On January 28, 2022, the General Office of the National Health Commission issued a notice on Printing and Distributing the Recommended Catalogue for Day Surgery (2022 Edition).
According to the requirements of the Notice, it is clear that day surgery should be vigorously promoted and the proportion of day surgery to elective surgery should be increased. Through this measure, the construction of the hierarchical diagnosis and treatment system will be promoted.
At present, the current distribution of medical resources in my country is uneven. Intuitively, if you are seriously ill, you will run north, Shanghai and Guangzhou.
However, some of these people who go to treat a serious illness may not be seriously ill. For example, if you have appendicitis, you have to go to Beijing, Shanghai and Guangzhou. As a result, “big hospitals” are overcrowded; “small hospitals” are worried that there are few patients.
For a “big hospital”, it is not that appendicitis cannot be treated, but such treatment is equivalent to “overkill”. Not only that, in the past, even appendicitis had to be hospitalized for a week before the patient could be released home. In this way, the turnover rate of hospital beds is the most worrying thing for surgeons in “big hospitals”.
For a “small hospital”, in order to make the hospital appear less deserted, it is also in favor of one-week hospitalization for appendicitis.
It’s like this in performance. On a deeper level, “big hospitals” have major surgeries and many surgeries, so they can siphon talents. In this way, the bigger gets bigger. Obviously, this is not conducive to solving the imbalance of medical resources. Because of this, it is a wise move for the state to promote day surgery.
However, “the ideal is full and the reality is very skinny”, is there any problem behind this? In other words, what details do we need to control.
Practice is the criterion for testing truth. Let’s see what netizens say?
A netizen from Jiangsu said: In order to increase the occupancy rate of the hospital, it is best to ask you to go home on the same day, that is, whether to go to the hospital for examination every day after you get home or a change of medicine? I feel that this medical method has been promoted, and it is the patients who suffer.
A netizen from Hunan said: Ambulatory surgery is a pit, a simple operation that could be done in outpatient clinic before but is now called ambulatory surgery. According to the result of hospitalization fees, the self-payment part of hospitalization is just enough to use medical insurance without paying a penny.
A netizen from Liaoning said: What is the cost of day surgery? Some day surgery is more convenient, but for those with high difficulty, normal hospitalization is better. , it is convenient for doctors to deal with emergencies after surgery in a timely manner.
A netizen from Shandong said: These are all previous outpatient surgeries, nothing unusual.
A netizen from Zhejiang (note: this is a doctor) said: Part of the current day surgery can benefit patients, But some are really inappropriate. The current problem in China is that some hospitals with super-large traffic, relying on their huge traffic, discharge some postoperative patients who should continue to stay in the hospital for treatment as day surgery. Many major surgeries abroad can be performed as day surgeries because community hospitals undertake follow-up post-operative rehabilitation medical services, or family doctors. We have not yet perfected this mechanism for referrals to lower-level hospitals in China, and all foreign day surgeries are transplanted. , not only has risks, but also damages the interests of some patients.
A netizen from Sichuan said: In fact, most hospital patients in our country do not want patients to stay in hospital for longer.
A netizen from Liaoning said: There are only 4 doctors in one department, hospitalization, preoperative preparation, and discharge after surgery. (apparently a paramedic)
A netizen from Hunan said: Improving the medical skills of hospitals below the county level is the key. Large hospitals are overcrowded, and patients are miserable.
A netizen from Beijing said: The beneficiary of this model, Beipiao, has a normal medical treatment process. Check in at 8:00am, end the operation at 11:00am, and leave the hospital at 2:30pm.
A netizen from Beijing said: Depending on the disease, kidney stone surgery is not suitable, and it is better to be hospitalized because of various discomforts after surgery. (It is estimated that I have experienced it myself)
A netizen from Tianjin said: The level of community medical services in our big cities is very low, and there is huge room for my country to develop and improve primary medical services!
A netizen from Zhejiang said: What’s so good about day surgery, it doesn’t matter after surgery, how can people feel at ease when they go back?
A netizen from Shanxi said: Day surgery is a bit of a nonsense. Before the stitches are removed, do you dare to guarantee that it will be fine?
……
It can be said that one stone stirs up a thousand waves, and there are different opinions. There are doctors and patients here. However, it seems that a key person is missing – the anesthesiology department.
Why is it critical? You can browse the catalog:
With the development of comfortable medical care, many surgeries need to be performed under regional or even general anesthesia. Without anesthesia, it is impossible to play at all!
Some people say, how can you be anesthetized, how can you be anesthetized?
