You must choose a hospital with electronic medical records to be documented.
On April 18, Zhang Yu, a physician oncologist at the Third Hospital of Beijing Medical College, posted a post in Zhihu that he exposed the dark curtain of tumor treatment under his real name and pointed the spearhead at his group of oncologists. He also made Lu Wei, a doctor from a third-class hospital in Shanghai, a direct complaint, saying that he recommended useless and ineffective diagnosis and treatment plans to patients for the primary purpose of earning profits.
Zhang Yu also asked the state to set up a medical red line at an early date to curb bad medical behavior in tumor treatment. It is reported that the National Health Commission has carried out investigation and verification of this.
Screenshot of Dr. Zhang Yu's Zhihu post
The key issues behind this incident are:
Do oncologists have to follow authoritative guidelines for the treatment of oncology?
How can we remove the communication barriers caused by the asymmetric information between doctors and patients?
Can some doctors' unethical behavior rely solely on regulation to solve the problem?
The most important thing is that as a patient or a patient's family, how to find a reliable hospital and doctor, how to judge whether the treatment you receive is standardized, and how to ensure your rights and interests?
On this series of issues, Quan now interviewed Professor Ji Xiaolong, a well-known pathologist in China and former director of the Pathology Department of the Armed Police General Hospital. In the field of tumor treatment, pathological diagnosis is the "gold standard" and pathologists are "doctors' doctors". Ji Xiaolong, the world's first doctor to use an atomic microscope for pathological observation, dissected the remains of China's first patient who died of AIDS and published a paper.
<h1 class="pgc-h-arrow-right" data-track="11" > chaos</h1>
All now: Dr. Zhang Yu said that in the vast majority of cases, the treatment of tumors should not be empty of money, but should be better and less expensive than the current treatment. In your opinion, is the phenomenon he said true?
Ji Xiaolong: It is too general to say that tumor treatment is too general, and tumors are divided into benign, malignant and somewhere in between. He should be referring to the treatment of malignant tumors, that is, cancer treatment. Only cancer treatment will be empty.
Which cancer treatment is not a double-cost? Malignant tumor patients eventually die; and most cancer patients will always find ways to cure as long as they are still alive. Therefore, the final result of cancer treatment must be that people and money are empty.
Quan Now: Zhang Yu pointed out the responsibility of doctors in the post, and he felt that in many cases, this situation of financial waste was caused by the doctor responsible for treating the tumor. What percentage of the responsibility do you think doctors are responsible for causing this phenomenon?
Ji Xiaolong: This is by no means a doctor's one-sided problem, there are many factors involved here.
First of all, China is a big country with a large population and a big cancer country. The base number is large and there are many problems, and this overtreatment will naturally occur.
Second, grass-roots hospitals below the county level, including some hospitals below the prefecture-level city level, are not standardized in cancer treatment. Why do patients have to run to Beijing, Shanghai and Guangzhou as soon as they are found to have cancer? At the very least, it is necessary to go to the provincial capital city, because the treatment of grass-roots hospitals is not standardized.
Third, cancer diagnosis is easy. There are hundreds of malignant tumors in the human body that can be called out in medicine. Like the common cold and stomach disease, it will also be diagnosed incorrectly, but these small problems will not kill people; but if the cancer diagnosis is wrong, the patient will die.
At present, whether it is China or the world, the error rate of cancer diagnosis is about 50%. The diagnosis is wrong at the beginning, and the final treatment must be wrong, you say that this problem is not serious? When I consult with patients, I encounter such misdiagnosis cases every day.
Now: Is it mainly because cancer is so complex that existing cognition is less accurate to recognize it?
Ji Xiaolong: No, it is mainly too difficult to train and train a doctor who can see cancer clearly and reduce mistakes to a few percent. This is the same all over the world.
So you can't blame a single doctor for giving patients a mess without figuring it out. This phenomenon is widespread. I just consulted a case this morning, and the patient was a 24-year-old girl. She found that her eyes were a little oblique, and her parents understood quite well, and took her directly to Shanghai for examination. The hospital in Shanghai found that she had a tumor in her chest, and the slanted eye became a small problem, so she quickly opened the tumor and took it out. The hospital was diagnosed with a malignancy that required follow-up treatment.
