For the supervision of the medical industry, which has a low social reputation, if there is no specific "detailed rules" to restrict it, it may be even more difficult to let the industry embark on the road of standardization. In this way, Shenzhen and Shanghai are really making a good start for the whole country.
Author｜Xu Yucai
Source｜Lao Xu Commentary Medical (ID: xyc13509147246)
Recently, the Shenzhen Municipal Health Commission issued the "Social Scores for Illegal Practice of Medical Institutions and Doctors in Shenzhen (Draft for Comments)" (hereinafter referred to as the "Points Measures"), which supervises all levels and types of medical institutions at all levels that have obtained medical institution practice licenses or traditional Chinese medicine clinic registration certificates in accordance with the law, as well as practicing physicians and practicing assistant physicians practicing in the city. Those who have severe points deducted will be directly revoked.
In fact, this move in Shenzhen is not new. As early as August 2015, Shenzhen formulated the "Interim Measures for the Management of Scores for the Poor Practice of Physicians in Shenzhen". In June 2017, the Shenzhen Municipal Health and Family Planning Commission also announced the results of the public solicitation of the "Shenzhen Medical Institutions and Physicians in Shenzhen". Judging from this announcement, the Shenzhen Municipal Health and Family Planning Commission at that time conducted a one-month public solicitation of the "Shenzhen Medical Institutions and Physicians in Shenzhen" (draft for comments) through the committee's portal website, but it is impossible to find the difference between this draft solicitation of opinions and today's one-month public solicitation of opinions and this draft is different from today. I don't know whether the "cumulative score method" was implemented at that time. Similar to Shenzhen's "Cumulative Score Measures for Illegal Practice of Medical Institutions and Doctors", Shanghai seems to formulate a method for the management of points for bad practice in medical institutions, and they were issued in November 2012.
How to regulate the practice of doctors?
Shenzhen "Points Measures" implements 5 deduction levels of 1 point, 2 point, 4 point, 6 point, and 12 points based on the severity of the "foul" of the doctor's medical practice. Many situations are that small details of medical personnel in their daily practice of medical personnel are included in the deduction of points. For example, in the seven situations where 1 point is deducted, there are signs with their name, photos, positions or technical titles when carrying out medical and health technical activities; in addition to emergency treatment or consultation, they carry out professional activities in medical institutions other than the registered place or filing place; prescribed drugs violate prescription management regulations and are punished with warnings; violate relevant regulations on the clinical application management of antibiotics and are punished with warnings, etc. The four situations where
deduct 2 points include the requirements of not meeting the technical qualifications and work experience required for the position, carrying out corresponding medical and health technical activities; practicing assistant physicians practice alone; carrying out diagnosis and treatment activities other than registered majors, etc. The six most serious cases of deducting 12 points at one time are not only buying and selling gametes, zygotes, embryos, or implementing surrogacy technology; using ultrasound technology or other technical means to conduct gender identification of embryos and fetal sex for others that are not needed by the gender of the embryo and fetus, or selecting gender artificial termination of pregnancy, including; in other emergencies that seriously threaten the lives and health of the latter, they are disobeying the dispatch of the health administrative department; ④ Obstructing the performance of their duties, refusing law enforcement personnel to enter the scene, or failing to cooperate with supervision, inspection, investigation and evidence collection; especially ⑤ Deceiving and inducing patients to receive diagnosis and treatment by false diagnosis, exaggerating the condition or efficacy, will also be included in the score deducted 12 points at one time.
In addition to including details in the "Points Measures", there is another situation that is to include the concept of "medical accident", which has become increasingly marginalized, in the deduction item according to different levels. If a medical accident occurs, the responsible doctor who bears minor responsibilities will be deducted 2 points, the responsible doctor who bears minor responsibilities will be deducted 4 points, the responsible doctor who bears major responsibilities will be deducted 6 points, and the responsible doctor who bears full responsibilities will be deducted 12 points. It is worth noting that the medical accident level is not used as the basis for doctors to deduct points, but only the "degree of responsibility" is used as the basis for doctors to deduct points. This is actually hoping that doctors will do their best to treat patients.
Who supervises the doctor’s point deduction system?
Article 1 of Shenzhen's "Points Measures" points out that the purpose of formulating the "Points Measures" is to standardize the professional behavior of medical institutions and doctors, maintain the normal order of the medical industry, and improve the quality of medical services. It is based on the "Shenzhen Special Economic Zone Medical Regulations" and other relevant provisions. The tenth meeting of the Standing Committee of the Sixth People's Congress of Shenzhen City was approved on August 25, 2016 and is now announced that Article 60 of the "Shenzhen Special Economic Zone Medical Regulations" implemented on January 1, 2017 stipulates that if medical institutions and doctors commit illegal professional practice, they shall be handled by the health administrative department in accordance with the cumulative score system, except for administrative penalties imposed in accordance with the law.
