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 in the form of writing on social platforms, and put forward possible solutions, calling on the state to pay attention to and supervise this. (Evan Finance Summer)
Attached is the full text of "To my beloved country and many cancer patients and their families-please join me in calling on 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 a general oncologist in the Third Hospital of Peking University and a member of the NLD. In the past 1 year, I encountered many things, which made me experience entanglement and pain, and also prompted me to think, why did such a problem occur? Now I think I have understood and have a lot to say, so I wrote this article.
Almost everyone in China feels this way. The country is getting stronger and stronger, people's living standards are getting better and better, unfairness is becoming less and less, and the system is becoming more and more transparent. We are all beneficiaries, and we are proud of the development and strength of our country.
But what I want to talk about today is the bad side, a lot of bad medical behaviors and some unscrupulous doctors in the current tumor treatment, and analyze the reasons and propose solutions. Please think about it, how many patients often worry about lack of money and people after suffering from tumors, talk about hospital discoloration, and even refuse to go to regular hospitals for treatment. Many people have 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 very likely that there will be no people and no money. Unfortunately, this impression is not entirely imaginary. In reality, such real cases happen constantly, and every real case is likely to mean the breakup of the family or even the return to poverty.
In fact, in most cases, the treatment of tumors should not require both manpower and financial resources, but should be better and cheaper than at present. So why are there still so many people going to empty buildings and money going to empty buildings? 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 the lack of supervision, which leads some doctors to act recklessly, and the resulting bad medical behavior harms the interests of patients. This is an important factor leading to the increase of disputes between doctors and patients, and it is also an important reason why people think it is difficult and expensive to see a doctor. It is very unfair that the consequences of some doctors' evil deeds should be borne by all citizens.
I can't accept that the doctor's bad medical behavior leads to an increase in the mortality rate of innocent patients or even direct death. In any case, this article must be written and made public: explain the current chaos in tumor treatment, put forward possible solutions, and call on the state to pay attention to and supervise.
Part one: The confusion of current tumor treatment.
Cancer patients are a very large group. In 2020, there will be 4.57 million new cancer patients and 3 million deaths in China. The mortality rate is still high and the incidence rate is still rising. Why is the mortality rate so high? In addition to the common diagnosis, it is advanced. 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 spent unnecessary expensive expenses, and a certain proportion of patients 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 thought is that until now, few people have voiced their condemnation of this behavior that violates the professional ethics of doctors.
I guarantee the truth of the following statements on the basis of my career:
In the past 1 year, I met more than 100 tumor patients in dozens of hospitals who received improper or even wrong treatment, which obviously violated the basic principles recognized by the tumor community, and some of them were 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 patients die. What's more, it involves not only local general hospitals, but also oncologists in several top three 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 cancer treatment guidelines (CSCO guidelines in China, NCCN guidelines in the United States or ESMO guidelines in Europe), and deliberately switched to other programs for cancer patients, and there is sufficient evidence to show that this program change is harmful to patients, because it will increase their economic expenditure, side effects and even mortality. So much so that I suspect that as many as 1/5 patients may have changed the standard treatment plan. Of course, there are more small mistakes.
Frankly speaking, changing the standard treatment scheme at will is 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 economic interests. The following are clinical examples:
1. Some doctors used lobaplatin instead of standard oxaliplatin, and raltitrexed and outdated deoxyguanosine instead of standard 5-Fu 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, which were not approved for the treatment of intestinal cancer, when treating patients with stage III after radical resection of intestinal cancer. There is sufficient evidence that such patients should only receive standard dual-drug chemotherapy, and randomly increasing targeted therapy will lead to a slight increase in recurrence and metastasis rate and an increase in mortality.
3. Some doctors deliberately exaggerate their illness and take adjuvant chemotherapy for patients who obviously 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 the preoperative chemotherapy of gastric cancer and intestinal cancer, some doctors 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.
Some doctors even give up the standard treatment plan directly, without informing and discussing the patients at all, and treat them as they want. For example, nasopharyngeal carcinoma was changed from external radiotherapy to particle therapy, and single liver metastasis of colorectal cancer was changed from surgery to radiofrequency ablation or interventional therapy instead of forced surgery.
6. Some doctors abused PD- 1 inhibitor, and misinformed the patients who did not need PD- 1 inhibitor after gastric cancer surgery, pancreatic cancer surgery, intestinal cancer surgery and cholangiocarcinoma surgery, which can significantly improve the curative effect, thus inducing these patients to use PD- 1 inhibitor.
7. There are countless other phenomena, such as forcing patients to do unnecessary hot perfusion chemotherapy after operation, giving unnecessary patients preventive injections of long-acting whitening needles and so on.
Being a doctor is really not easy. Hard work, high pressure, and income are often out of proportion to pay, but I don't think these are the reasons for doing evil. According to medical principles and relevant laws and regulations, medical practitioners are not allowed to change the standard scheme at will, nor is it the gift of doctors to patients, but the responsibility and obligation of doctors to give patients correct treatment as much as possible. It is precisely because patients and their families have weak medical knowledge and weak legal awareness that it is not easy to defend their rights in medical litigation, so many doctors have bad medical behavior, but they don't have to bear the consequences or even have trouble. It is obviously very wrong for these doctors to use their dominant position and power to hurt patients. Specialists in top three hospitals should be the most trusted and reassuring patients, which is also the glory of being a doctor, but unfortunately it has not become a reality at present.
