The author of this article: Cha Cha
Recently, the Beijing Municipal Health Commission released the “2022 Action Plan for Improving Medical Services in Beijing”, which mentions that “medical institutions are encouraged to open evening outpatient clinics, night outpatient clinics and weekend outpatient clinics.”
Photo source: Beijing Health Commission
Such outpatient clinics are not new and have been opened by hospitals across the country before.
Take “night outpatient clinics” as an example, many hospitals have launched a slogan: to solve the problem of inconvenience for office workers, students, and silver-haired people to see a doctor during the day, and to alleviate the difficulty of public registration and improve their medical experience.
At the end of June, “Xi’an No. 1 Hospital Opens Night Clinic for Office Workers” rushed to the hot search. In the comment area, in addition to convenient discussions, doctors also expressed their own needs: how to balance working time and pressure, how to implement subsidies, and how to play a role in diverting patients…
So in practice, have outpatient clinics such as dusk, night, and weekends played the expected role? What difficulties did doctors encounter when running outpatient clinics during the original rest time?
Can’t prescribe, can’t get medicine: a doctor’s “cook without rice”
The effectiveness of doctors in the outpatient clinic is inseparable from the supporting measures provided by the hospital. The lack of any link may put them in a situation of “no rice without rice”.
At 8:00 p.m., Dr. Xu Li was sitting in the outpatient room. The general pharmacy and auxiliary departments were off work early. Only emergency orders could be checked and prescribed medicines. “For example, if you want to draw blood, Even if it is an emergency item, patients are not willing to pay more for examinations in regular clinics.”
She positions herself as a “doctor” in the night outpatient clinic. “Occasionally someone comes to us with a test sheet after get off work. If the condition is serious, we directly recommend going to the emergency department. Ordinary outpatient clinics can’t handle it.”
Even when supporting department services are provided, physicians can be held back by unreasonable process regulations. Ultrasound doctor Li Hua was arranged by the department to serve the night outpatient clinic. In practice, he was often troubled by how to review the application form. “The hospital requires that only the night outpatient clinic order can be done during the night time period, such as 17:30. Start the night outpatient clinic, then the order opened at 17:20 can only be reserved for the examination time from 8 to 17:00 during the day.”
Li Hua’s department handles an average of 1,000 regular numbers during the day and less than 10 at night. Faced with huge differences in needs, he often has to face the dissatisfaction and doubts of patients who have placed orders during the day but have not made an appointment. In order to avoid conflicts, he can only choose to add it, or the patient can find a doctor and change it to an emergency order.
The “Interim Regulations on Outpatient Quality Management of Medical Institutions” issued by the National Health Commission in June this year mentioned that medical institutions at the second level and above should incorporate outpatient quality management into the work system of the Medical Quality Management Committee.
Interim Provisions on Outpatient Quality Management in Medical Institutions
Photo source: National Health Commission
This indicates that the operation of the clinic should be standardized and systematic. In order to achieve homogeneity between outpatient clinics, preparations should be made for each link such as auxiliary diagnosis and inspection, registration fees, drug support, logistics support, and admission management. Lilac Garden users once shared that they went to the outpatient clinic at night and felt “the pressure of the entire hospital waiting for the outpatient doctor to get off work”.
Image source: Lilac Garden comment area
In addition, one of the functions of the Beijing Health and Health Commission to encourage the opening of such outpatient clinics in the document is to “optimize the number source supply structure and guide patients to seek medical treatment at staggered peaks”, which is different from the crowd during the day. Clinics at night may encounter empty scenes.
Xu Li usually has 40 to 50 outpatient clinics during the day and half a day at most. In her one-year night outpatient clinic experience, “the most time I met 3 people, it was just early 5:30. Just here. There are not many patients at night, and I spend most of my time sitting in the clinic.”
The way to achieve the convenience of reducing the waiting time for consultation and having more time options should be to increase the outpatient time reasonably rather than to expand it indefinitely. In the case that the outpatient clinic has basically met the local medical needs during the day, Xu Li felt a waste of resources, “The outpatient clinic has been added during the daytime on weekends, and there is no problem with testing and taking medicines. Patients can rest during this part of the time. Come”.
A few years ago, Li Hua’s department asked to work 2 hours of overtime at night because of too many patients.At that time, “no one knew that everyone was still crowding in during the day”, and the outpatient clinic at night lasted for a month and then nothing happened. Cost and benefits affect how far this type of outpatient service can go. In “Discussion on the Operation Model of a Class-A Hospital”, it is mentioned that opening multiple departments at night requires the hospital to have enough disease sources to ensure revenue and expenditure balance.
If a worker wants to do a good job, he must first sharpen his tool. The result of prolonging the time may be twice the result with half the effort. When the system it’s in doesn’t work well, the pressure sinks on the doctor.
How many does a doctor need to be broken into?
In a discussion on the Lilac Garden Forum, 75.6% of people voted for measures to increase weekends, holidays, night outpatient departments, etc. burden”.