The person who said this should at least not know much about anesthesia. A complete anesthesia process includes at least three links: preoperative visit, intraoperative anesthesia and postoperative visit. Among them, the preoperative visit is the most critical stage.
During the preoperative visit, the anesthesiologist needs to fully grasp the patient’s physical condition, past medical history, current medical history, the surgical procedure and possible associated risks. Only by fully understanding and preparing before surgery can we ensure the safety of patients’ lives and provide the best surgical environment for surgery during the operation. At the same time, it also lays a foreshadowing for whether patients can achieve their desire to go home early after surgery.
For example: Suppose the patient has high blood pressure, and it is the kind of high blood pressure that may affect the perioperative safety, and the anesthesiologist needs to intervene in advance to adjust the blood pressure.
Some people say, why is the anesthesiology department to adjust blood pressure, isn’t it the internal medicine department to adjust blood pressure?
Speaking of this issue, we must emphasize: in the operating room, it is the anesthesiology department, not the internal medicine department, that protects your safety. From the point of view of the strategy of adjusting blood pressure, anesthesiology and internal medicine are also different. For example, taking antihypertensive drugs containing reserpine will not allow immediate surgical anesthesia, otherwise there may be life-threatening severe circulatory fluctuations during the perioperative period.
Even if there is no high blood pressure, the preoperative visit is usually completed the day before the surgery. If you don’t come to the hospital, where will the anesthesiologist find you?
Some people say: If there is no high blood pressure, it is enough to go to the hospital one day before the operation and let the anesthesiologist take a look?
The reality is, I’m afraid it won’t be what you want. Because most of the hospital’s anesthesiology department is very busy. It does not mean that the anesthesiologist will have time for preoperative visits after you come.
Some people say, “Small hospital” is not very busy?
Sorry, the total number of anesthesiologists in China is less than 100,000, and there are nearly 80 million operations in the operating room that require anesthesia every year. Assuming that “small hospitals” have fewer operations, anesthesiologists will naturally flow to “big hospitals”. Those who stay behind can only cope with the daily operations of the “small hospital”. Moreover, no matter whether public or private, they do not support idlers. The “raised” people are basically “just right”.
The Department of Anesthesiology is not only responsible for surgical anesthesia, but also for labor analgesia, emergency first aid and even pain diagnosis and treatment. In other words, even if you come to the hospital in a hurry, you have to wait for the anesthesiologist to finish before coming to see you.
Also, many times the information on the day before surgery is more reliable. For example, if you didn’t catch a cold a few days before the surgery, but you just caught a cold the day before the surgery, the surgery would have to be postponed.
Someone asked: Is a cold related to surgery?
It has nothing to do with surgery, but it has to do with anesthesia. People with severe colds have extremely sensitive airways. During surgery, airway events can occur for a variety of reasons. Postoperatively, this “little” cold may also lead to an infection in the lungs, resulting in a prolonged hospital stay.
From this point of view, the patient can hardly do anything the day before surgery, and has to come to the hospital.
Patients want to be discharged from the hospital early, but they cannot do without two things:
One, minimally invasive surgery. If the operation is big, early discharge can only be an illusion;
Second, the anesthesia plan is extremely optimized. For example, in order to reduce the impact of general anesthesia drugs on the body, combined epidural anesthesia or nerve block is required.
After surgery, there is also the problem of post-operative visits to the anesthesiology department. If the anesthesiology department does not complete the postoperative visit, the closed loop of perioperative safety cannot be completed.
However, the Department of Anesthesiology remainsOf course there is a shortage of manpower.
Some people say that the anesthesiology department has to cooperate, and you have to work overtime!
Sorry, the current labor intensity is already high enough. In recent years, among the doctors who died suddenly, the anesthesiology department has the highest proportion. Compared with the total number of millions of physicians, 100,000 anesthesiologists are so small.
Speaking of which: is day surgery a good thing?
The answer is yes. Either way, this is the general trend. However, leaders should not only focus on setting beautiful goals, but also consider the problems that must be solved in the specific implementation.
Add why there are so few people in anesthesiology?
Although the Ministry of Health in 1989 has defined the anesthesiology department as a clinical department, which director treats the anesthesiology department as a clinical department?
Even if the anesthesiology department is reluctantly divided into clinical departments in name, what about the treatment?
The question is, who wants to come to a subject that is neither famous nor profitable?
Without successors, what will you do to solve the shortage of anesthesiologists? ! (Note: At present, the total number of anesthesiologists is less than 100,000, while the actual clinical demand is 300,000!)
[Warm reminder] Please pay attention, here are a lot of professional medical science, to reveal the secrets of surgical anesthesia for you~