Is it reliable for a doctor to receive 250,000 visits online
Misdiagnosis, white diagnosis, AI prescription and other Internet diagnosis and treatment chaotic phenomena occur frequently, and the national regulatory policy continues to tighten
● In recent years, ? The Internet + medical health? The development is rapid. By the end of 2021, the national Internet hospital has reached more than 1700. Along with this, misdiagnosis and white diagnosis, first medicine and then prescription, AI prescription, diagnosis and treatment accidents and other chaotic phenomena have become a buried in the industry? The first time I saw this, it was a very good thing that I was able to see it.
● Patients? The first time I saw a lot of people in the world, it was a very good time to see a lot of people in the world. The first time I saw this, I was able to see a lot of people who had been in the hospital for a long time, and I was able to see a lot of people who had been in the hospital for a long time. The first time I saw this, I had to go to the hospital to see the doctor, and then I had to go to the hospital. Some diagnose it as "mouth ulcers caused by tongue infection", while others diagnose it as "mouth inflammation". The mouth is inflamed. and some say it is? The first thing you need to do is to get rid of the problem and get out of the way.
● The doctor with the highest number of online consultations on a platform had 250,000 consultations. Assuming an average of 10 minutes of online consultation time per person, the online consultation time is about 41,667 hours, if the whole year, 10 years for 3650 days, then the average daily online consultation time of about 11.4 hours in the 10 years
● Clearly the status of the main body of artificial intelligence, such as artificial intelligence and other automatic generation of prescriptions only by the health care institutions are directly held accountable; improve the traceability system of medicines, make full use of the QR code to identify the main body of the medicine, and then the medical institutions are not responsible. The system of traceability, make full use of the two-dimensional code recognition function to do a good job of reviewing online prescriptions, to ensure that the regulation of traceability
? In the end, which doctor is right?
Earlier this year, Xia Liang, who lives in Changde, Hunan Province, was plagued by mouth ulcers for some time,? A lot of white skin appeared in his mouth and it hurt to drink water? Affected by the epidemic at the time, he decided to find the cause of the disease and solve the pain through online consultation.
However, the few doctors he consulted gave several completely different diagnoses, which confused Xia Liang and raised questions about the accuracy of online consultations.
This is not an isolated case. According to the China Internet Network Information Center released this year, the 49th "China Internet Development Statistics Report", as of December 2021, China's online medical user scale reached 298 million, an increase of 38.7%. And with the rapid development of Internet diagnosis and treatment, misdiagnosis and white diagnosis, first medicine and then prescription, AI prescription, diagnosis and treatment of accidents and other chaotic phenomena have also come, becoming a buried in the industry of a ? The first time I saw this is when I was a kid, and I was a kid, and I was a kid.
In response to the above problems, regulatory initiatives to plug leaks and remove mines continue to advance. From 2018, the National Health Commission, the State Administration of Traditional Chinese Medicine promulgated the "Internet Diagnosis and Treatment Management Measures (for trial implementation)" to make clear provisions for medical institutions to carry out follow-up consultations online, to the recently announced "Internet Diagnosis and Treatment Supervision Rules (for trial implementation)" to ensure that? The Internet Diagnosis and Treatment The newest addition to the list is the newest addition to the list, the newest addition to the list, the newest addition to the list, the newest addition to the list.
Online diagnostic misdiagnosis is frequent
Xia Liang to the "Rule of Law Daily" reporter recalled that he was online diagnosis of the first doctor, is a tertiary hospital stomatologist. To the other side have seen the self-timer's oral photos and text description of the symptoms, the doctor diagnosed as ? Mouth ulcers caused by fire? The doctor said that the mouth ulcers are caused by fire. Eat some anti-inflammatory drugs, drink more water, good rest will be fine? The first time I saw this, I was able to get a prescription for an anti-inflammatory drug, and I was able to get a prescription for an anti-inflammatory drug offline.
