Because it is unacceptable for innocent patients to die because of doctors' bad medical behavior, Dr. Zhang Yu decided to explain the current chaos of tumor treatment and put forward possible solutions in the form of writing on social platforms, and called on the state to pay attention to and supervise it. (Wen AI Finance and Economics Summer)
Attached is the full text of "To my beloved country and many cancer patients and their families-please join me in calling for the country to set up a medical red line as soon as possible to curb the bad medical behavior in cancer treatment":
My name is Zhang Yu. I am an ordinary oncologist in the Third Hospital of Peking University and a member of the Democratic League. In recent 1 years, I have encountered many things, which have made me experience entanglement and pain, and also prompted me to think, why are there such problems? Now I think I have understood it and have a lot to say, so I wrote this article.
Almost everyone in China feels this way. The country is becoming stronger and stronger, people's living standards are getting better and better, there are fewer and fewer unfair phenomena, and the system is becoming more and more transparent. We are all the beneficiaries, and we are proud of the development and strength of our country.
However, what I want to talk about today is the bad side, which is about a large number of bad medical behaviors and some unscrupulous doctors in the current tumor treatment, and analyzes the reasons and puts forward solutions. Please think about it, how many patients often worry about the lack of money and people after suffering from tumors, talk about hospitals and turn pale, and even refuse to go to regular hospitals for treatment. Many people have formed the impression that tumor treatment is not only expensive but also ineffective. They go to the hospital to make money, and in the end, it is likely that people will be gone and money will be gone. Unfortunately, this impression is not entirely imaginary. In reality, such real cases are constantly happening, and each real case is likely to mean a broken family or even a return to poverty.
In fact, in the vast majority of cases, the treatment of tumors should not be both human and financial, but should be better and less expensive than at present. So why are there still so many tragedies in which people and money are empty? Practically speaking, many of them are caused by doctors who are responsible for treating tumors.
In my opinion, the biggest problem in medical care at present is not to support doctors with medicine, but the lack of supervision, which leads to some doctors' wanton behavior, and the resulting bad medical behavior hurts the interests of patients, which is an important factor leading to the increase of disputes between doctors and patients, and it is also an important reason why ordinary people think it is difficult and expensive to see a doctor. It is very unfair that the consequences of some doctors' evil deeds are borne by all citizens.
I can't accept that the death rate of innocent patients has increased or even directly led to death because of doctors' bad medical behavior. In any case, this article must be written and made public: explaining the current chaos of tumor treatment and proposing possible solutions, calling on the state to pay attention to and supervise.
Part I: Chaos in current tumor treatment.
Cancer patients are a very large group. In 2020, there were 4.57 million new cancer patients and 3 million deaths in China. The mortality rate remained high and the incidence rate was still rising. Why is the mortality rate so high? In addition to the common diagnosis, it is in a late stage. Based on my own eyes, I have reason to believe that this is caused by irregular or even wrong diagnosis and treatment. A considerable proportion of patients have spent unnecessary expensive expenses, and a certain proportion of patients have died because of irregular or even wrong diagnosis and treatment. Although this ratio is difficult to count without specific statistics, it is likely to exceed our imagination. It can be said that the land of China is full of blood and tears, and what is more worthy of our deep thinking is that until now, few people have voiced their condemnation of this violation of doctors' professional ethics.
I promise the truth of the following statement with my career as a guarantee:
In the past 1 year, I have encountered more than 100 cases of tumor patients in dozens of hospitals who have received improper or even wrong treatment, that is, treatment that obviously violates the basic principles recognized by the tumor community, some of which are very bad behaviors, which will be illustrated by examples later. Without exception, these bad medical behaviors lead to a substantial increase in patients' expenses, and bring harm and pain to patients, and even some patients die. What's more, it involves not only ordinary local hospitals, but also oncologists in several 3A hospitals. Even some doctors in Beijing, Shanghai, Guangzhou, Tianjin and Chongqing have obvious misconduct in tumor treatment. What's more, it is highly suspected that some departments have formulated a unified strategy, failed to follow the most authoritative guidelines for cancer treatment (CSCO guidelines in China, NCCN guidelines in the United States or ESMO guidelines in Europe), and deliberately switched to other schemes for cancer patients, and there is sufficient evidence to show that this scheme change is harmful to patients, because it will increase their economic expenses, side effects and even mortality. So I suspect that there may be as many as 1/5 patients who have changed the standard treatment plan. Of course, there are more minor mistakes.
