Experts: Excessive treatment increases medical costs

At present, both doctors and patients worship the technology excessively, but I do not know over-examination and treatment of people harmful our reporter Shoshunan intern Le Lihong last week, China Economic Network, Sohu and other institutions issued a joint "National People's Livelihood series survey" shows that after the implementation of the new health reform, residents said that the "doctor expensive" problem slightly eased, But it is still the biggest difficulty in medicine. For the current medical treatment of the biggest problem, 44.3% of the Beijing-Shanghai Sui three city residents preferred "to see a doctor expensive."　　37.2% of the population's biggest wish for health care is to solve most of the medical costs and reduce the level of personal pay through Medicare.　　However, Professor Hu, director of the Heart Center of Peking University People's Hospital, a famous cardiovascular expert, said in an interview with the Chinese youth daily that to reduce the medical burden of the people, it is not necessary to reduce costs.　　Do a heart coronary artery CT scan, the amount of radiation equivalent to 750 X-ray chest film China Youth Daily: In your opinion, what is the basic procedure for doctors to treat patients? Hu: Roughly five steps: first, ask the patient's medical history in detail, communicate with the patient, this is also the most important step; second, the physical diagnosis, specifically divided into "hope"-to see if the patient has jaundice anemia, etc. "touch"-touch the patient's chest and abdomen; "Knock"-knock on his lungs and heart; "Listen"-　　is to use a stethoscope. Third, using some basic techniques to examine and diagnose diseases, for example, to do ECG, chest blockbuster, these techniques usually after many years of clinical use, the diagnosis is valuable and low cost; four, let the patient do non-invasive auxiliary examination, such as doing treadmill test, echocardiography, and finally, the patient to do CT (　　The short name of computer X-ray tomography, a fully functional detector-Editor's note, coronary angiography and other costly and traumatic examination. During my study in the United States, the biggest harvest was to see the diagnostic process. In fact, for experienced doctors, the first four steps to diagnose most diseases, the last step is completely unnecessary.　　But now many doctors in the process of diagnosing the cart before the horse, interrogation half, immediately let patients do CT, radiography, nuclear magnetic. Many doctors ignore the most basic things, rely too much on cutting-edge technology to solve common diseases and leave the suspects to precision instruments. When I was at a meeting with a senior title, I saw a doctor proudly saying that he hadn't worn a stethoscope in the last 10 years. I don't know how he became a cardiologist. As far as I know, not wearing a stethoscope diagnosis, is really not a separate phenomenon. I also heard a famous professor at a university say: "CT and radiography are like fluorescent lamps, and the stethoscope is like a kerosene lamp." Why should we abandon the fluorescent lamp and return to the time of the kerosene lamp?　　"I don't agree with that," he said. Now biomedical technology is developing rapidly, and doctors are far from the humanities and the patients. The problem of the doctor-patient relationship in our society is also related to some doctors ' neglect of the interrogation stage and the communication with patients. Doctors blindly rely on technology that will pull the diseaseMan's distance.　　China Youth Daily: Some people may feel very normal, since some advanced medical technology can replace the "hope, touch, knock, listen" and other links, then why waste time? Hu: Many people feel that CT, radiography and other examinations are harmless and can be done casually. In fact, these tests are costly, traumatic and can cause permanent injury to patients.　　For example, a coronary artery CT scan, radiation is equivalent to 750 X-ray chest film, which does not need to do CT examination of young people, especially young women, not only play a role, but also waste medical funds, more importantly, this will give patients a lifetime risk of cancer.　　This is called "excessive treatment", that is, patients do not need, and even bring about negative harm of the examination and treatment.　　In Germany, 95% of cardiac catheters are reused, and China is a one-off Chinese youth Daily: is "over treatment" common? Hu: Universal.　　The United States has, India has, China also has; 30 years ago, 10 years ago, and today. Two American medical experts published an article earlier this year, two extreme examples to illustrate "over treatment".　　One example is that a more than 50-year-old American male patient, in just 5 years, has done more than 50 cardiac angiography, replaced 27 heart stents-China's highest record is 13 brackets. Another example is a 48-year-old American woman who went to see a doctor because of a chest pain, first performed a CT scan, found a plausible lesion in the heart's coronary artery, and underwent a heart bypass. After bypass, the bridge blood vessel appears thrombus, the patient appears to shock, finally can only do heart transplant operation.　　