The author of this article: Tun Tun
Complaint calls are probably the TOP 3 phone calls that doctors don’t want to receive.
“Doctor, why are you talking so loudly! What attitude!”
This is the 4th time that Dr. Wang has received such a complaint this month. In the rehabilitation department where the elderly are mainly concerned, Xiao Wang unconsciously developed the ability to speak loudly because he was worried that the elderly could not hear clearly. habit.
“Doctor, speak louder, I can’t hear you at all.”
This is the 5th time that Dr. Wang has received such a complaint this month. Since he was deducted from the medical department for speaking loudly, Xiao Wang will deliberately control his volume when he goes out of the clinic.
Dr. Xiao Wang, who was trapped in the complaint, muttered for the 365th time this month: I have never neglected any case, why is it still being complained by a patient?
“Silenced” patients
The patient who complains aggressively on the other end of the phone is actually the absolute weakest in the medical service. During the entire medical treatment process, the doctor is the one who leads the whole process, and the patient is almost “invisible”.
Bearing the brunt of the problem is that patients have limited knowledge of medical care and are unknowingly excluded from the discussion of diagnosis and treatment.
After eight years of medical education and clinical work, doctors have long understood that there are limits to what medicine can cure. However, for patients, under the influence of a large number of drug advertisements and case propaganda, they have too high expectations for “cure”.
In a study of 1,139 lung and rectal cancer patients, 69% of lung cancer patients and 81% of colorectal cancer patients were unaware that chemotherapy could not cure their cancer at all .
Treatment in the way the patient expects may not necessarily be the best outcome. In 2012, a study published in JAMA showed that among the most satisfied patients, total health care expenditures increased by 8.8%, over-the-counter prescription drug expenditures increased by 9.1%, and patient mortality was also higher.
As a result, in order for patients to give up their beautiful fantasies and accept a suitable diagnosis and treatment plan, sometimes doctors have to exert a little pressure to persuade patients to cooperate with treatment.
As for this diagnosis and treatment plan, how the doctors scratch their heads and how to operate cautiously on the operating table, patients who do not know much about medicine may not be able to feel it.
On the other hand, the development of modern medicine has given the right to speak to instruments and data, and the patient’s expression is almost invisible.
Before the development of natural science, the subjective feeling of the patient was the center of medicine, and the pain of the patient was the reason for medical intervention. Adequate communication between doctors and patients is not only for extracting disease-related information from patients’ narratives, but also for comforting and encouraging patients.
After the 16th century, medicine led by the West entered the era of “science”, and instruments almost completely changed the dialogue between doctors and patients. With the help of stethoscopes, sphygmomanometers, CT and other instruments, doctors can more intuitively observe the morphological changes of organs and quickly locate the problem.
It is also the development of science. Today’s doctors are faced with laboratory reports. The diagnosis of diseases depends on the comparison of the reported data with the standard values, and the judgment of surgery or not. It is based on indications. Behind these data, patients’ feelings as “people” are gradually marginalized with the development of technology.
In the hospital, there is no very clear and convenient channel for patients to express their displeasure. If you are not satisfied with eating in a restaurant, you can find a waiter, a manager, a boss, or a consumer association. In the hospital, patients do not know who to complain to, and in the end they can only call the mayor’s hotline 12345 to be transferred to the specific department of the hospital.
The “Measures for the Management of Complaints in Medical Institutions” issued in 2019 stipulates that medical institutions above the second level should set up a doctor-patient relationship office or designated departments to uniformly undertake complaint management.
“Medical Institution Complaint Management Measures”
Being separated by the barriers of medical knowledge, personal subjective expressions are also replaced by data, all kinds of grievances and helplessness have nowhere to tell. When the other end of the complaint phone asked, “What problem did you encounter?”, a thousand words could only be summed up in one sentence:
“The doctor here is so bad!”
Why is it so hard to “have a good attitude”?
“China Doctor-Patient Relationship Survey” shows that poor service attitude is the main reason for patients’ dissatisfaction with doctors, accounting for 51.4%.