Frankly speaking, changing the standard treatment scheme at random can be described as the most harmful behavior in tumor treatment. Many anti-tumor drugs are very good in themselves, but they are abused by some doctors and even doctors in top three hospitals. There are two basic reasons for this situation: one is the lack of professional knowledge, and the other is the economic benefits. The following are clinical examples:
1, some doctors used lobaplatin to replace the standard oxaliplatin, and used raltitrexed and eliminated deoxyguanosine to replace the standard 5-Fu drugs in postoperative adjuvant chemotherapy for patients with gastric cancer and intestinal cancer. There is sufficient evidence that this behavior will lead to an increase in the recurrence and metastasis rate to varying degrees.
2. Some doctors added bevacizumab/cetuximab on the basis of chemotherapy, and even added anrotinib or apatinib that were not approved for the treatment of intestinal cancer when they were treating patients with stage III after radical operation of intestinal cancer. There is sufficient evidence that such patients should only receive standard dual-drug chemotherapy, and increasing targeted therapy at random will lead to a slight increase in recurrence and metastasis rate and an increase in mortality.
3. Some doctors deliberately exaggerate the condition and adopt adjuvant chemotherapy for patients who clearly don't need chemotherapy, such as patients with stage I intestinal cancer or stage IIA dMMR intestinal cancer and stage IA gastric cancer. There is evidence that this can only bring harm to patients and may even increase the risk of recurrence and metastasis.
4. In preoperative chemotherapy for gastric cancer and intestinal cancer, some doctors do not choose the most sure treatment scheme, but choose the scheme with poor curative effect or even adopt the wrong scheme, such as docetaxel chemotherapy for patients with intestinal cancer and pemetrexed chemotherapy for patients with gastric cancer.
5. Some doctors even abandon the standard treatment plan directly, without informing and discussing the patients at all, and treat them as they want. For example, nasopharyngeal carcinoma should be changed from external radiotherapy to particle therapy, and single liver metastasis of colorectal cancer should be changed from surgery to radiofrequency ablation or intervention, instead of forced surgery.
6. Some doctors abused the PD- 1 inhibitor, and wrongly informed the patients that they did not need PD- 1 inhibitor treatment after gastric cancer surgery, pancreatic cancer surgery, intestinal cancer surgery and cholangiocarcinoma surgery, which could obviously increase the curative effect, thus inducing these patients to receive PD- 1 inhibitor treatment.
7. There are countless other phenomena, such as forcing patients to do unnecessary hot perfusion chemotherapy after operation, giving preventive injections of long-acting whitening needles to unnecessary patients, and so on.
It's really not easy to be a doctor. It's hard work, great pressure, and the income is often out of proportion to the effort, but I don't think these are any reasons for doing evil. According to the medical principles and relevant legal requirements, medical practitioners are not allowed to change the standard scheme at random, and it is not the gift of doctors to patients, but the responsibility and obligation of doctors to give them the correct treatment as much as possible. Just because patients and their families have weak medical knowledge, weak legal awareness and it is not easy to defend their rights in medical lawsuits, many doctors have bad medical behaviors without having to bear the consequences or even have no trouble. It is obviously very wrong for these doctors to use their dominant position and power to harm patients. Specialists in top three hospitals should be the most trusted and reassuring for patients, which is also the glory of being a doctor, but unfortunately it has not become a reality at present.
Part II: Causes of bad medical behaviors.
(1) Lack of supervision. This is the most important reason. Doctors are human beings and make mistakes. However, many doctors arbitrarily change and make treatment plans under the guise of "individualized treatment", which is euphemistically called to improve the curative effect, but in fact it is for their own benefit. And we are surprised to find that there is no effective control over this kind of behavior at present. If there is no supervision, a considerable proportion of doctors will really change the treatment of patients to be more expensive and worse. What's more, some doctors simply ignore the life and death of patients and extract the greatest benefits without being punished. This is one of the deepest sources of medical contradictions. Without supervision, some doctors will inevitably put their own interests above those of patients.
