn't want to wait in line, so he broke into the female doctor's consultation room directly. Weng Yuan outside the door didn't react, and the old woman in the house hurriedly stood up and said, "Okay, okay, I'm going out, and the one who really sees a doctor is here." ”
After some consultation and simple examination, Boss Wang asked to be hospitalized again.
The female doctor smiled and said, "Our hospital is small, only ten beds, you can wait if you want, it is estimated that you will have to wait for several days." ”
Boss Wang's face was surprised: "Such a small hospital is still full of beds, who wants to come here to be hospitalized?"
Female Doctor: Don't you see the group of old people outside? Their children almost all live far away, and they rarely come back on weekdays, and everyone is busy. Only when they are hospitalized can these elderly people call their children and ask them to come back to see them.
Wang: But you should always have some principles, right? Let the people who are not sick occupy the beds, what about the people who are really sick?
Female Doctor: Seventy or eighty people, who can't find any illness on his body? You want to be hospitalized even if you have a minor illness, let alone these old people. Besides, we are afraid of complaints, so we can only try to arrange for them to live.
Boss Wang was extremely depressed, but he couldn't lose his temper, because he was also similar to someone who was looking for a sick person and wanted to be hospitalized.
Boss Wang went out of the community hospital and called a classmate with whom he had a good relationship to complain about what happened to him.
The classmate laughed out loud and said, "If you don't say such a trivial matter earlier, I have an acquaintance with great powers, and it is no problem to arrange for you to be hospitalized." Do you really want to live, which hospital do you want to go to?"
Boss Wang hurriedly asked, "What is the number of your acquaintances?"
The classmate said: "He has a relationship with the office of the patient's home in many hospitals, you don't understand, now it has become a business to find a bed for people, and the price is clearly marked, a bed in the top three is 8,000 yuan, and a bed in the second class is 5,000 yuan." As long as you are willing to pay for it, there is nothing you can't do. ”
Boss Wang's heart ran over with 10,000 grass and mud horses, and he was stunned for a long time and muttered: "This damn thing, it's more profitable than me making a supermarket!"
The classmate said: "If you are sick in the future, you will come to me, and it is not a problem to register as an expert, my acquaintance has a network, and I can invite experts to your home to see a doctor, 20,000 yuan each time, how about it?"
Two words popped out of Boss Wang's mouth: scalper.
The classmate laughed again: "What a scalper, what a scalper is so ugly, people call it communication between doctors and patients." Okay, don't talk about it, you will come to me when you see a doctor in the future, and the price will definitely give you a discount. ”
The speculation and imagination of laymen are inevitably full of loopholes, please spray lightly.
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