This is certainly, because in any technical field, a level is a level.
In the summer of 1992, I was admitted to the thoracic surgery department of the city hospital due to illness. One day, the ward came to a few old folks: one of them is a patient, was two people assisted still walking unsteadily, the appearance of falling. Followed by a few people, one of the female crying eyes are red and swollen, still in tears. One of them comforted her and told her not to be anxious. When my brother comes out of the operating room, I'll ask him to take a look. He can not see, there is the director of it ...... The woman cried choking difficult to say: oooh, oooh ...... Our family has an old man, under the small, all rely on him to earn a salary to support the livelihood of a single person. If you cut off your arm, you can't go to work and earn money later, who will support our family of six ah? ......
Hearing the accent is hometown, asked what happened? The original woman's husband is the county reducer plant maintenance workers. In the dismantling of a machine on top of a steel plate suddenly broke, in the steel plate under the spring of the huge thrust, broken steel plate in the left palm open an L-shaped mouth. Blood flowed out immediately. Factory doctors emergency treatment, sent to the county people's hospital. There for half a month, the wound is long, but the palm is swollen like a bear's paw. Finally, the left arm is also swollen, the pain of dizziness, these days eat what vomit what. I don't want to eat, but I'm also dizzy and nauseous. Some doctors in the county said to amputate to save their lives, some said to cut the palm, digging up the rotten meat, cut off the blackened pinky and ring finger, and then look at the situation, can not cut the hand again. Because of his wife's firm opposition, in the factory for several days, which was introduced by the old factory director, to the city hospital to find his son to see a doctor.
A moment later, the attending doctor finished surgery, changed his clothes over. After a careful examination, and then invited over the director to come. The two set a treatment plan, first anti-inflammatory, control infection caused by the systemic symptoms, and then depending on the situation to do a clean operation.
That night, the patient did not cry nausea, and did not cry hand and arm suffocation. On the third day, the color of the arm returned to basically normal, no longer black and blue, swollen and shiny. All five fingers could be moved. On the fourth day, a debridement operation was done, clearing out a lot of broken iron filings, broken cotton gauze and other foreign objects. That afternoon, he played poker with a few accompanying workers, sticking playing cards in the cracks of his fingers, which was discovered by the nurse, who gave him a lecture. He was still happy: I was cured! The first thing you need to do is to get your hands dirty!
Two days later, he and his wife happily said goodbye to everyone, discharged home.
This is the first time I've ever seen a woman in the world with a baby.
A level is a level!
The first level is the first level!
Hello, I am a medical worker, for this problem, from the perspective of the different (medical staff, patients) answers are naturally different, the following I will analyze objectively from the point of view of the medical staff, you are welcome to comment on the area of their views.
I will county and township hospitals collectively referred to as "grass-roots hospitals", that is to say, the patient in the grass-roots hospital treatment for a few days did not get better to the big hospitals very quickly look good is the technical reasons? My answer is that most of the reasons are yes, I will analyze for you one by one what is not the case.
First, the current situation of our patients' access to health care.
This may be the most common people have to say, it is difficult to see a doctor, it is difficult to see a doctor, it is difficult to fall countless heroes, big hospitals are overcrowded, grass-roots hospitals, especially the door of the health center can be sparrow Luo, the root cause is the uneven distribution of medical resources.
Why this uneven distribution of medical resources: around the medical staff of friends should be clear, the growth cycle of the doctor is very long, municipal hospitals are basically the requirements of graduate students, provincial hospitals are not much scientific research projects thesis Dr. may not be able to get into the better county hospitals are to graduate students, and medical students in the school undergraduate period than other professions more than 1 year, plus the standardized training of resident doctors. Coupled with standardized residency training, many into the clinical has been the years, this talent is certainly not willing to grass-roots hospitals ah, including treatment, work environment, etc., so the grass-roots hospitals and large hospitals compared to the lack of core competitiveness, so from the technical level than the grass-roots hospitals have been killed, what is the atmosphere, large hospitals, professors, tutors level characters, clinical, scientific research will be, the grass-roots hospitals Talent scarcity, learning atmosphere is relatively poor, many factors together with the results of the natural need for me to say more.
Second, the people to see the hospital introduction
Many people have a characteristic, especially in economically developed areas, small illnesses must go to the provincial hospital to see, there have been patients and I said that this is the face of this is a kind of trend. In fact, there is no need to be fashionable and realistic.
