Rural health workers are mostly locals, and everyone knows them from Dongzhuang West Village. In this acquaintance society in the countryside, we can't completely follow the rules, but we still have to take care of the relationship. In fact, the competition in the rural medical market is also very fierce, and outsiders are not allowed to intervene in anyone's territory. However, if the patient has a good impression on a doctor from another village and thinks that he is of high level and must see him take an injection, then he can only listen to the patient. In particular, some elderly patients with chronic diseases are old and weak, and they are inconvenient to move. Under normal circumstances, village doctors are on-site service.
Now that the traffic conditions are good, many families have cars, and most of them go to the hospital to see a doctor. Only those who have a headache and brain fever can get some medicine in the village. Although the reimbursement is not much, it is more convenient and affordable than going to the hospital. Faced with this situation, village doctors also tried their best to hold patients and prevent the outflow of financial resources. Visiting is one of the ways. As long as they take over first, patients will be embarrassed to find someone else. If you need to go to a hospital, the village doctor will recommend which hospital you go to and which doctor you want to see, and sometimes you will accompany you personally, with a very good attitude.
It is said that village doctors are not allowed to make house calls in some places, and they should wait for patients to come to the clinic. In rural areas, this is a bit divorced from reality. It should be based on the principle of convenience for patients, and rules and regulations should not be divorced from rural reality.
Health workers in our village make house calls. They prefer to make house calls rather than help people in clinics.
In 2006, there were three health workers in our village clinic, also called doctors. They are all from the village, two attending doctors and one intern. One morning, I suddenly lay in bed and felt dizzy and nauseous. My wife went to see one of the doctors at once because they were not far away. The doctor arrived in less than 10 minutes, and the doctor said it. I didn't understand it at that time, saying it was the best medicine for treating cerebral blood supply deficiency. Acanthopanax senticosus, mixed with 2 bottles of water, a total of 3 bottles of water, 80 bottles of water and 240 bottles of water. I hung up for 7 days in a row, and when I checked out, I said, I'll give you a box of the best medicine. It's called Xipilin, 65 tablets per box, 1 box 65438. I bought it at another doctor's house, because both of them sell medicine. When I arrived, I gave the name of the medicine. Because I knew the price the doctor sold me before, I gave him 100 yuan, and he asked me for 75 yuan. I said it was a wrong number. He said no, 25 yuan has a box. Didn't I give him 75 yuan change? I looked at the medicine box at that time, the same manufacturer, the same specification, 12 capsules, but the price was different. I stammered out my question at once. The doctor said that private treatment is not that expensive. Isn't my 25 yuan just to earn your money? Only then do we know that the same medicine has different prices.
Because dizziness is a chronic disease, it took several years to get better. One year, I was working in Jiangning, Nanjing, and I was very dizzy. I went to the local community health service station. I was a female doctor at that time. She told me that the disease was no big deal. Just pay more attention. Don't suddenly sit up and turn over in bed in the morning. Don't look up at the sky Drink more ginkgo leaves for me.
Therefore, getting up early is not good. Health workers in our village like to make house calls. A small cold can give you water for a week, and then you will be pushed to a big hospital. If you don't have a fever and your illness doesn't get worse, he will be willing to come to your house every day for a year, so that he can make money. Because we are a plain here, every production team is next to the village clinic. A few minutes' walk will cost ten cents for medicine. Therefore, the health workers in our village like to make house calls most, and they have not changed until now. . .
National laws clearly stipulate that doctors can only practice medicine in registered medical institutions, otherwise it is illegal to practice medicine.
It is convenient for the masses to see a doctor, but if something really happens, illegal medical practice will bear criminal responsibility.
Besides, even if the doctor visits, he can only look at it, which doesn't make much sense.
Facilitate each other and put yourself on the verge of breaking the law. The doctor-patient relationship is so bad now, forget it.
This problem is very practical, and similar situations often occur in rural areas of our country, sometimes causing great disputes and contradictions.
In order to be reasonable and legal, we must first see whether the rural health workers who don't want to make house calls have registered and obtained the practice certificate. If he is not qualified to practice, then he is law-abiding if he does not make house calls, and there is nothing wrong with it. If the rural health worker is registered to obtain a practicing certificate, then he is at least suspected of breaking the law if he does not make house calls.
Let me talk about the second situation. What should I do if I don't make a house call after obtaining a practicing certificate after registration?
Visiting is the legal obligation of rural health workers.
According to the fifth item of Article 24 of the Regulations on the Management of Rural Doctors, rural doctors should fulfill the obligation to publicize health care knowledge and educate patients to villagers.
This paper shows that rural health workers should not only make house calls, but also have the obligation to publicize health care knowledge and health education to villagers.
Visiting is the duty of rural health workers.
Article 25 of the Regulations on the Management of Rural Doctors stipulates that rural health personnel have the obligation to visit villagers frequently, and on the one hand, they should assist relevant departments to do a good job in primary health care services; On the other hand, the epidemic situation of infectious diseases and poisoning incidents should be truthfully reported and reported in time.