After 3 days of taking anti-inflammatory medication as prescribed by the doctor, there was no improvement, so Xia Liang chose 3 doctors to consult on the other two platforms. Provided graphics and before the same, but got a different diagnosis: some doctors think it is ? Tongue inflammation caused by mouth ulcers? The doctor diagnosed it as? Oral inflammation? and others claimed it was a Candida infection. Candida infection?
These three doctors have prescribed different medicines for him, making Xia Liang confused.
He did not dare to take the medicine easily, and then went to the city to an offline hospital, diagnosed as: Candida infection caused by antibiotics. The condition was relieved with the right medication.
A senior doctor at a stomatology hospital in Beijing told reporters that Candida infection is actually not difficult to determine for stomatologists, the reason why? The same graphic, the diagnosis is inconsistent?
? Stomatologists offline consultation, in addition to observing the oral cavity, asking about the condition, but also press, touch, comprehensive judgment results. The online consultation doctor can only rely on the graphic, it is difficult to accurately judge, not to mention the prescription.? The doctor explained. In his opinion, patients in the network consultation can be uploaded offline hospitals to take the film, issued a pathology report for review, re-diagnosis or consultation, but not the first diagnosis.
In recent years, ? Internet + medical health? rapid development. From the Internet hospital to clear common diseases, chronic disease patients Internet consultation can be reimbursed by the health insurance, from the online sale of drugs to the core diagnosis and treatment to the Internet health insurance, the introduction of programs to actively support the comprehensive development of online health care, building a solid foundation for the growth of online medical user scale.
At the same time, it's not uncommon to see people like Xia Liang consulting a number of doctors online for the same condition, but getting a variety of diagnoses.
Zhang Xingze, a third-year student at a university in Beijing, describes himself as a? The first time I've seen this, I've seen a lot of people who love to be sick. The first time I've seen this, I've seen a lot of people who are not familiar with it," he said.
The deepest impression is that he had some small red spots on his skin, which were itchy and itchy, and in order to solve the problem quickly, he opened an online consultation app and picked a dermatologist who was very specialized in dermatology. The labeling is very professional? The doctor, spent 109 yuan for graphic consultation. As a result, the doctor told him that he might be suffering from a skin disease and suggested buying the appropriate medication for treatment. Later he went to the offline hospital for a detailed examination, the result is to eat pineapple allergy.
? Online consultation is convenient, but the description of the disease is generally limited to text and pictures, easy to misdiagnosis or diagnosis of the situation of white diagnosis. The first thing you need to do is to get a good idea of what's going on in the world," he said.
A number of industry insiders interviewed agreed that? The first time I've seen this, I've seen a lot of it. Diagnosis and treatment is not suitable for all patients, common diseases, chronic diseases of the follow-up, is a long time since the positioning of the Internet diagnosis and treatment. However, the industry has always lacked specific standards for what constitutes a repeat visit, leading to some regulatory vacuums.
First choose drugs and then prescriptions AI prescription patients to buy drugs
In addition to diagnosis, the purchase of prescription drugs is ? Internet + healthcare? Another feature of the convenience of the people. However, the reporter found in the investigation, some Internet medical platforms are using ? First shopping for drugs, and then due to the drug formula, and even by artificial intelligence software automatically generated prescription? The way of operation.
Xie Li, who lives in Huaihua, Hunan Province, had bought Pudilan Anti-inflammatory Oral Liquid for her 4-year-old child from an offline hospital in early 2020, when the doctor issued a prescription for it. In March of this year, due to the child again appeared similar symptoms, she tried to buy this drug in an online drug purchase platform, she was soon transferred to the platform side? Online medical advice? section. After she uploaded her prescription from two years ago, she was transferred to the online consultation section of the platform. The physician? immediately sent her a link to buy.
The reporter recently placed an order for prescription levofloxacin capsules on a drug-buying platform, and the platform prompted? Please select the line has been diagnosed disease? Reporters in? Disease column? randomly checked a few items,? Prescription / medical records / examination report column? were empty, and confirmed that ? has been diagnosed with this disease and used the drug, and no history of allergies, no relevant contraindications and adverse reactions? , quickly passed the validation, after submitting the list, the system jumped to the consultation section.