(2) Some doctors are ignorant and greedy. Incredibly, some doctors can put their patients' lives at risk for money. Sometimes it is clear that it is wrong to change the patient's standard treatment plan, but it is just to make changes for the benefit, or to let tumor patients who do not need treatment at all. This kind of situation is not uncommon in clinic.
(3) As a vulnerable group, patients can only choose to trust doctors, but it is difficult to know the treatment errors, and even if they know the treatment errors, they are powerless to resist. Complaints to the health and health commission are often sent back to the hospital to deal with themselves, so they can only resort to the law. However, the complexity and high cost of legal procedures often discourage injured patients. Some patients with low income themselves are poor due to illness, and it is even more difficult to afford the high cost of rights protection.
Systematic abuse of doctors' authority, violation of the principle of diagnosis and treatment to obtain benefits and serious damage to patients will make many good doctors and young doctors feel disappointed and cold. Is it fair that doctors who work hard for patients' lives earn far less income than those who make bad medical behaviors? I believe the country will not turn a blind eye to this. .
There are also problems in the current medical system: the fundamental interests of doctors and patients are inconsistent, and sometimes even opposite. This is especially true in the field of tumor treatment. That is to say: if the doctor thinks of the patient wholeheartedly and everything is based on the interests of the patient, the doctor will be very bitter and poor. On the other hand: if doctors don't care about patients at all and start from their own interests, doctors will get rich rewards, sometimes even beyond the imagination of ordinary people.
Many years ago, when I discovered this fact in hindsight, I was silent for a long time, and for the first time I had doubts or even a little disgust about the profession of doctors. I hope the medical profession is more noble and doctors are more worthy of respect.
Some doctors can well identify the patients who can't be offended and those who can't resist. What makes people extremely angry is that many patients who are not well-off in economy go to 3A hospitals in first-tier cities from foreign towns and even rural areas with hope, and meet unscrupulous doctors, and then they are told by doctors that they are using individualized schemes specially formulated for patients, which have good curative effect, but are more expensive, and trick patients into obeying and treating them. The result is often a sharp increase in expenditure and a subsequent increase in mortality. Obviously, it is the greed and selfishness of doctors who make such shameless things, but they are determined to be grandiose and arbitrarily extract the blood and sweat of patients. I seem to hear the triumphant laughter of some unscrupulous doctors, and the huge expenses of patients have turned into luxury cars, cars and wine for these doctors.
This is the biggest and constantly changing unfair status quo of cancer medical treatment.
(Note: If any cancer patients read this article, please read my article "How Cancer Patients Avoid Being Empty of People and Money" written by Dr. Zhang Yu of WeChat official account on WeChat, which should be helpful. )
Solution:
I have thought it over and over again for a long time. It is really not easy to treat medical chaos, but I think the following four points are the most important ways.
(1) The most important thing is to control medical chaos according to law. At present, it is really too difficult for patients to protect their rights through law. Can the state add a supplementary clause on medical disputes, that is, a rapid handling procedure: when it is clear that doctors use wrong drugs or other treatments that do not meet the instructions and guidelines and clinical norms for patients, and there is no detailed and accurate informed consent, the court will directly judge the doctor's dereliction of duty and make rapid economic compensation. In this way, patients' rights protection can significantly shorten the time and be simple, which can directly deter medical malpractice.
(2) Strengthen the supervision system. If the first article can be solved, then we can consider establishing a registration system for bad medical behaviors, and once found, register for life. Moreover, detailed rules can be formulated, such as directly suspending the doctor's qualification or permanently revoking it if it happens three times. We can even consider establishing the responsibility system of attending doctor-director and dean, so as to urge hospitals not only to compete for clinical and scientific research strength, but also to attach great importance to preventing the occurrence of bad medical behavior.
