Author of this article: Chacha
At 8 pm, Dr. Xu Li was sitting in the outpatient room. No patient had registered since 6 pm.
Even if someone comes, what Xu Li can handle is very limited. Ordinary pharmacies and auxiliary departments have closed early, and only emergency orders can be filled with prescriptions and examinations. But she still had to stay up for another hour before getting off work. Over the past year, she has experienced such three-hour "night clinics" twice a week.
If you search for "night clinic", you can see that many hospitals have launched slogans to solve the problem of office workers, students, and seniors who have no time to see a doctor during the day. Experts are in charge to alleviate the difficulty of citizens registering and improve their medical experience.
Source: A hospital public account
In actual operation, has the night clinic played the expected role? What difficulties do doctors encounter in conducting night clinics?
Unable to write orders or get medicines: the doctor’s "baking without rice"
The effectiveness of doctors in night clinics cannot be separated from the supporting measures provided by the hospital. The lack of examinations, medicines and other links may put doctors in " "There is no cooking without rice" situation.
Xu Li’s hospital does not have a separate auxiliary department or pharmacy staff for the night clinic. “For example, if you need to draw blood, it must be considered an emergency item. Patients are not willing to pay more for examinations in ordinary clinics.” She said He positions himself as a "guiding doctor" in the night clinic. "Occasionally, someone comes to us after get off work with a laboratory test sheet. If the condition is serious, we directly recommend going to the emergency department, as ordinary outpatient clinics cannot handle it."
Even if the package is provided In terms of department services, doctors may also be hampered by unreasonable process regulations. Ultrasound doctor Li Hua is assigned by the department to provide night clinic services. In actual operation, he is often worried about how to review the application form. “The hospital requires that only orders issued by the night clinic can be processed during the evening time period. For example, the night clinic starts at 17:30. , then the order opened at 17:20 can only make an appointment for the inspection time from 8 to 17 o'clock during the day."
Li Hua’s department handles an average of 1,000 ordinary numbers during the day, and less than 10 at night. Faced with the huge difference in demand, he often has to face the dissatisfaction and doubts of patients who placed orders during the day but did not make an appointment. In order to avoid conflicts, he can only choose to add additional procedures, or the patient can find a doctor to change it to an emergency order.
Regarding the requirements for outpatient management, the National Health Commission issued the "Interim Regulations on Outpatient Quality Management in Medical Institutions" in June this year, which mentioned that medical institutions at level 2 and above will incorporate outpatient quality management into the working system of the Medical Quality Management Committee.
This also shows that the operation of the clinic should be standardized and systematic. Night outpatient clinics must be of the same quality as daytime outpatient clinics, and preparations must be made for all aspects such as auxiliary diagnostic examinations, registration fees, drug support, logistics support, and admission management. This is also a more efficient arrangement for patient visits or doctor visits.
Interim Provisions on Quality Management of Outpatient Clinics in Medical Institutions
Source: National Health Commission
In addition to complete supporting facilities, costs and benefits affect how far night clinics can go. "Discussion on the Operation Model of Tertiary A Hospitals" mentioned that opening multiple departments at night requires the hospital to have enough sources of disease to ensure balance of revenue and expenditure. Unlike the crowds during the day, the clinic may encounter an empty scene at night.
Xu Li usually sees a maximum of 40 to 50 outpatients in half a day during the day. In her one-year night outpatient experience, “the most I met were 3 people, and they came just after 5:30. There are not many patients at night. I spend most of my time sitting in the outpatient clinic.
The convenient way to achieve the convenience of reducing the waiting time for medical treatment and having more time choices should be to reasonably increase the outpatient clinic time instead of unlimited expansion. As the daytime outpatient clinic has basically met the local medical needs, Xu Li feels that it is a waste of resources. "We have added outpatient clinics during the weekend on weekends, and the tests and medicine collection are all fine. Patients can come during this part of the rest time."
Even if there are enough sources of disease, the arrangement will be chaotic and the diversion effect will not be achieved. A few years ago, Li Hua's department was required to work overtime for two hours at night because of too many patients. "No one knew that everyone still came during the day." The night outpatient service lasted for a month and then stopped.
If you want to do your job well, you must first sharpen your tools. If the night clinic is trapped in the form of "night" and "outpatient", the result of extending the time may be half the result with twice the result. When the system in which they work does not work well, the pressure immediately comes to the doctor's side.
How many does a doctor need to be divided into?
In a discussion on the Dingxiangyuan Forum, 75.6% of people voted for measures such as adding weekends, holidays, and night outpatient departments, saying "I don't support it very much, as it may increase the burden on doctors."