Referral is the work scope of rural health workers.
Article 27 of the Regulations on the Management of Rural Doctors' Practice stipulates that rural doctors should truthfully introduce their illness to patients or their families, and refer patients who are beyond the scope of general medical services or cannot be diagnosed and treated in time due to medical conditions and technical level; In case of emergency, if referral is impossible, first aid should be given, and medical and health institutions with rescue conditions should be asked for help in time.
What kind of administrative punishment will be imposed for refusing door-to-door service?
Article 38 of the Regulations on the Management of Rural Doctors stipulates that rural doctors who violate the provisions of these regulations in their practice activities shall be ordered by the health administrative department of the people's government at the county level to make corrections within a time limit and give a warning; If it fails to make corrections within the time limit, it shall be ordered to suspend its practice activities for more than 3 months and less than 6 months; If the circumstances are serious, the practice certificate of rural doctors shall be withheld by the original issuing department.
Where do villagers complain when they refuse door-to-door service?
Article 35 of the Regulations on the Management of Rural Doctors' Practice stipulates that the health administrative department of the county-level people's government is responsible for inspecting the practice of rural doctors, collecting villagers' opinions and suggestions on their professional level and work quality, accepting villagers' complaints against rural doctors, and making a summary analysis.
The summary and analysis results and the training of rural doctors will be the main contents of the assessment of rural doctors.
Considering that rural health centers can shield each other's officials, it is suggested to go to the county health bureau (now the county health and health Committee) to complain.
Conclusion: As long as a rural health worker has a practicing certificate, it is his legal obligation to make a house call. Refusing to make house calls will be subject to administrative punishment, and villagers can complain to the county health bureau.
Do you agree with me?
Don't village health workers make house calls? What if I don't make house calls?
I used to be a doctor in the countryside. There are all kinds of people in the country. At that time, there were no telephones in the countryside. Every time I make a house call, I have to walk on one leg for hours. I am very tired at the end of the day. Sometimes when I'm gone, someone is waiting to see a doctor at home. Sometimes it is normal for people to stop visiting. Some people are young and sick, but they have to wait until the doctor comes home. The traffic is convenient now, and no one is leaving. Then, who will recognize the oil fee generated by the house call, even if you pay the oil fee?
Let me give you an example. There is a Chinese massage doctor in Chengdu Affiliated Hospital of Traditional Chinese Medicine, who is very skilled. Many rich people said to him: do more time, money is not a problem. The doctor said: Ask the patients in the back line, do they agree? They all agreed. Who would agree? It's time for the teacher to get off work and wait until tomorrow. Are you the only one who feels sick? Should others feel pain? Why others have to wait so long. I think the teacher is fair. Everyone has 10 minutes, even if everyone has 10 minutes, they should work overtime after work hours to complete the number signed on the same day. Doctors are people, not machines. Also need to rest.
Doctors in rural areas sometimes stay up late to rescue emergency patients. At that time, I was young and could eat, but when I was old, I wouldn't make house calls.
The transportation is convenient now. If rural doctors don't make house calls, you can send them to rural clinics or hospitals. It must be based on saving people.
There must be a reason why rural doctors don't make house calls, both men, women and children, and they are far away. There are mountain roads and peace roads.
Especially now with rural medical insurance, everyone has to keep a lot of records, which is much more complicated than before. If there is a shortage of doctors in your area and the coverage is wide, it is normal for doctors to be too busy. Understandably, only doctors who have worked in the countryside know this kind of pain.
It shouldn't be illegal for rural doctors not to make house calls! Although it is the responsibility of medical workers to heal the wounded and rescue the dying, it also depends on whether doctors have the ability to serve everyone well and satisfy everyone's hearts.
I don't know if the answer given by Chinese medicine practitioner Yu Si is correct. Please forgive me if there is anything wrong. There's no need to struggle with these things.
This problem should be discussed from the medical conditions in various regions!
In areas with good medical conditions, patients generally try to choose good medical institutions for treatment. Many patients can't see rural health workers. Is it necessary for rural health workers to make house calls under such circumstances?
If it is an area with poor medical conditions, there are two situations in which rural health workers cannot make house calls.
There is a patient whose condition is mild and it is impossible to call a doctor to see a doctor at home. The patient is also embarrassed to bother the doctor, so he'd better see a doctor himself!
Secondly, for patients who are suddenly seriously ill and have no ability to take care of themselves, the general family members look for rural health workers and doctors have to make house calls.
If the village health worker doesn't make house calls for some special reasons. At this time, the seriously ill family members will lift the patients and carry them back to medical institutions for treatment!
Just look at what the county community clinics are doing: meetings, publicity, filling out forms, mobilization and telephone interviews. . . . The workflow of rural health workers in the future is nothing more than this. . . Visit or not? Now that the government is unified in management, there will definitely be supervision calls.
It used to be called "please sir" to call a doctor home, but now it is called "please doctor". A phone call, whether it is day or night, whether it is cold or hot, has become the habit of rural doctors to carry medicine boxes with them and make house calls at any time. When visiting, rural doctors never complain that there is no money for visiting, but only expect patients to be safe.
