China-Japan healthcare gap: what makes it Asia's No. 1 cancer specialist hospital
Tokyo Cancer Research Institute Ariake Hospital in Japan is a cancer specialist medical center with 20 operating theaters and 700 beds, and its comprehensive strength is ranked No. 1 in Asia, and its level of diagnosis and treatment of gastrointestinal tumors is especially excellent. In recent years, many domestic patients have traveled to Japan to seek treatment at the hospital through Hauppauge Ark.
△Cancer Research Ariake Hospital
Not only that, recently a domestic medical staff sent to the hospital to study and further training Li Zhuofei, the experience of the domestic status quo, but also issued a "loose strings, can not play the strong sound of the times!" such a sentiment. This kind of sentiment.
The hospital is not large, but developed into Asia's most advanced cancer treatment center. This, exactly how to do? Let's take a peek at the medical staff's account of the gap between Chinese and Japanese medical care?
Arming Hospital - First Impression
On the way to visit the hospital, the first thing I saw was the outpatient hall, which was bright and clean. There were quite a few patients waiting for treatment, but it was very quiet, with both staff and patients deliberately lowering their voices and talking in low tones.
Japanese medical system: appointment + referral
It is reported that the Japanese patients, take the appointment system and referral system, that is: the patient is sick, the first to the community hospital, you must obtain a certificate of referral to the primary hospital, in order to go to a large hospital for treatment. If you can't trust a small hospital and go directly to a large hospital, I'm sorry, but the insurance company is not responsible for covering the high medical costs. Therefore, almost all patients who come to the hospital have already made an appointment for transfer and consultation departments (except for the landlord), and there is no long queue and overcrowding in the outpatient clinics of domestic hospitals.
Patients come to the hospital, complete the registration procedure, will receive a device similar to a cell phone (PHS). The PHS beeps and vibrates when the patient's turn comes up. Patients can walk around the hospital without having to wait in the clinic area. Avoiding large screen displays and computerized number calling protects patient privacy while reducing noise.
Elevator details: pay attention to public morality, emphasize etiquette
Step into the elevator, I immediately found an interesting phenomenon: the elevator, there are a few buttons wear and tear serious, but the parts of the loss, it seems that not quite the same as the domestic. I secretly speculate on the reason, and decided to pay attention in the future days to observe and verify what is going on.
In the following days, I went to work every day and observed that both employees and patients were very willing to wait patiently for those who came after them when they rode the elevator, leaving the door open for others. So so, broken is often open the door button. On the contrary, the domestic public elevator, nine times out of ten are closed button broken, open button safe and sound.
From this detail, we can see that the Japanese people in the public **** place to pay attention to public morality, emphasize the side of etiquette.
Perfect system
A perfect system is essential to get the job done efficiently and safely.
Case discussion system
Every Tuesday and Thursday, it is the time for case discussion in the department. From 7:30 a.m. to 9:00 a.m., everyone from the dean down to the residents must be on time.
The discussions are concise and efficient, and the residents report their cases by making slides that are easy to understand. My impression is that the residents have a solid foundation of basic knowledge and know the pathophysiology, imaging, gastrointestinal endoscopic manifestations, and pathologic features of tumors. Every relevant blood vessel and every suspicious lymph node could be identified and labeled.
Furthermore, for some cases with important vascular variants, they were able to detect them in advance in the preoperative CT reading, and think about the intraoperative response plan, and propose it to the whole department to discuss whether it is reasonable and feasible.
Such important work often requires drawings to explain it clearly, and it is not uncommon to see images like this at the symposium:
Beautiful, isn't it? I was wowed anyway.
Talking with the residents, I learned that every night since college, they have needed to spend an hour or two practicing drawing. First, they drew at the object, and by the end of the practice, they were able to look at the CT films and reduce the blood vessels to such an image based on the anatomical relationships.
And as far as I could see, the drawings they made before the surgery were so accurate that there was almost no difference from what they saw during the surgery!
