Release date: 2017-07-21
If the doctor can do as little as possible and simple explanation work, if the patient can communicate with the doctor as much as possible and ask about the treatment plan, then the relationship between doctors and patients will be more friendly and intimate. Direction development?
This theoretical hypothesis is now tested in practice at the Shanghai Pulmonary Hospital. In the past year and a half, patients and doctors have been “liberated†by introducing “medical assistantsâ€, which are not in the “Occupational Classification of the People’s Republic of Chinaâ€.
Surgery surged, doctors were too busy
About six or seven years ago, Shanghai Pulmonary Hospital was only a "small hospital" with an annual operation of more than 1,000 units. In recent years, with the improvement of the detection technology of chest and lung diseases, more and more “early†patients have come to this hospital to seek a single-hole thoracoscopic minimally invasive surgery with less trauma to the body.
This "more and more" is implemented on a specific number, which is an increase of 20% to 30% of the annual surgery. In 2015, the hospital had an annual operation volume of more than 8,000 units, and in 2016 it reached more than 10,000 units. By this year, the hospital had completed more than 6,000 operations in the first half of the year, including the off-season of the Spring Festival, and the lungs were three. Four levels of difficult surgery are also among the best in the city.
The only surgery in this hospital, thoracic surgery, has a total of more than 40 doctors. They average 3 to 4 people to form a treatment group, usually consisting of a chief physician, an attending physician and one or two residents. Every week, an excellent thoracic surgeon is able to treat 30 to 40 patients.
Take the Jiang Gening group, the director of thoracic surgery, as an example. Four doctors “manage†35 to 40 patients every day. Assuming that an average patient is accompanied by only two family members, the four doctors will communicate with 105 to 120 patients and their families during the week.
There is no small matter in the operation. Every patient wants to get the doctor's care as much as possible. Even if it is a simple doctor's advice, telling him what to pay attention to after surgery is good.
But the doctors' time is really limited.
The joint investigation results of the Civilization Office and the Medical Department of Shanghai Pulmonary Hospital show that most patients have higher satisfaction with hospital services, especially for doctors. However, if patients are advised on the hospital's services, most of them are more entangled in the "number of times they meet with doctors."
Xu Xin, deputy director of the Medical Department, told the China Youth Daily, Zhongqing Online reporter that the director, deputy director and attending physician of the hospital thoracic surgery should go out of the clinic. A treatment team should perform an average of 3 to 4 operations a day, which can only be guaranteed every day. Patients can be seen in the morning and afternoon rounds of ward rounds.
The sick people don't know about this. They will be more difficult with the nurse because of the removal of the catheter after surgery; because the preoperative examination is too cumbersome, and all the doctors who can see the table; because they have to find a doctor for their own surgery, face to face consultation, And loud noises in the ward.
But in fact, in Jiang Gening's view, these small disputes can be completely avoided. "As long as there is a person who can explain and dock with him, it will be fine. The patient will not be unreasonable."
Introducing "Medical Assistant" to work on the details of the service
Jiang Gening has a wide network of thoracic surgery in the world. Thoracic surgeons from all over the world, mainly developed countries, will go to the Shanghai Pulmonary Hospital for further study. At the same time, these foreigners will also invite Shanghai doctors to visit abroad. Tell the doctors in Shanghai about foreign practices.
In the United States, there is an “assistant physician†position, which is equivalent to a “doctor's secretaryâ€. From the patient's admission, admission, to ward arrangements, simple initial medical advice, and postoperative communication, all are completed by “assistant physiciansâ€. . The salary of the "assistant physician" is mostly paid privately by the surgeon. Of course, the cost of surgery in the United States is expensive, and the doctor can pay this part of the money.
But in China, this is obviously not feasible. Jiang Gening thought, can you compete for a part of the nursing staff in the hospital, and they will take on other tasks except the doctor's advice from the US “assistant physicianâ€, “mainly responsible for communicating with patients throughout the process and breaking the bottleneck of improving medical service levelâ€.
This idea has been supported by many hospital leaders. The Hospital Civilization Office and the Medical Service have just begun to prepare related matters to improve the quality of medical services – “communication†with the lowest cost and the most critical point of medical services. .