Wanting to have a “better service attitude” is not just hypocritical. When describing the disciplinary attributes of medicine, “Cambridge History of Medicine” said, “Medicine is the most human in the natural sciences and the most scientific in the humanities.” Since its birth, the dual attributes of natural sciences and humanities of medicine mean that while diagnosing and treating diseases, patients should also be given spiritual, psychological, emotional and other care.
But for doctors, a bad attitude is not intentional, it’s just “Too busy” workload had to make some trade-offs.
Especially in the top three, a doctor sees 40 to 50 outpatient visits in a single day, and sometimes even sees 70 patients a day. According to the normal working hours from 8:00 to 12:00, even if only 40 patients are seen a day, the average admission time for each patient is 6 minutes. Many patients have to follow up after getting their test results, which means extra time. Therefore, the time for a single consultation is likely to be divided again.
In order to be able to see more patients, doctors can only sacrifice some aspects such as greeting each patient, explaining the condition, and comforting each patient. And these cut-off times are precisely what the patients look forward to most.
From the patient’s point of view, going through a hasty medical treatment process, you will feel that you have not been taken seriously and that you have not received the humanistic care that you expect. In one survey, 46.7% of respondents felt that seeing their doctor was “a bit perfunctory.”
In contrast, in primary medical service centers such as village hospitals and township health centers, there are fewer patients and most of them are chronic diseases. Patients with chronic diseases often come, and can talk to the doctor more every time. Research shows that the lower the level of the hospital, the higher the trust and satisfaction of the patients.
On the other hand, the consistent orientation of the entire medical environment does not revolve around humanistic care.
In the performance appraisal of national public hospitals since the previous year, among all 55 indicators, only 2 indicators focus on patient satisfaction, and 2 indicators focus on appointment and waiting time. The indicators all revolve around technical and operational dimensions such as medication, cost, and surgery.
“National Grade III Public Hospital Performance Assessment Manual”
The hospital rankings released by the Institute of Hospital Management of Fudan University every year, the evaluation dimensions include discipline construction, clinical technology and medical quality, scientific research level, and do not focus on patient services.
Image source: Fudan University Hospital Management Institute
Under such a professional environment, for doctors, only by improving clinical skills and scientific research capabilities can they help their career development and provide better services to patients, not directly Physician’s benefit.
When the humanistic care that patients urgently need has been neglected for a long time under various factors, the seemingly embarrassing complaint telephone has become their last channel of communication:
“Doctor, I’m not calling to complain about you, I’m calling to complain about society.”
Planning: yuu. | Producer: gyouza
Image source: Visual China
References:
[1] Liu Yunzhang, Liu Yuyuan, Zhao Jinping, Bian Lin. Historical review and improvement countermeasures for the weakening of patients’ right to speak: Based on the goal of building a community with a shared future for doctors and patients [J]. Chinese Medical Ethics ,2021,34(08):929-932+938.
[2] Zhu Didi, Lin Mengjie, Lian Huan, Chen Wei, Huang Jiancheng, Liu Gaoshuang, Lu Jianhua. Investigation and analysis of the current situation of doctors’ professional image and doctor-patient relationship cognition [J]. Medicine and Philosophy ( A), 2013, 34(09):49-53.
[3] Zhu Bowen, Luo Jiaojiao. Does Internet Use Affect the Public’s Trust in Doctors?——An Empirical Analysis Based on Data CSS2013 [J]. Jiangsu Social Sciences, 2017(03 ):70-78.DOI:10.13858/j.cnki.cn32-1312/c.2017.03.011.
[4] Tang Jinling, Han Qide. Reflections on modern medicine [J]. Medicine and Philosophy, 2019, 40(01): 1-6.
[5] Wang Siping. On the attributes of the medical industry and the relationship between doctors and patients [J]. Medicine and Philosophy, 2019,40(10):62-64+69.
[6] Weeks J C, Catalano P J, Cronin A, et al. Patients’ expectations about effects of chemotherapy for advanced cancer[J]. New England Journal of Medicine, 2012, 367(17 ): 1616-1625.