In fact, this person was just suffering from anxiety disorder. There are also many "over treatment" phenomena in our society. About 80,000 people die from antibiotic abuse every year in our country, and about 200,000 die from drug abuse. Many people have a cold fever to go to infusion, the hospital is filled with intravenous infusion of people. This is absolutely invisible to the United States, Europe, India and Cuba.　　Now there is a noteworthy phenomenon, many elderly people, even if not ill, will regularly go to the hospital infusion, because they think, infusion can dilute the blood, to prevent cerebral thrombosis, which is actually harmful to the detriment. China Youth Daily: Why is there "over treatment"?　　What are the consequences of an "over treatment" phenomenon? Hu: First of all, we must understand the difficulties and confusion of some doctors. "Over treatment" is sometimes difficult to avoid, there are a lot of unknown areas of medicine, the specific reasons for many diseases are not clear. For example, 90% of hypertensive patients, we can not tell the specific reasons for the disease. For this reason, some doctors inevitably use unwanted technology.　　Some doctors are in charge of the patient's attitude, the net sprinkle slightly larger, in order to finally Laozhao fish. We can not ignore that the current traditional medical model is very easy for doctors to produce "scientism", "technology first" concept and biotechnology worship.　　For example, a young woman who is often bored and has a palpitation, the doctor may have two procedures for her diagnosis:Process one, the doctor purely from the biological point of view, advised her to do ECG, CT, radiography, but may eventually find patients are normal. So the doctor said, I use the most advanced technology to help you remove the coronary heart disease hat.　　But the result is that the patient's woes are not resolved, and the unnecessary tests give her a lifetime of cancer risk. Process two, if the doctor after training, not only will consider the biological factors of the patient's illness, but also consider psychological and social factors, may open the field of vision, out of the circle. He may find that she does not have a family history of coronary heart disease, and there are no other risk factors, the risk of coronary heart disease is very small. The symptoms are likely to be caused by anxiety and panic. If he took a scale to measure the patient, and then talked several times, he might also take off the hat of coronary heart disease and prescribe some medicine for the treatment of mental illness.　　In this way, patients to avoid a lot of costly, traumatic examination, and feel very warm, realize the "doctor-patient Harmony", but also cured the disease. In addition, "over treatment" has to do with the benefits of the health care system. Now many hospitals compare gross income, if a hospital bought CT machine, contrast machine, they will think, this machine must be used, how many years to recover costs. The department and doctor's bonuses are also directly linked to the prescribed medicines and checklists.　　If the doctor cannot complete the "target" assigned by the hospital, the bonus will be deducted. Another example is the heart bracket, a two thousand or three thousand-yuan bare metal stent, and a drug stent for tens of thousands of dollars. These two kinds of stents have advantages and disadvantages, different people, different diseases should choose different stents. In the United States, the proportion of 20%~30% is the use of bare metal stents, in Germany and Sweden, bare metal stent use ratio of about 50%. But the situation in China is that we use drug stents almost 100% of the way. Because the doctor may say, cheap is not good goods. For this issue, I have repeatedly proposed to reform, but it is still difficult to solve. Manufacturers sell two thousand or three thousand yuan bracket, profit space small, expensive bracket profit space.　　Hospitals, too, sell expensive stents, from hospitals to departments to individuals, to get more economic benefits.　　You may not want to face up to such a very grim fact-the existence of various interest chains, which ultimately hurt the interests of patients and public health, which I can not bear!　　China Youth Daily: It has been suggested that "excessive treatment" is also related to the blind reliance of the general public on technology, which also makes some doctors feel pressure, if there is no high-end technology, it is difficult to obtain patient trust. Hu: Yes. I see that many doctors think that the stent is the best way to treat some heart disease, many patients think so, do not put the stent he is not at ease. Both doctors and patients have an excessive admiration for technology. Especially the rich, the health care conditions are better, you do not give him the most expensive and the most advanced inspection he does not do. Now there are a few hospitals, not according to the needs of patients and specific conditions for physical examination, but to see how much the patient can pay, and then like packaging, to introduce you to various "grades" of the inspection.　　