The common diseases, frequent diseases in the county hospital can cope with, precisely because it is common, frequent, treatment experience has been very sufficient, treatment program is basically the same as the big hospitals, has been very mature, so there is no need to go to the big hospitals.
Unusual diseases, rare diseases recommended to go to provincial hospitals, why, big hospitals have enough talent, advanced equipment and instruments, experienced in the diagnosis and treatment of this disease, but also for this disease scientific research talent can further do scientific research, to do the subject, this is the role of the big hospitals, not only just to see the disease, but also to undertake scientific research, teaching, prevention, health care, and other functions.
Third, the answer to the question
In the grass-roots hospitals can not handle the patient without the patient's family said that the doctor will take the initiative to tell you to transfer, why, no one will be so stupid, such as pulmonary hypertension in women during pregnancy, surely provincial hospitals, liver failure requires transplantation is surely a provincial hospitals, the doctor is not likely to stay in order to keep you in this, because once the accident is a medical error.
Sometimes some of the equipment is so, grassroots hospitals you can not buy, and do not need to buy, the level did not get to carry out this project, some drugs are the same, the hospital pharmacy simply do not have you this symptomatic drugs, then transferred to the higher hospitals, a clear diagnosis of course, it seems to be faster.
Seeing a doctor sometimes really have some advice, why, provincial hospitals also have a function is to teach, many graduate students, the following hospitals for advanced training doctors, doctors how to learn technology? So maybe you go to the provincial hospital your knife may also be under the guidance of the professor of advanced training doctor to do, if only common diseases, county hospitals may still be the director of the main knife for you to operate, go to the big hospitals are also difficult to find a number one to see a doctor for three minutes.
Summarize: rational look at the grassroots level to see small diseases, big diseases, big hospitals to see, the formation of a virtuous circle, so that the three diagnosis and treatment in practice, so that the people really benefit.
County and township grassroots hospitals due to the doctor's own problems, coupled with medical equipment is not as advanced as the big hospitals, so the number of people to see the doctor is small. Medical graduates of high-level personnel are to large hospitals, in the masses of people with improved life, economic surplus, health awareness, that is, minor illnesses will go to the municipal hospitals to see a doctor, it is the grass-roots hospitals to reduce the income of the medical staff, the wages and salaries of medical personnel with the reduction of municipal hospitals tens of thousands of dollars per month, even tens of thousands of dollars, while the grass-roots hospitals will only have a few thousand dollars, a good doctor go to the big hospitals.
County hospitals should be merged with municipal hospitals, with municipal hospitals sending doctors to sit in the hospitals, county hospitals doctors can go to the municipal hospitals on duty. The implementation of the same salary, the same treatment. Patients can have surgery in the city hospitals and do post-treatment rehabilitation in the county hospitals, with the same reimbursement rate. Through the merger of city and county hospitals or escrow, this will be the medical staff to improve wages, the patient enjoys the same conditions of the city medical conditions, the same doctors and experts in the treatment, but also saves the cost of medicine, the convenience of the patient's family.
Now the county highway, buses a lot of their own into the village, the rapid increase in the number of private cars, the rural masses of health awareness, in addition to the sense of the Chang will look at the town, that a few go to the county hospital? The first thing you need to do is to go to the county to take an hour, and then go to the city to take an hour or two.
County hospitals merged or to the city hospitals, or there are city hospitals in charge, first of all, improve the income of health care workers, reduce the cost of patients, but also improve the level of medical care, in the grass-roots hospitals to see the doctor can also look at.
The technology is not as good as it should be.
To give an example of experience to support this.
It was 2009, in the provincial people's hospital for training, rotating to the pediatric internal medicine department on the first day of the director of the room, very lively, there are undergraduate doctors, trainees, interns, students, international students, pediatric clinical postgraduate students, and we are nearly 30 people attended.
The director came to the bedside of a six-year-old boy who was ready to be discharged that day, and introduced him: the child started with fever, and was hospitalized in the local county hospital for three days, but the cause of the disease was not detected, and the child's fever did not subside every day, with a maximum of more than 40 degrees Celsius, which led to the transfer of the local city tertiary hospitals, and three days' treatment, but there was no improvement, and the key was that the cause of the fever was still not found, and the child was transferred to our hospital. After several doctors in the department of consultation, careful study, that in the child's right armpit found in a soybean-sized enlarged lymph nodes is the whole body physical examination, the only found valuable positive signs, surgery to take down the biopsy, and at the same time arranged for the other relevant examination did not find a special diagnostic value of the abnormality of the three days after the report diagnosis of necrotizing lymphadenitis, the appropriate adjustments in the treatment program, and soon the symptoms are relieved, the hospital was hospitalized for the ninth day, and could not find any improvement. The first day of hospitalization was the ninth day of hospitalization, and the patient was discharged.