The child's parents were more rational, and he borrowed his medical records and came to Beijing for consultation. At first glance, it seems to be malignant, but according to our experience, it is finally judged to be benign. Then as long as the surgery is removed, it will be fine. Imagine if her parents didn't come to the consultation, wouldn't a healthy child have to go to radiation therapy and chemotherapy? Examples abound, every day.
Traditional cancer treatment has three magic weapons, surgery, radiation therapy, and chemotherapy. This is first-line treatment. Some malignant tumors have no first-line treatment, at this time the so-called second-line comes up, what is the second-line? For example, biological therapy such as immunotherapy and gene therapy. The problem is that the effects of these second-line treatments are still in the process of continuous improvement and exploration and obtaining new data. This is where China's cancer treatment needs to be improved, and a large number of biological treatments are basically rubbing the edge.
In this field, many pharmaceutical companies will invite doctors to hold academic seminars, bring in the relevant oncologists, introduce their new methods, and then give a high commission for each patient who is introduced to receive a new treatment.
In the doctor-patient relationship, the patient is in an absolute disadvantage
<h1 class="pgc-h-arrow-right" data-track="28" > motivation</h1>
Now: Will this commission prompt doctors to proactively recommend these new drugs or therapies to patients who are not applicable? If this is the case, the doctor's primary purpose is not to cure the patient anymore, but to act more like a salesman.
Ji Xiaolong: Of course there is. The patient does not understand, the doctor said how advanced this method is now, the patient is easy to believe, what do you have to do? At present, the only plan I can think of is to suppress the charges, and biological treatment costs hundreds of thousands of yuan. You cut the cost down and he won't go down this path.
Quan now: However, there is an industry view that if the research and development of new drugs does not get high returns, it is not conducive to pharmaceutical companies to innovate.
Ji Xiaolong: Anything that can go forward is to balance the pros and cons.
Now: Should a cancer patient or his family believe the diagnosis at this time after getting a doctor's treatment plan, such as a diagnosis by an authoritative doctor in a top three hospital?
Ji Xiaolong: At this time, we must not be afraid of trouble, and then find another standardized hospital to obtain a second medical opinion, the purpose is to reduce the diagnosis of cancer errors. This kind of error is all too common to be rare.
At present, there is a significant gap in cancer treatment in China compared with countries with relatively perfect medical systems, one of which is that many hospitals do not lend patient information. This is contrary to medical norms, and even if the Health Commission explicitly stipulates that medical records can be borrowed, these hospitals do not comply. This asymmetrical approach to patients in hospitals is all too common.
If the second medical opinion is consistent with the first, the patient does not have to run. If the two are inconsistent, you have to find another one to diagnose.
All now: this disparity in the status of patients and doctors, hospitals, patients are too weak, coupled with the current tension between doctors and patients, patients do not believe in doctors, doctors guard against patients, how to ensure the patient's right to know?
Ji Xiaolong: Patients and families will never understand everything, because the professional threshold of medicine is very high, and there are a series of basic theories and practical experiences behind it, which cannot be explained clearly in 10 minutes and 20 minutes. The only thing that cancer patients can guarantee their own interests is to go to a regular hospital for medical treatment. In the treatment of cancer, if the diagnosis is standardized, and the second and third companies are unanimous, you can be generally at ease.
Because the professional threshold of medicine is very high, patients and families never have a complete right to know.
<h1 class="pgc-h-arrow-right" data-track="40" > correction</h1>
All now: Overdiagnosis and overtreatment in the medical field is an old problem, especially in the field of tumor treatment, which is more worthy of attention, because it involves the life and death of patients, the cost of treatment is huge, and cancer is like a lever, which magnifies the excessive medical phenomenon in other fields. In nearly half of the misdiagnoses, are there doctors who know that treatment is not suitable for patients, but still deliberately recommend it?