In fact, in the medical field, cheap is good goods, the key is to see what patients fit.Therefore, the problem of "expensive to see a doctor" is not only a problem of high medical costs, too much reliance on technology and "over treatment" for patients will also push up medical costs.　　We should love technology, but we must not worship technology blindly. In addition, medical consumables can not be reused, but also indirectly raise the cost of medical care. In Germany, 95% of cardiac catheters are used repeatedly. But in our country the cardiac catheter is all disposable.　　If the quality of consumables, including kidney dialysis supplies, can be standardized disinfection, processing-this has no difficulty in biotechnology, can avoid a lot of waste, reduce medical costs. Now, some European countries and the United States are considering the problem of reuse of medical equipment. Germany has fully implemented the repeated use of medical equipment, which in Germany is not only a disinfection technology, it has become the German environment-friendly, economical model of economic development. The United States has also put the issue on the agenda.　　No one in my country has discussed this issue. In China, the use of cardiac stents increased by 60,000 a year for 3 consecutive years, and the mortality rate of cardiovascular diseases in the common people increased year by century China Youth Daily: Over-reliance on technology not only pushes up medical costs, it does not necessarily have a good therapeutic effect. I see a Beijing cancer hospital statistics: 20 years ago, the diagnosis of gastric cancer through the fiber gastroscope, routine biopsy pathological diagnosis, such as only 440 yuan, and now the basic diagnosis needs 2830 yuan. The chemotherapy for gastric cancer averaged 100 yuan per person from 20 ago, raising the current 15050 yuan.　　But the 5-year survival rate of patients with gastric cancer declined compared to 20 years ago. Hu: A Finnish cardiologist and his team, in collaboration with local governments and businesses, have spent 35 years advocating a lifestyle change. For example, first advocated people eat bread gradually reduce the amount of butter, and then through legislation, against trans-fatty acid substances into food, and finally promote people to eat vegetable oil. After 35 years, people's life expectancy increased by more than 10 years, and coronary heart disease patients decreased by 80%.　　They found that the greatest contribution to longevity is not the heart bracket, not more drugs, but the mobilization of social resources to promote the health of the whole population. In China, the use of cardiac stents increased by 60,000 a year for three consecutive years, and the mortality rate of cardiovascular diseases in the people increased year by year. The key to reducing the morbidity and mortality of such diseases is prevention. The United States and Finland have done a survey, the death rate of myocardial infarction, the public's contribution to the decline in blood pressure accounted for about 24%, reducing blood lipids and cholesterol-lowering contribution rate of about 18%, the people quit smoking contributed about 12%, strengthen the movement accounted for the 6%~7%.　　The contribution rate of heart bracket and bypass surgery to the death rate is only 3%~5%.　　China Youth Daily: How can we fundamentally solve the problem of "excessive treatment"? Hu: To solve this problem fundamentally, we must start with the reform of medical education and medical service mode.　　Now University medical students, most of the study is biotechnology knowledge and skills, lack of humanities education. In today's medical school, we increasingly regard medicine as a biotechnology subject, epidemiology, preventive medicineLearning and other majors are separate teaching, and the students ' humanistic connotation is less.　　This is actually from the outset for the "scientism" and "technology first" concept of the curse. The current health care system also needs to be reformed. In Singapore, a doctor who makes more than 3 heart brackets must give a written explanation. If a doctor does not give a reasonable reason, or a more expensive bracket, his medical qualifications will be questioned. Singapore also prescribes which diseases to bypass and which diseases to make the stent, and if the patient was given a stent, the doctor must also explain the reason in writing. If it is not clear, health care will be refused fees, doctors may be disqualified from practicing medicine. In these respects, our country's related policy needs to be perfected urgently.