What does the director want to emphasize? Don't let go of every valuable sign found in the checkup, even if it's not too obvious signs, to get to the bottom of it, there should be a gain; remember, in the face of disease, the vast majority of people are suffering from common diseases, frequent diseases, should start from this aspect, don't think about whether it will be a difficult and complicated disease, there are so many difficult and complicated disease, so that you have to meet.
Speaking of which, that city tertiary hospital, I really have been, its pediatrics have several chief physicians, the level is not low, the problem is where? I believe that the county hospital and the city hospital pediatrician to the child body check should be found in this enlarged lymph nodes, just inertia so that the doctor's thinking some of the constraints, the old thought to find the primary focus, not like the provincial hospital doctors reverse thinking, directly from the enlarged lymph nodes to start, and a clear cause of illness.
The topic is back to the provincial hospital pediatrics, then **** there are eight chief physicians, usually most of the working time is sitting in the clinic, and outpatient clinics are each for their own, the need for personal clinical work experience, high level of technology to be able to do a good job of the first gate is very necessary. Of course, there are also young and middle-aged pediatricians in the outpatient clinic for general outpatient and on-call services. Ward doctors are young and middle-aged doctors, most of them have postgraduate education, to the municipal level, that is basically undergraduate students, a small number of postgraduate students, to the county level is mainly undergraduate mixed with specialist graduates, the starting point of the doctor is not the same, the gap is naturally formed. The wards advocate teamwork, there are one or two top-level doctors to lead the team, as well as many attending physicians and deputy chief physicians can be unique, you can deal with the daily work of diagnosis and treatment.
It is normal for grassroots hospitals and large hospitals to have a significant technology gap, and grassroots doctors want to improve their practice, but they are limited by a variety of objective conditions, so even if they work hard, their ability to improve is limited, and they cannot reach the level of large hospitals with the same level of seniority.
I am Dr. Kang, thank you for your attention!
This is a question that I guess makes a lot of people wonder and want to know more about it. I, as a senior surgical director, to give you a few words.
1, if it is a common disease, multiple diseases, county and township hospitals and large hospitals are technically more or less the same.For example, common medical diseases: colds, hypertension, diabetes, acute gastroenteritis, acute bronchial tracheitis, and so on; as well as common one or two types of surgery and part of the tertiary surgery, such as: appendicitis, gastroduodenal perforation, simple intestinal obstruction, varicose veins, inguinal hernia, ureteral stones, ectopic pregnancies, tooth extraction and other diseases surgery. There is also no technological gap between the county hospitals and the well-endowed township hospitals and the big hospitals. Because these diseases, the county and township hospitals usually often treat the disease, the use of drugs and large hospitals are similar, the experience is naturally very rich, there is not much of a gap in technology.
But it is true that some patients, for example, some of the fever, cough-based acute bronchitis patients, or stone patients, in the county and rural hospitals for a few days of treatment, there is still no significant improvement, but the transfer to the big hospitals less than a day or two on the good. People may think that the doctors in big hospitals are of high standard and are gods and goddesses. In fact, this is not the case, because the treatment and recovery of diseases take a certain amount of time. Most of them should be in the primary hospitals after a few days of medication, in fact, the disease may have been healed to a certain extent, but the patients and their families do not believe that they will be completely cured after being transferred to the big hospitals and using medication again. To put it in metaphorical terms, it is a case of "those who planted the tree before us will enjoy the coolness of the tree after us". If the onset of the disease at that time to go to a large hospital for treatment, we may also rarely see the above diseases hospitalized for one or two days on the discharge of the bar.
2, difficult diseases, serious diseases, major surgery or large hospital technology is good.For example, an acute attack of myocardial infarction, cerebral infarction patients, if there is no intervention in the conditions of the county hospitals, relying solely on thrombolytic therapy is not necessarily treatment. But if this kind of patient to a large hospital, emergency intervention, may soon be good. There is also, for example, complex stone disease, in the county hospital injection conservative treatment, that is, more days is not much use, to the big hospital surgical treatment, a solution to the problem.