A few seconds later, a? received several messages in a row, the first of which emphasized that? The first of these messages emphasized that Internet healthcare only provides medical services to repeat users. When the reporter replied? No? The first one is to make sure that you have a good understanding of the situation, and that you have a good idea of what you are doing.
Yang Mu, a Beijing resident, also had such an experience, and he wondered if it was really a licensed physician behind the screen: ? In? When buying prescription drugs on the platform, it feels like there is no difference between the other side and the robot, as long as the typing is past, the other side will quickly agree within 10 seconds, without giving any professional advice at all.? The first time I saw this, I was able to see the other side of the coin, and I was able to see the other side of the coin, and I was able to see the other side of the coin, and I was able to see the other side of the coin.
Some people in the Internet healthcare industry suggest that if a regular Internet hospital, a licensed doctor issued an electronic prescription, there should be a doctor's signature, the Internet hospital electronic chapter. It is not excluded that some small Internet medical platforms still exist with artificial intelligence, robots and other tools to automatically generate prescriptions, some large platforms will use AI and so on to assist the doctor to ask the diagnosis, such as asking the patient how old he is, where he is not feeling well, etc., but the prescription must be required for the doctor to open.
Deng Yong, professor of law at the Beijing University of Traditional Chinese Medicine, told reporters that in order to ensure the safety of patients' medication, previously China's "prescription management approach" "medical institutions prescription audit norms" are clearly stipulated that physicians in the diagnostic and therapeutic activities for the patient after the prescription, the pharmacist to audit, but the relevant norms do not have to be on the ? Auto-generated prescriptions? This behavior is expressly prohibited.
? The law does not prohibit can be. The specification is not clear, the local practice will be chaotic. In reality, some platforms choose to ?AI prescribing, customers directly pick up drugs? s model, skipping the traditional prescription issuance and review process, turning prescriptions directly into ? Selling drugs. This type of behavior is a serious violation of China's drug management system, but also to the safety of patients with medication buried the risk of hidden danger. Deng Yong said.
Whether the huge number of consultations is real online doctor who to regulate
For online consultation, the doctor answered a few times is considered a complete consultation, the platform on the display of the doctor's consultation volume there is no false standard, the response to the patient's diagnosis of the content of the doctor's real response? The reporter randomly interviewed more than 10 people in Beijing, Tianjin, Hunan and other places and found that these are also the main problems plaguing them.
Hao Cherry, a sophomore at a university in Beijing, knows this well. She often use online medical consultation, but so far it is not clear how many questions the doctor answered to reach the standard charge. In the beginning, there are a few questions counted as free advice, but as long as you talk, even a question, such as a thank you or hello. When the free times run out, the doctor is just getting to the point, and in order to learn more, you have to pay for a membership. After paying the money, the doctor will ask for lab results and other information. The first thing you need to do is to get your hands on some of the most popular products and services in the world, and then you'll be able to get your hands on some of the most popular products and services in the world.
Before the online consultation, the first platform to see which doctors receive more, and then determine which doctor to ask, which is a resident of Qufu, Shandong Province, Zhang knife knife used to practice, because in her view, the doctor received more means that their medical skills are strong and popular with patients. However, she noted that some online medical platforms are often labeled with tens of thousands or even hundreds of thousands of doctors, and she could not help but question whether these data are true.
Reporters in an online consultation platform to dermatologists as the object of search, found that the platform online dermatologist with the highest number of consultations for 250,000 times. Assuming an average of 10 minutes per person online consultation time, online consultation time is about 41,667 hours, if the year round, 10 years for 3650 days, then the average daily online consultation time of about 11.4 hours in 10 years.
For these issues, a platform related person in charge told reporters that over the years they have actually been exploring? quality control?
? The core issue is who is responsible for the diagnosis made by doctors online. Offline hospital doctors, supervised by the local health commission, hospitals and departments will also be standardized management; and online doctors, is relatively independent.? The aforementioned senior doctor of a Beijing dental hospital said.