If a medical institution accumulates scores to reach the corresponding scores within one scoring cycle, the health administrative department shall give a warning, order the suspension of business and rectification, and revoke the medical institution's practice license.
If a doctor accumulates scores within one scoring cycle and reaches the corresponding score, the health administrative department shall give a warning, order the suspension of practice, and revoke the physician's practice certificate. The specific methods for accumulated scores shall be formulated separately by the Municipal People's Government.
Therefore, the "Points Measures" are based on the law, and the doctor's point deduction system in accordance with the "Shenzhen Special Economic Zone Medical Regulations" should be implemented by health administrative department in accordance with the law. How to supervise
?
Article 4 of the "Points Measures" stipulates that the municipal and district health administrative departments are responsible for the scoring of illegal professional behaviors of medical institutions and doctors in their jurisdiction in accordance with the principle of combining hierarchical management and territorial management. Article 5 of
stipulates that the health administrative department shall adopt daily supervision, special supervision and case investigation to strengthen supervision and inspection of the professional behavior of medical institutions and physicians. This article stipulates the form of supervision, including daily supervision, special supervision and case investigation. Article 6 of
stipulates that if a medical institution or physician has illegal practices that should be scored according to these Measures and should be subject to administrative penalties in accordance with the law, the health and health administrative department shall also score points while making the administrative penalty decision. If the administrative penalty decision is revoked or changed, the scoring decision made by the health administrative department shall be revoked or changed accordingly. If the health administrative department revokes the medical institution's practice license, cancels the registration certificate of the traditional Chinese medicine clinic or revokes the medical institution's practice certificate in accordance with the law, or revokes the medical institution or doctor's practice certificate, the medical institution or doctor will no longer be given scores. The meaning of this article
is that administrative penalties cannot replace points, but points given based on administrative penalties should be revoked as the administrative penalties are revoked. Article 7 of
stipulates that if a medical institution or physician has any illegal practices that should be scored as stipulated by these Measures and does not subject to administrative penalties in accordance with the law, the health and health administrative department shall make a score decision within 3 months from the date of discovery of the illegal practice. If the situation is complicated or there are special reasons, the processing period may be appropriately extended with the approval of the head of the health administrative department at the same level, but the extension period shall not exceed 3 months.
Before making a scoring decision, the health and health administrative department shall inform the parties in writing of the facts, reasons and basis for making the scoring decision, and listen to the opinions of the parties. If the facts, reasons or evidence proposed by the parties are established, the health and health administrative department shall adopt it.
If the illegal facts are conclusive, if the medical institution or doctor is given a score of less than 2 points, a scoring decision can be made on the spot. The meaning of this article
is that illegal acts that are not enough for administrative penalties but should be scored should be points. The score can be decided on the spot for 2 points. If the parties are allowed to defend the facts, reasons and basis for making the scoring decision, and the facts, reasons or evidence proposed by the parties are established, the health and health administrative department shall adopt it. At the same time, it is required that before making a scoring decision, the health administrative department shall inform the parties in writing and listen to the opinions of the parties. This is a procedure established by the "law". Article 8 of
stipulates that if the illegal practice of medical institutions and doctors is not discovered within two years, scores will no longer be given. This is just like the statute of limitations for civil litigation.
The period specified in the preceding paragraph shall be calculated from the date of the occurrence of the illegal practice; if the illegal practice is continuous or continuous, the calculation shall be calculated from the date of the end of the act. Article 9 of
stipulates that medical institutions and physicians are suspected of deceiving or inducing patients to receive diagnosis and treatment or engaging excessive medical treatment or other illegal acts. If the health and health administrative department believes that it is necessary, it may entrust the Municipal Medical Association and other social organizations to conduct professional certification. The professional certification opinions can be used as the basis for handling the health and health administrative department. This article is actually a professional problem such as "Medical institutions and doctors suspected of using false diagnosis, exaggerating the condition or efficacy to deceive or induce patients to receive diagnosis and treatment or have excessive medical treatment" that should be entrusted to professional institutions for identification, showing the spirit of the law. Article 13 of
stipulates that the municipal health administrative department shall establish electronic files for illegal professional practice of medical institutions and doctors to achieve interconnection across the city. The health administrative department that makes the scoring decision shall enter the scoring situation in a timely manner. Article 14 of
stipulates that the municipal health administrative department shall notify the Municipal Medical Institutions and physicians of illegal practice scores to the Municipal Medical Association, and make it public to the public through government portals and other means. This is more powerful, perhaps the most powerful thing to regulate the behavior of medical institutions and physicians.
Maybe the "Points Measures" is not easy to implement, but for the supervision of the medical industry, which has a low social reputation, if there is no specific "detailed rules" to restrict it, it may be even more difficult to let the industry embark on the road of standardization. In this way, Shenzhen and Shanghai have really set a good start for the whole country. (Original title: Doctors practice implement a point deduction system, and take stock of measures to regulate doctors’ practice. Who will supervise the point deduction system of doctors and how to supervise?)