3, of course, different regions, in fact, the level of medical care is also a gap.For example, some township hospitals in a few developed areas, because of the massive introduction of talent and hospital construction, have been three hospitals, the level may be stronger than a few backward areas of the city hospital. In addition, between different hospitals, there is also a gap between the level of various specialties; and is the same hospital level of doctors is also a gap. Therefore, not only to find a hospital, but also to find a suitable doctor. Of course, as long as we usually more contact with the hospital medical staff, or on the medical treatment of the patient inquired about, these situations are also relatively easy to know.
In short, it is recommended that we can see common diseases and diseases in the county hospitals, difficult and serious diseases and major surgery or to the big hospitals. Usually nothing to learn more about the hospital's situation, once the need for medical treatment, but also can do accurate medical treatment.
I'm an internist, and as the title suggests, it's a good thing that the county hospitals can't treat the patients in the big hospitals because the medical technology doesn't work? There is indeed one aspect of the factor is so, but not entirely so.
The role of grass-roots hospitals to pave the wayA comparison like fever, a recurring fever if the patient first arrived at a county hospital, this time in accordance with the routine routine, the exclusion method is the most commonly used, infectious? Non-infectious? Tumor? Autoimmune cause? Or infectious diseases? After a few days of examination should come out of the results also came out, the family looked at the hospital for a week, the light of the examination fee cost me so much money, the reason can not be found, then transferred to a higher level of hospitals, higher level of hospitals to the lower level of hospitals to see the examination, treatment programs, ouch, the conventional can not be found cause, which will need to be based on experience, is it malaria? Or arteritis? Or infective endocarditis? Or some specific hematologic disorder? Reduce the front of the waiting time, and the higher hospitals first for this kind of difficult and experienced, equipment and means of examination, so find out the cause of the symptomatic treatment will be very soon.
The difference in treatment means
For example, the nephrology department came to a pesticide poisoning, or other toxic poisoning, may have to do blood perfusion, just, this grass-roots hospitals can not even carry out this technology, do a few days of hemodialysis effect is not good, transferred to the higher level of the hospital perfusion to do, and soon improved.
Another example, I still take the nephrology department to do comparison, came to an acute nephritis patients, may need to hormone congestion to have the effect, hey, grassroots hospitals do not have experience in this area of medication, a, in case of sudden death how to do, hey, that is a small dose in the use of family members to look at the treatment for a few days has not been good, and hasten to transfer to a higher level of hospitals to see that this is obviously to shock treatment, this time and the family to talk to, shock treatment has an effect, but there is a risk. Treatment has an effect, but there is a risk, there is a high probability of sudden death, but there is no better way, the family thought, have come to the big hospitals, and then can not be cured also have no way to treat on, and soon alleviate the treatment, oops, or a big hospital doctor technology is good.
The gap in equipmentLet's take an analogy, a recurrent chest pain episodes of patients, primary hospitals with CTA swept out highly suspected of being caused by coronary artery stenosis, but this is, after all, only a silver standard, I do not have an interventional room, that can only be used to dilate the vasculature of the drug, but this is the treatment of the symptoms do not address the root cause, the patient looked at, what is the use of it, will not be able to see the disease, immediately to the big hospitals to look at, ah, the doctor is also considered to be Coronary artery stenosis, what are you waiting for, immediately go to the interventional room imaging, which is the gold standard, imaging found that there is really a stenosis of the blood vessels, that well, installed a stent, the patient was discharged from the hospital and no longer chest pain, the chest is not stuffy, or a large hospital doctor technology cattle.
Summary: The above is just a simple list of points, in fact, is a combination of many factors, undeniable, large hospital technology is certainly better than the grass-roots hospitals cattle, otherwise there is no so many people flocked to the big hospitals to see a doctor, but it is difficult to solve the problem of access to health care, the state also vigorously implement the three-tiered diagnostic and treatment, and only three-tiered diagnostic and treatment of the role of the true, and only then it will be possible to improve the people's access to health care problems.The road has a journey,
The disease has a course,
It is not impossible,
The insider is the most clear.
As a general practitioner, I have worked in several tertiary hospitals, practiced in several county hospitals, and also worked in grassroots health centers, and I have a certain understanding of county and township hospitals, as well as provincial tertiary hospitals, and I'll talk about my personal views next.