Regulatory policies have landed one after another to better ensure the quality of diagnosis and treatment
Internet diagnosis and treatment appeared to be a large-scale growth began in 2018, which is the year the General Office of the State Council issued a report on the promotion of the ? Internet + medical health? Development Opinions", aimed at improving the modernization and management of health care. By the end of 2021, there were more than 1,700 internet hospitals nationwide.
Over the years, in order to regulate the behavior of Internet diagnosis and treatment, "Internet diagnosis and treatment management measures (for trial implementation)," "Internet hospital management methods (for trial implementation)," "remote medical service management norms (for trial implementation)" and other normative documents have been introduced, on the Internet diagnosis and treatment services involved in the qualification of medical institutions, practitioners qualification, equipment and facilities to ensure that the service process standardization requirements. In particular, in June this year, the National Health Commission and the State Administration of Traditional Chinese Medicine jointly formulated the "Internet diagnosis and treatment supervision rules (for trial implementation)" after the release of the public expectations.
The rules address social concerns such as prescription review, privacy protection, and quality control of diagnosis and treatment in Internet diagnosis and treatment.
For the Internet can see what disease, the rules require that must meet the conditions of re-examination: patients should be provided with a clear diagnosis of the medical records, such as outpatient medical records, inpatient medical records, hospitalization, discharge summary, diagnostic certificates, etc., by the receiving physician to retain the relevant information, and determine whether to meet the conditions of re-examination. When there is a change in the patient's condition, this visit is judged by the physician to be the first diagnosis or there are other circumstances that are not suitable for Internet diagnosis and treatment, the receiving physician should immediately terminate the Internet diagnosis and treatment activities, and guide the patient to the entity health care institutions.
Deng Yong believes that these standards are more operable and give doctors more professional authority, further clarifying the service boundary, regulatory boundaries, and is conducive to the standardization and standardization of Internet diagnosis and treatment services.
Whether the quality of online diagnosis and treatment is consistent with offline diagnosis and treatment, the rules give a positive answer: the requirement of physical medical institutions as the basis for the Internet diagnosis and treatment into the overall health care service supervision system.
For those who don't have a prescription to buy prescription drugs, the rules strictly prohibit? The first drug after the prescription? Prescription drugs should be sold, transferred and used with a physician's prescription. It is strictly prohibited to provide medicines to patients before the prescription is issued.
This is especially worth recognizing in the view of Deng Yong, ? In line with the current Internet diagnosis and treatment? Return to serious medical? The company's website has been updated with the latest information on the latest developments in the industry, including the latest news on the latest developments.
This is the first time I've ever seen the Internet.
He also pointed out that to make? s provisions into practice, multiple factors must be considered, such as the status of subjects such as artificial intelligence should be clarified,? Although we call it artificial intelligence, but it is the same as some physician assistants, are not given the right to prescribe the subject, the current "prescription management measures" "medical institutions regulations" relevant provisions are still insufficient, the target of punishment is limited to ? personnel? Subsequent revisions should take into account the specificity of subjects such as artificial intelligence, and the automatic generation of prescriptions only by artificial intelligence, etc. should be compared with the ? Use of non-health technicians? the same as the medical institutions are directly held accountable?
Deng Yong believes that the rules of responsibility should also be clarified.? Currently in the process of Internet diagnosis and treatment, the rights and responsibilities between medical institutions and physicians are still adjusted through the contract, there is no clear legal provisions. For the multi-spot practice of physicians, in the contract signing process, medical institutions are often in an advantageous position, if the contract agreement? Improper prescription caused damage, after the medical institution compensation should be mainly borne by the physician?
Improving the drug traceability system is also indispensable. Deng Yong proposed that the relevant departments should increase the audit of the authenticity of the source of the prescription, the source of the prescription to establish a strict review system, improve the laws and regulations on the source of the prescription. Take advantage of the Internet and make full use of the QR code recognition function to do a good job of reviewing online prescriptions. At the same time, complete retention of transaction records and transaction evidence to ensure that regulation can be traced back to its roots.