(3) Promote the peer supervision mechanism. Whether some doctors with high professional level and excellent professional ethics can be selected for regular audit, so as to strictly investigate potential mistakes and correct them in time. Frankly speaking, the knowledge level of tumor in many local hospitals is really backward and needs to be corrected and improved.
(4) Popularize correct knowledge to the public. Many basic medical principles are not difficult to understand. When doctors make bad medical behaviors, it is necessary to try to distort patients' ideas and instill wrong information in patients. But if the patient has understood what is going on, it will be idle to increase the difficulty of bad doctors to do evil. There are many doctors (many of whom are surgeons) in China who lack basic knowledge about the use of anti-tumor drugs, and their attitudes are sloppy, blind and confident, and their professionalism is poor. As mentioned above, I have seen a surgeon who used docetaxel to treat intestinal cancer. The guess is that the doctor thinks that docetaxel is very effective in treating gastric cancer, so it can definitely treat less malignant intestinal cancer, so it is applied, but in fact docetaxel is completely ineffective in treating intestinal cancer. That's it, using the wrong medicine even led to serious consequences. The patient still has no ability to resist it. First, it is too simple to go to court. Second, follow-up treatment needs to be carried out in the hospital, so as not to offend the doctor.
Therefore, we urge the state to set up a red line in various ways and strictly supervise the implementation: any bad medical behavior that clearly violates the rules and harms the life rights and interests of patients must be punished severely and quickly. Personally, I think this is the most important one to improve the quality of medical care. Only when this red line is carried out and strictly implemented can we protect the safety of patients and reduce disputes between doctors and patients, which is a blessing to the people. I don't even think it is necessary to control the fees by DRGS system, as long as doctors treat patients as the center. In view of the fact that the country has lowered the prices of many anti-tumor drugs for the people, as long as doctors don't spend money indiscriminately for their own interests, the expenditure on patients and medical insurance will drop significantly.
The third part is a case study: How can a doctor increase the patient's expenses tenfold and die earlier?
Let's take a look at a typical medical malpractice. Actually, I have written about this doctor, and many people already know him. He is a general surgeon in a well-known 3A hospital in Shanghai, Dr. L. He is amiable, and what he said makes many patients feel very reasonable, but unfortunately, in fact, the above is just a manifestation, behavioral corruption and moral decay. Many patients are treated with the primary purpose of earning profits.
He admitted a patient with AFP positive in advanced gastric cancer. Although this type is rare, it should be treated according to the diagnosis and treatment norms. Usually, the cost of first-line, second-line and third-line treatment of gastric cancer is not high, and the country can reimburse it. However, Dr. Lu was not satisfied. As a result, the patient's life span was significantly shortened, the cost was more than 10 times higher than that of conventional treatment, and he had no savings and owed more than 100,000 debts. Let's see how Dr. L did it.
(1) It costs about 20,000 yuan for patients to have NGS sequencing. NGS used by Dr. L is the most unreliable blood test at present, not the more reliable tumor biopsy. That is to say, the NGS results are almost of no reference value. According to the routine, it is more accurate to detect the pathological sections of gastroscope used in patients' diagnosis, and patients need to go back to the local area to take samples. But Dr. Lu was very anxious and decided to take a blood test first.
(2) Adopt a wonderful second-line treatment scheme: pemetrexed, anrotinib, oxaliplatin, capecitabine and tamoxifen, which is an unprecedented treatment scheme for gastric cancer created by Dr. LL himself. Any doctor who knows the basic knowledge of tumor drug treatment knows that this scheme is completely unreasonable. The standard second-line chemotherapy for gastric cancer is a taxane regimen. At present, it is considered to be one of the most effective treatments and the cost is low. However, after forcibly changing to the above wonderful scheme, the cost has risen sharply and it is completely ineffective.
(3) Recommend invalid, expensive and illegal NKT treatment to patients: the cost of each treatment is as high as 30,000. At present, it is considered that NKT treatment is almost completely ineffective for advanced tumors. Therefore, the state has repeatedly banned NKT treatment fees and is limited to free clinical research. Dr. Lu tried his best to induce the patients' families to accept the treatment, telling them that it would have a good effect, so that they could borrow money to carry out this treatment, and eventually they lost both money and money. You know, this money is the patient's hard-earned money, and it will take more than 1 year to save 30,000 yuan. In order to see a doctor, patients and their families can only live in the basement to save money every time they go to Shanghai, and with the hope of controlling and curing the disease, they are grateful to send special products to Dr. L. As a result, how did Dr. L repay?