Ji Xiaolong: Every year, oncologists around the world participate in various conferences to form a consensus on tumor treatment, and now most tumors have standard treatment plans, and regular doctors in regular hospitals treat them according to this. Due to China's large population and large number of cancer patients, the consensus at the grassroots level is not well implemented. In a top three hospital, doctors are unlikely to take this risk. Now the top three hospitals are electronic medical records, each step has left evidence, if the doctor does this, a check will find out.
However, it should be noted that this is only said in terms of formal treatment and consensus treatment, and for second-line biological therapy, it is difficult to say because it is not within the scope of consensus.
All now: In fact, Dr. Zhang Yu broke the news that the main is also second-line treatment, some doctors did not use first-line treatment to see the effect, but directly recommended second-line treatment.
Ji Xiaolong: This situation is mainly in grass-roots hospitals, and it is obviously illegal for regular large hospitals to do so, and doctors cannot stay in hospitals.
All now: Some doctors may really not put the patient's life first, but prioritize treatment options that bring benefits to the doctor himself, how do you think about this behavior?
Ji Xiaolong: I think this situation can be regarded as deliberately hurtful, because he is doing it for the sake of profit when he knows that he should not do it.
All now: From the perspective of these doctors, the reason why he is not afraid of punishment is also weighed in his mind, including whether it is worth it and what kind of punishment he may be punished if he is discovered.
Ji Xiaolong: The key is that it is difficult for patients to get evidence. Many grassroots hospitals are not standardized, medical records are not electronic, there is no archive, and he can deny what he has said.
Quan Now: The patient will also be particularly worried, once he encounters a similar situation, how will he defend his rights? Or, if patients are not satisfied with the final treatment outcome and then doubt whether the treatment plan is reasonable, how should they confirm their suspicions?
Ji Xiaolong: As I said just now, as long as it is a regular hospital, there is an electronic medical record, get the information, and then go to the insider.
Twenty years ago, China's hospitals were not yet widely electronic, when many doctor-patient disputes went to court, and the courts could not make judgments because of the lack of evidence. Now that large hospitals are generally informatized, patients also have the right to copy medical records. All this makes those who have wrong intentions and other plans dare not take risks again.
Here to remind cancer patients, no matter which hospital to go to, must choose a regular, electronic medical record, so that there is evidence, doctors do not dare to do what they want.
Quan now: But patients will still wonder, will there be so-called peer care? Even when it comes to the medical malpractice identification procedure, can you trust the conclusions of the medical identification team?
Ji Xiaolong: I have experienced too many such situations, and in China for so many years, medical disputes and medical malpractice appraisals have always been the case of peers shielding each other, covering up each other, making big things small, small things small, and then losing some money. This cannot be avoided.
But for cancer, if you think that you have been deceived in the treatment, or suffered from irregular treatment, you take the evidence, and then compare the treatment consensus, the specifications of the World Health Organization, someone covers up the identification of medical malpractice, you go to the court to file a lawsuit, the judge is not a doctor, then you still have to rely on the evidence to speak.
Quan Now: Zhang Yu also proposed a solution to the current chaos of tumor treatment, and he asked the state to set up a medical red line as soon as possible to curb bad medical behavior in tumor treatment. In your opinion, is this a recipe for combating the chaos of tumor treatment?
Ji Xiaolong: There is a standard for first-line treatment, and I think the red line he said refers to the red line of biological therapy, which needs to be solved with great efforts, and the only one that will have a big problem in cancer treatment at present is this one. This requires regulation in place. The competent department should carry out which kind of biological treatment for which one, how much is charged, how efficient it is, and come up with a regulatory provision to understand it clearly.
The trouble is that the current consensus in the field of biotherapy is not in place.
Finally, we still have to remind patients that when encountering cancer, do not be helpless, first find a regular hospital, get the first diagnosis, and then find the second one to get the second opinion; if it is not the same, find a third. In short, the diagnosis is clear first, and then the treatment is according to the formal plan, and the regular hospitals have a normative consensus. Don't listen to the fools of informal hospitals and traveling doctors.