While exclaiming in admiration, I couldn't help but think of Mr. Fujino in Lu Xun's novel, who was strict with his students.
Operating room safety checking system
We used to watch Japanese dramas, and saw the male god, Shumei Donzawa, standing in the position of the chief surgeon, solemnly announcing, "Today, we are performing radical resection of esophageal cancer for this patient named XXX, with an estimated operating time of 5 hours and 20 minutes, and an estimated bleeding volume of 50 ml ... ..."
I always thought that images like this were rendered out of art. It was too performative to do so in reality. I didn't realize that it turned out to be true.
Every surgery, no matter how relaxed and pleasant the atmosphere before the operation, must fulfill such a procedure: at the beginning of the operation, the surgeon stood on the stage and solemnly announced what kind of surgery is going to be done today, the estimated time required for the operation, the expected amount of bleeding, who is the main surgeon, who are the assistants, and who are the anesthesiologists and nurses, etc., even including Dr. Li from China, is also in the scope of the readings. The doctor was also read out.
At first I thought it was a bit funny to be in a Japanese drama. But then I realized that this practice is, on the one hand, a preoperative checklist to ensure medical safety, and on the other hand, a reminder to stop joking around and start working seriously.
Standardized surgery
Standardized surgery is a hallmark achievement of Japanese surgery. And the rigorous work ethic of Japanese healthcare professionals is the basis for ensuring that standardized surgery is consistently performed.
Strict adherence to guidelines
Here, whether a young surgeon or an internationally renowned professor is in charge, for every operation, the extent of lymph node dissection, the distance of gastrointestinal tumor resection, the extent of vascular nudity, and which blood vessels need to be dissected intraoperatively ...... all must be strictly adhered to the guidelines.
Guidelines stipulate that the distance from the tumor 5cm cut off, then it must be 5cm measured with a ruler during the operation, do not allow such words as "the naked eye to judge the edge of the cut off cleanly, feel almost by experience" and so on.
All tumor cases must undergo a rapid intraoperative pathological examination of the margins to ensure that there is no residual tumor. In gastric cancer surgery, intraoperative gastroscopy is mandatory to determine the tumor location and distance from the margins before dissection; after anastomosis, gastroscopy is necessary to check whether the anastomosis is patent and to ensure that there is no anastomotic bleeding or anastomotic leakage. After suture reinforcement of the anastomosis, gastroscopy again to ensure that there is no mis-sewing ......
Intraoperative video or photographs must be kept to prove that you have done it according to the standard, and to be taken out for supervision at the next round of case seminars.
"Obsessive-compulsive disorder" makes for great surgeries
What struck me was the first day I visited a gastric cancer surgery, where the surgeon wasn't happy with one of the stitches (which seemed harmless enough to me), but the Japanese didn't think it was up to snuff, and so he took it apart and re-sewed it, repeating the process eight times, before he was satisfied with the end.
I think it is this kind of seemingly "obsessive-compulsive" work ethic that creates each and every one of these wonderful surgeries. At the Ariake Hospital, the 80-year-old doctors all performed Whipple (pancreaticoduodenectomy) surgeries with flying colors.
After the surgery, the same cumbersome workflow: the disposal of pathology specimens, explaining the condition to the patient's family, the writing of medical documents, and the entry and analysis of scientific research data. ...... The working hours of most doctors here are from 7:00 a.m. to 11:00 p.m., and there is no complaining or laughing in the office late at night. There is no laughing and joking, everyone is working hard in silence.
Every night when I go back to my dormitory, I think about how Japan has improved over us for many reasons. But there is one thing that we can do, and that is to work twice as hard and focus twice as hard on our work. Only in this way can we not be eliminated by the times.
A slack string cannot play the strong sound of the times!
Today I visited a wonderful radical surgery for stomach cancer. After the operation, the surgeon in charge asked me with a smile, "What do you think of our Japanese surgery?"
I smiled back and replied, "It has a hypnotic feeling."