(4) Abuse of auxiliary drugs: Dr. L has prescribed many auxiliary drugs, such as Ridaxian. Of course, Ridaxian itself is a good drug, but it is really not suitable for patients with poor economy, and its cost performance is too low.
As a result, the patient was wiped clean, and when the money was spent, Dr. Lu began to ignore it until the patient died, and the survival time was very short. Although the prognosis of AFP-positive gastric cancer was indeed worse, if the standard second-line treatment was used, the survival time would probably be longer and the cost would be much lower.
What needs to be explained is: I only wrote about Dr. L, not because no other doctors did so, but actually there were cases that I thought were worse, just because the first evidence was insufficient, and second, I was under too much pressure. I have my own job and family, and I have children and daughters. The more doctors I offend, the greater the pressure. My wife and mother have repeatedly asked me not to accuse such dark incidents, but I really can't help it. If the state does not strictly control them, innocent patients will definitely lose their lives.
I would like to ask similar doctors to do me a favor and stop doing this kind of thing. This is not what doctors should do. The patient's life is also life. Your behavior has caused my family conflicts, and I will have a very headache.
Part IV: Expectation
In all fairness, the country is constantly improving and purifying the medical environment, and 4+7 purchasing with quantity reduces drug prices, increases the fees for doctors' diagnosis and treatment, and improves the treatment of doctors. These are all very good and important measures. If the country does not reduce the prices of many cancer drugs, the abuse will certainly be more rampant. This is a clever move to take a radical step, but it is really not enough. I expect the country to clean up the roots and rectify bad medical behavior. I hope that in the future, doctors can abide by the basic norms of tumor treatment and treat patients as the center.
Supervision, supervision, supervision. As long as there is no effective supervision in the medical industry, doctors who harm patients and even take risks will not be eliminated. Please pay attention to it by the relevant state departments. In the medical industry, this is the most important thing, and it is also what the people expect most.
As a doctor, the most important quality is to cherish the life of every patient. Although we can't equate patients with our family members, we should realize that patients' lives are precious, and we need to treat every patient seriously and try our best to fulfill the bounden duty of doctors and save lives. How many medical staff resolutely went to the most high-risk areas to treat patients during the COVID-19 period? They are the role models of our generation, not the doctors who earned a lot of money by bad medical behavior, and they should be spurned.
Also, as I said before, what I expect is fair medical care, fair to patients and fair to doctors. Doctors treat patients wholeheartedly and take pride in curing patients. Patients can understand, cooperate and understand doctors and achieve the best treatment effect. Why shouldn't the doctor-patient relationship improve? It is not the mistakes I pointed out in medical treatment that damage the doctor-patient relationship, but the doctors who make bad medical behavior to patients, who are the culprit. Only by curbing these behaviors and punishing the bad behaviors according to law, so that every doctor can see a doctor well, I believe that our doctors will certainly gain greater trust and real respect from patients.
I hope everyone can speak out. If everyone is afraid of retaliation and turns a blind eye to this bad behavior, or even thinks that it is irrelevant, it is a big mistake. It is not one person who is ultimately injured, but each of us and even our descendants.
Call for supervision, treat medical chaos according to law and protect patients. This is what the country should do. It is hoped that the state will standardize medical behaviors and severely crack down on bad medical behaviors. And please do it as soon as possible, without delay. Only in this way can everyone walk into the hospital without fear of being treated unfairly. I very much hope to work in a better medical environment in the future. The focus of doctors' work is always to treat patients rather than others. Doctors and patients are kind to each other and fight against diseases.
I hope more people will read this article and cause a buzz. Everyone should know what is right and what is wrong.
I hope I can get more support for my efforts to make this sound. A single spark can start a prairie fire.
I hope that the medical care in our country will become the best medical model in the world.
Zhang Yu 202 1 Apr18th, 2002