Image source: Lilac Garden Forum
Look at working hours first. The “White Paper on the Practice of Chinese Physicians” released in 2018 shows that the average weekly working hours are 51.05 hours for physicians in tertiary hospitals, 51.13 hours for physicians in secondary hospitals, and 48.24 hours for physicians in primary hospitals, all of which exceed 51.05 hours. The standard working hour system stipulates that the daily working hours shall not exceed 8 hours and the average weekly working hours shall not exceed 40 hours.
Opening outpatient clinics during breaks allows doctors to stretch their working hours time and time again. Dr. Wang Fang from the Department of Respiratory Medicine needs to see more than 30 patients in the morning, and often sees it at 12:30 or 1:30. “During the day, the outpatient number is not limited, and we are already overworked.”
In terms of work content, for example, an attending doctor has to undertake daily tasks in addition to outpatient clinics, managing patients, and possibly leading students in a teaching hospital. In the time of lack of flexibility, Xu Li sometimes encounters consecutive night shifts and night clinics. “If you are really tired, you can change the shift hours, but you can’t always change with others, or because there are not enough people.” When it comes to personnel replenishment, the feedback she often gets is that “it costs money to recruit too many people, everyone insists.”
In addition to working hours and pressure to “break a doctor into several for use”, there is no unified implementation plan for performance subsidies for this type of outpatient clinic.
Xu Li has not seen the rumored subsidy of 1,000 yuan in the past year. She feels that the subsidy that cannot be implemented is a by-product of the low number of outpatient clinics at night. , “It’s not overtime pay, the hospital doesn’t care about this part of the money, it has to be earned by Keli himself.”
Li Hua initially felt that the performance appraisal method brought about by the time spent in the evening must not be the same as that of the regular outpatient clinic. “After all, it takes up the time in the evening.” The option of compensatory rest and subsidy that was actually put in front of him was “come two hours late in the morning, no money, or a subsidy of 15 yuan an hour, and nothing else.”
This made him feel that his outpatient clinic at night was like a compulsory overtime work, and the conflict in his heart stemmed from “the overall working hours, staff allocation, and corresponding treatment, which involved going home after get off work at night. Safety issues, and how to provide a place to rest for those who cannot go home are still unresolved.” He said, “If it can be solved, the hospital will not be closed for 24 hours in the future.”
Outpatient clinics open during breaks, need to be discussed on a case-by-case basis
Before starting the night outpatient clinic, Li Hua encountered many “fake emergency departments” due to work at night. “For example, the chief complaint was 33 weeks pregnant and asked for an examination. More things are worse than less things, these They will also go through emergency procedures.”
Photo source: National Health Commission
Some hospitals also need to accept emergency patients referred from the surrounding area, and doctors are always busy. Night outpatient clinics provide an idea for alleviating the shortage of emergency resources. However, before the effect of diverting patients can really be achieved, a lot of publicity needs to be done to the patients. “The hospital has made a special video, such as introducing that the location of the night outpatient clinic is the same as that of the day outpatient clinic. However, many people are still confused. Go to emergency room or outpatient clinic.”
In addition, nighttime clinics vary widely between departments. Compared with Shennei, Pediatrics and other departments, Xu Li of the Nephrology Department encountered more cases without patients, or oolong scenes. “The patient came in at night, and found that he needed a morning urine test, and then scolded and left.”
Xu Li’s hospital has opened night outpatient clinics in almost all departments. As a result, doctors in some departments have nowhere to go and waste their rest time. In this regard, Xu Li thinks that it is necessary to set up departments reasonably according to the local situation and optimize it. “For example, if the purpose is to serve office workers, then open night outpatient clinics for diseases that office workers are more likely to get, instead of opening all departments at the same time.”
Another consideration is how to avoid exacerbating the siphon effect of large hospitals with such outpatient visits. Xu Li and Li Hua work in both Grade-A hospitals, and they use the resources of senior experts to harvest a group of patients who can be treated in lower-level hospitals. fixed”.
There are also some outpatient extensions that are adjusted seasonally. Li Hua’s hospital will receive notices from May to October every year, requesting to open intestinal outpatient clinics 24 hours a day, because intestinal infections tend to occur during this time period. At other times, the intestinal clinic is relatively unnecessary to open 24 hours.
More and more outpatient work has not allowed XuLi and Li Hua improve job satisfaction or career achievement. On the contrary, because of the confusion in the arrangement and the lack of positive feedback in the results, they all agreed that the new night outpatient clinic opened by their own hospital was like a follow-up behavior because the surrounding hospitals had all launched, “There are no patients at night, I am outpatient clinic at night. It is like a decoration.Similarly, people are still crowded to see a doctor during the day, The night outpatient clinic does not play a practical value, and it will become a decoration“.
Xu Li, Wang Fang and Li Hua are all pseudonyms in the text
Planning: Y^OH
Producer: gyouza
Image source: Visual China