Speaking of the overall level of medical technology, of course, is the three big hospitals than the county hospitals to be higher, this is not to question the fact that the three hospitals, whether it is talent, equipment and other aspects of the strength of the county hospitals can crush the township level, the provincial level of three big hospitals to bring together the provinces of the most outstanding medical talent, the most sophisticated medical equipment, the overall level of medical technology is of course, than the county hospitals to be higher. Now, even if you are a graduate, if you are not a famous university, no scientific research results, want to enter the three hospitals can not enter, so the big hospital doctors are basically postgraduate degree or more, the doctor is countless, and even a lot of them have the experience of staying in the ocean, the level of medical technology can not be high?
The level of county hospitals is also good, many county hospitals equipment is almost comparable to the three hospitals, a lot of good conditions of the county hospitals are almost all postgraduate level of doctors, of course, a little economically underdeveloped areas of the county hospitals and the three hospitals or a big gap, both in terms of equipment and talent gap is not small.
The level of township health centers is far worse, many township health centers lack of medicine, difficult conditions, low treatment of doctors, and work is also very heavy, the doctor in addition to seeing a patient is also responsible for public health, rural poverty alleviation and other work, take a meager salary, do a heavy work, how would the talent willing to go to the townships? Of course, the township also has its own positioning, the township is mainly responsible for providing residents with the most basic health protection, if the patient's condition requires, but also can be transferred to a higher level of hospitals, so that the positioning of the township health centers determine its overall level of hospitals than the county to be a little worse.
There is a big difference in the level of technology between different levels of hospitals. Dr. Howe's deepest impression is a few lung cancer, colon cancer patients, the local hospital doctors believe that there is no chance of surgery, recommended conservative treatment to prolong life. Later, the patients went to Shanghai and had successful surgeries, and several of them are still alive today.
Several of them are highly educated, and they have taken notes on their conditions and the treatment methods of the doctors in Shanghai, and brought them back to communicate with Dr. Howe, and they have benefited a lot from the experience.
Doctors need lifelong learning
A lot of diseases that were not well treated last year may have a breakthrough this year.
Like this old man, who used to have COPD and a lower-than-normal immunity in his lungs, was infected with a type of Nucella bacteria.
This bacterium is weakly virulent but has a high mortality rate! And is not sensitive to commonly used antibiotics, if not early and effective control of the mortality rate, even more than 30%. Fortunately, he was in the provincial hospital, respiratory doctors noticed that he had hypoproteinemia, taking into account this infection, increased sulfonamides and linezolid, and the condition improved significantly after a month:
If it is in a smaller hospital, due to the limitations of the level of technology, it is very likely to miss the opportunity for early treatment.
Don't listen to the rumors, listen to the professional guidance of the doctor.Every hospital has a backbone of business, and small hospitals have many masters of the art, so don't beat them all to death.
For example, many readers on the Internet said that the level of so-and-so hospital is not good, and resolutely can not go. The hospital's internal people, the most understanding of the situation with the company, which doctor high level of business, have a reputation.
Like this left lower lung cancer, 8.4 cm, many neighbors said do not cure, so big lung cancer certainly can not be cured, easy to people and money.
But the patient was operated in the local hospital, and it has been more than 5 years without recurrence:
The patient and his family have the right to know, no matter what level of hospitalization, the doctor will inform all kinds of information in detail. Overall the big hospitals are a bit higher level and more expensive, but it is not absolute. For example, for common stomach cancer, small lung cancer, small liver cancer, breast cancer, etc., there is no need to go to a higher level hospital if the local hospital can treat them. It is easy to take care of the treatment close to home and the reimbursement rate is high.
I am Dr. Howe in Imaging!
Some patients have actually been treated in county hospitals, because the families are too eager to heal, always complaining about the lack of results, the doctor is inexperienced, always changing the medicine, the disease is more and more serious, had to be sent to a higher level of hospitals. Superior medical look at the medical records, used drugs no longer use, minimize the scope of medication, the right medicine, the disease is well. My county hospital, a physician's son is sick, hospitalized for half a month, consultation many times, change the medicine also many times, the more serious the disease, had to be transferred to a local hospital to see the situation, do not dare to accept. Sent to the provincial hospital, the physician turned over the medical records, do check, hospitalized for observation, is not medication, regardless of how parents urged, only that observation observation, seven consecutive days without medication, the eighth day of discharge, the disease is cured.