Huang Yaju was the first batch of nurses to apply for competition. Of the first five applicants, only three were admitted. Before becoming a medical assistant in thoracic surgery, Huang Yaju was a department head nurse. The post of the head nurse of the department is under the director of the nursing department of the whole hospital, above the head nurse of the ward.
"New position, I want to try it. This will serve the patient more directly and have a sense of accomplishment." Huang Yaju is now a medical assistant in a treatment group in thoracic surgery. Every day, she has the realm of every doctor in the group, and she can find these doctors in no time wherever they are. "I know their itinerary, I will call them and they will pick up, knowing that it is an emergency."
In addition to accompanying the doctor to check the room every day, Huang Yaju will see the patient at least 2 to 3 times a day. After a doctor receives an operation patient in an outpatient clinic, the patient will be picked up by Huang Yaju. She will give the patient a business card with her mobile phone number and WeChat QR code, which will be turned on 24 hours.
At present, there are 5 medical assistants in the Department of Thoracic Surgery of Shanghai Pulmonary Hospital, all of whom are senior nurses. These include a department head nurse, a ward head nurse and three senior nurses who have worked for more than 10 years.
The emergence of a medical assistant "liberated" doctors and patients
The emergence of medical assistants has smoothed the communication between doctors and patients, improved the quality of service, and “liberated†doctors and patients all, so that doctors and patients “have their own dutiesâ€.
Yang Yang, the attending physician of thoracic surgery, can finally drop the small book that has been turned yellow. Ten years ago, he just entered the thoracic surgery studio. At that time, the small book of the attending physician gave a vivid lesson to the newly graduated medical student. Every patient’s name, condition, and place to pay attention to care were all recorded. In this little book.
When the attending physician went out of the clinic, Yang Yang had to deal with all kinds of chores. For example, he will receive about 5 to 6 surgical patients per week, and each patient's admission and bed will be called by him. "A lot of calls are often made, there is no bed, and patients have to wait. The patient's experience will be very bad. I always feel that no one will call him later." Yang Yang said that at this time, the doctor was helpless. "I have fewer patients. If you are the director or deputy chief physician, you think you have to waste their time by calling the bed every day."
This does not include the various consultations for handling patients. Sometimes the doctor is still on the operating table, and the patient is in a hurry to call. "Why have I already done CT in the outer court, and I have to do it again here?"
Today, all of the above issues can be handled by a medical assistant. As long as the doctor opens a hospitalization order, the patient can go to a certain floor of the inpatient department to find a medical assistant in his treatment group. The bed arrangement, preoperative examination, postoperative appeasement, and post-discharge follow-up are all completed by the medical assistant, which realizes the seamless connection of “care for patients†in medical services.
Xu Jing, a medical assistant in the treatment group of Professor Jiang Gening, receives a lot of patient calls every day. Almost all of them are trivial. There is no "difficulties" that the chief physician needs to answer personally, but it is a matter of "heartache". In the past, these calls were usually directed to the chief physician and answered by the doctor.
Zhang, a 65-year-old foreigner, was unwilling to do a preoperative bronchoscopy, and he planned to take care of his family. Xu Wei discovered it, and it was inevitable that it would be explained in a moment. The old man refused to do it because he felt that the bronchoscopy was too painful.
Xu Wei transferred the report he had made before and pointed out every detail in the report that he did not make clear. "You see, these angles are not done, it will affect tomorrow's surgical plan, in case of surgery. If there is any problem, it will be too late to change the plan temporarily."
Xu Wei found that almost all the entanglements, dissatisfaction, and disputes related to surgery can be solved through "communication and interpretation." When the medical assistant came over a year, she had never seen a particularly unreasonable patient. "You tell them why, they can understand."
The patient was also "liberated". In addition to seeing the doctor twice a day, they can always find their own "medical assistant." For example, Huang Yaju found in a routine post-operative tour that a patient had a large amount of pleural effusion and may have chest bleeding. She called into the operating room with a phone call, and the doctor immediately gave verbal instructions, such as heart monitoring, blood pressure measurement, and transfer to the intensive care unit.
In this case, it is not easy for a general nurse to find a change in the condition, and secondly, the attending doctor cannot be found in time. The role of the medical assistant is also reflected.
Source: China Youth Daily
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