Source: Lilac Garden Forum
First look at the working hours. The "White Paper on the Practice Status of Chinese Physicians" released in 2018 shows that the average working hours per week are 51.05 hours for doctors in tertiary hospitals , 51.13 hours for doctors in second-level hospitals , and 51.13 hours for doctors in first-level hospitals . 48.24 hours, which exceeds the standard working hour system which stipulates that the daily working time shall not exceed 8 hours and the average weekly working time shall not exceed 40 hours.
In recent years, many hospitals have successively implemented night clinics, morning clinics, noon medical clinics, dusk clinics, non-holiday clinics, etc. The common thing under different names is that doctors’ working hours have changed again and again on the original basis. being elongated. Dr. Wang Fang of the Respiratory Department needs to see more than 30 patients in the morning. He often sees patients at 12:30 or 1:00. "There is no limit on the number of outpatient clinics during the day. 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 taking care of students in teaching hospitals. In the lack of flexibility, Xu Li sometimes encounters night shifts and night outpatient clinic visits. "When I'm really tired, I change the duty hours, but I can't always change with others, because there are not enough people." When it comes to staff recruitment, the feedback she often gets is "if you hire too many people, you have to pay for it, so everyone insists."
In addition to the working hours and pressure of "breaking one doctor into several," Xu Li has not seen the rumored 1,000 yuan subsidy in the past year. The subsidy she feels cannot be implemented is the number of night outpatient clinics. The inevitable by-product of underemployment is, "It's not overtime pay. The hospital doesn't care about this part of the money. Corey has to earn it himself."
There is no unified implementation plan for performance subsidies for night clinics. Li Hua initially felt that the performance appraisal method brought about by spending time in the evening must not be the same as that of regular outpatient clinics. "After all, it takes up time in the evening."The actual options before him were to choose between compensatory time off and subsidy: "Come in for two hours late in the morning and have no money, or get a subsidy of 15 yuan an hour, and nothing else."
This made him feel like working overtime in the night clinic was like compulsory overtime. His inner resistance came from "the overall working hours, staff allocation, corresponding treatment, involving safety issues when returning home from work at night, and how to pay and not be able to return" Issues encountered at work such as a place for family members to rest have not yet been resolved." He said, "If all can be resolved, it will be okay for the hospital to remain open 24 hours a day in the future."
Opening a night clinic requires discussion on a case-by-case basis
Before opening the night clinic, Li Hua encountered many "fake emergencies" due to work at night. "For example, she complained of being 33 weeks pregnant and asked for a check-up. More is worse than less. If anything happens, these will also go through emergency procedures."
Source: National Health Commission
Some hospitals also need to accept emergency patients referred from surrounding areas, and doctors are always in a busy stage. Night clinic provides an idea to alleviate the shortage of emergency resources. But in order to truly achieve the effect of diversion of patients, a lot of publicity needs to be done to the patients. "The hospital has made a special video, for example, introducing the same location of the night clinic and the day clinic. But many people still can't figure out whether to go to the emergency room or to go to the emergency room." Outpatient clinic. 》
In addition, the situation of night outpatient clinics in different departments is very different. Compared with departments such as Nephrology and Pediatrics, Xu Li from Nephrology Department encounters more situations where there are no patients or unprovoked situations. “The patient came at night and found out that he needed a morning urine test, but then he left cursing. ".
The hospital where Xu Li works allows almost all departments to open night clinics. As a result, doctors in some departments have no use and waste their original rest time. In this regard, Xu Li thinks that departments should be opened reasonably according to local conditions for optimization. , "For example, if the purpose is to serve office workers, then we should open night clinics for diseases that office workers are more likely to get, instead of opening them in all departments at the same time."
Another thing to consider is how to avoid exacerbating the siphon effect in large hospitals due to night outpatient clinics. Xu Li and Li Hua work in tertiary hospitals. . What they can harvest by using senior expert resources may be a group of patients who can be treated in lower-level hospitals. "In my heart, there will be some people who come to see for hypertension at night. In fact, community hospitals can solve it with .”
There are also some outpatient clinic extension needs that will be adjusted according to the season. Li Hua's hospital receives a notice from May to October every year, requiring it to open a 24-hour intestinal clinic because intestinal infections tend to occur during this time period. This arrangement is not only convenient for the people, but also to prevent the diagnosis of infectious diseases. At other times, there is relatively no need for intestinal clinics to operate 24 hours a day.
Working in the night clinic did not improve Xu Li and Li Hua's job satisfaction or sense of career accomplishment. On the contrary, because of the chaotic arrangement and the lack of positive feedback in the results, they unanimously believed that the opening of night clinics in their own hospitals was more like a follow-up behavior because surrounding hospitals had opened them. “There are no patients at night, so I go to the night clinics.” It's like a decoration. Similarly, people still crowd in to see doctors during the day, and the night clinic has no practical value and will become a decoration."
Xu Li and Li Hua are pseudonyms in the article