Xinmi city fuwenna
Rural doctors at the grassroots level not only serve people in their own villages, but also serve people in neighboring villages and even Shili villages.
As a special group, I met some old, weak and disabled patients. I think every colleague has had the experience of making house calls. However, the Law on Medical Practitioners clearly stipulates: "Individual medical institutions are not allowed to make home visits, and medical practice places must be in their own institutions. Otherwise, it's illegal, and it's beyond the scope of business, and it can be closed for rectification or fined ... "So, in the face of the needs of the masses, should our rural doctors make home visits?
For a simple example, grandma Zhang in the village has been paralyzed in bed for more than five years. In the past five years, whenever Grandma Zhang has a headache and a fever, as long as Grandpa Zhang calls, I will ride my bike to their home to see Grandma Zhang. A few days ago, I saw a patient in the village health clinic. Grandpa Zhang called and said, Come and see! Your grandmother is dizzy and sick ... "If I don't go right away, Grandma Zhang will be very uncomfortable. However, there are still several patients waiting to see a doctor! Fortunately, several reasonable patients seemed to see through my mind and agreed that I should go and see Grandma Zhang first.
When I arrived at grandma Zhang's house, I carefully finished four vital signs tests for her, and the initial diagnosis was dizziness. Considering grandma Zhang's weak constitution, I suggest that she go to the hospital for a check-up so that she can receive regular treatment. Hearing that he was going to the hospital, Grandpa Zhang said sadly, "In recent years, your grandmother Zhang's illness has almost spent all my money. I believe you, just give her rehydration at home! " Listening to Grandpa Zhang's almost pleading words and watching Grandma Zhang sick in bed, my heart melted and I agreed to let my brother send the infusion medicine to Grandma Zhang's house. I gave grandma Zhang an injection, adjusted the dripping speed, observed for more than ten minutes, and made sure that there were no adverse reactions before riding a bicycle and quickly returning to the village health center.
About an hour and a half later, Grandpa Zhang called: "Your grandmother Zhang is flustered and has chest tightness. Come and see! " With a stethoscope, a sphygmomanometer and a first-aid needle, I boarded my bike and rushed to Grandma Zhang's house. It turned out that after I left, Grandpa Zhang's son felt that the infusion speed was too slow, so he adjusted the drip speed up. I quickly adjusted the dripping speed until the infusion was over and grandma Zhang's dizziness and nausea were relieved, and I was relieved.
When I got home, my husband shouted at me angrily, "How many times have I told you? The leader said that infusion in the village health center is a formal medical treatment, and home visit infusion is not protected by law! No house calls, but soft-hearted However, in the event of a medical accident, patients and their families will not be soft! " I know my husband is right, but I also feel wronged.
When I mentioned making house calls, my good friend who was practicing medicine in Zhoukou told me, "Wen Na, a patient in a neighboring village was cut by a sickle and asked me to dress it. To tell the truth, my hand was scratched a few days ago, and I don't want to go until I get well. However, when I say I'm a little busy, people call me a big shelf! After I went there, my hands were polluted by the patient's blood despite my special attention. Later I heard that he was a patient with chronic hepatitis. If I am infected, who will be responsible for me? "
Speaking of whether rural doctors should make house calls, He Chuanyi, an outstanding national rural doctor in Kaifeng, told me on the phone: "You can make house calls and see their symptoms. If you encounter patients with mild symptoms, just give them a little oral medicine. But I certainly won't give them infusion in their home, because some patients will have allergic reactions or adverse reactions when infusion is done in front of us, let alone in their home. When I make house calls, I usually don't accept four kinds of patients, that is, too young, too old, with serious chronic diseases, and arrogant and hostile. When I meet these kinds of patients, I advise them to go to the hospital for treatment. It's not that I don't want to see it Everything is for the' safety' of rural doctors themselves! " My husband and I agree with He Chuanyi.
When talking to me about this problem, Xinzheng's old classmate said with a smile: "These days, rural doctors are afraid of making mistakes when they make house calls, and they are afraid of offending people if they don't make house calls! We also clearly stipulate here that rural doctors cannot treat patients beyond their own scope of diagnosis and treatment. If they make house calls privately, they will have to bear the consequences if something happens. I am an obedient rural doctor, but I have become a rigid person in the eyes of patients. My relatives also advised me to be flexible and not to walk into a dead end, so as not to offend people and make no money. I'll see the situation later! Anyway, when I meet a seriously ill patient, I dare not look at the horizon! "
A classmate in Zhejiang said: "A village doctor there went to the patient's home for an infusion. There was nothing unusual a few days ago, but during the third infusion, the patient suddenly fell into a coma. Although the village doctor gave the patient a cardiotonic soon and dialed 120, he still failed to save the patient's life, and the village doctor paid a heavy price for it. Therefore, I said that I would not make house calls. "
What do you think after listening to the voices of the above colleagues? Should rural doctors make house calls? Who will be the "patron saint" of our rural doctors in case we encounter some unexpected situations when making house calls?