The second part: the reasons of bad medical behavior.
(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 improving the curative effect, but in fact it is for their own interests. And we are surprised to find that there is no effective control over this behavior at present. Without supervision, a considerable proportion of doctors will really make the treatment of patients more expensive and worse. What's more, some doctors simply ignore the life and death of patients and extract the best interests with impunity. 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. It is incredible that some doctors can risk their patients' lives for money. Sometimes it is wrong to change the patient's standard treatment plan, but it is only for the benefit, or for cancer patients who don't need treatment at all. This 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 error, even if they know the treatment error, they are powerless to resist. Complaints to the health and health commission are often sent back to the hospital for their own handling, so they can only resort to the law. However, the complexity and high cost of legal procedures often deter injured patients. Some patients with low incomes are themselves poor due to illness, and it is even more difficult to bear the high cost of safeguarding rights.
Systematic abuse of doctor's authority, violating the principle of diagnosis and treatment to gain benefits, causing serious damage to patients, will make many good doctors and young doctors feel disappointed and indifferent. Is it fair that doctors who work hard for patients' lives earn far less than doctors who commit bad medical behaviors? I believe that 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 contradictory. This is especially true in the field of tumor treatment. That is to say, if the doctor thinks of the patient wholeheartedly and puts the interests of the patient first, the doctor will be very bitter and poor. On the other hand, if doctors don't care about patients at all, they will get rich rewards from their own interests, 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 about the profession of doctors, even a little disgusted. I hope that the medical profession is more noble and doctors are more worthy of respect.
Some doctors can well distinguish patients who can't be offended from patients who can't resist. What makes people extremely angry is that many patients who are not well-off come to the top three hospitals in first-tier cities from other towns and even rural areas with hope, meet unscrupulous doctors, and then are told by doctors to adopt individualized programs specially formulated for patients, which have good curative effects but are more expensive, tricking patients into obeying treatment. The result is often a sharp increase in expenditure, followed by an increase in mortality. Obviously, it is the greed and selfishness of doctors who do such shameless things, but they insist on being grandiose and arbitrarily squeezing the blood and sweat of patients. I seem to hear the triumphant laughter of some unscrupulous doctors, and the huge expenses of patients have become the luxury cars, cars and wine of these doctors.
This is the biggest and ever-changing unfair situation of cancer medical treatment.
(Note: If a cancer patient sees this article, please read the article "How Cancer Patients Avoid Losing People and Money" written by Dr. Zhang Yu, the official account of WeChat, which should be helpful. )
Solution:
I've been thinking about it for a long time. It is not easy to treat medical chaos, but I think the following four points are the most important methods.
(1) The most important thing is to control medical chaos according to law with the support of law. At present, it is really too difficult for patients to defend their rights through law. Can the state add a supplementary clause on medical disputes, that is, fast handling procedure: when it is clear that doctors use the wrong drugs or other treatment methods that do not conform to the instructions and guidelines and clinical norms, 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 obviously shorten the time, which is simple and easy to implement, and can directly deter medical accidents.
(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 direct suspension or permanent revocation of doctors' qualifications after three times. We can even consider establishing the responsibility system of attending doctor-director and dean to urge hospitals not only to compete for clinical and scientific research strength, but also to attach great importance to preventing bad medical behavior.
(3) Promote the peer supervision mechanism. Can you choose some doctors with high professional level and excellent professional ethics to conduct regular audits to strictly investigate potential mistakes and correct them in time? Frankly speaking, the level of tumor knowledge 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, they will try to distort patients' thoughts and instill wrong information into patients. But if the patient already knows what is going on, it is idle to make it more difficult for the bad doctor to do evil. Many doctors in China (many of them are surgeons) lack basic knowledge about the use of anti-tumor drugs, and their attitudes are sloppy, blind, confident and professional. As mentioned above, I have seen a surgeon treat intestinal cancer with docetaxel. The guess is that doctors think that docetaxel is very effective in treating gastric cancer, and it can definitely treat intestinal cancer with low malignancy, 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. First, the lawsuit is too simple. 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 obviously violates the rules and harms the 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 implemented and strictly enforced can we ensure the safety of patients and reduce disputes between doctors and patients, which is the blessing of the people. I don't even think it is necessary to use the DRGS system to control fees, as long as doctors are patient-centered. In view of the fact that the country has reduced 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 do doctors increase the patient's expenses tenfold and die early?
Let's look at a typical medical accident. In fact, I wrote about this doctor, and many people already know him. He is a general surgeon, Dr. L, from a well-known 3A hospital in Shanghai. He is amiable, and what he said makes many patients feel very reasonable, but unfortunately, the above is just a manifestation, with corrupt behavior and moral decay. The main purpose of many patients receiving treatment is to make a profit.
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 for gastric cancer is not high, and the state can reimburse it. However, Dr. Lu is not satisfied. As a result, the patient's life expectancy is obviously shortened, the cost is 10 times higher than that of conventional treatment, there is no savings, and hundreds of thousands of debts are owed. Let's see how Dr. L does it.
(1) It costs about 20,000 yuan for patients to do NGS sequencing. The NGS used by Dr. L is the most unreliable blood test at present, not a more reliable tumor biopsy. In other words, the results of NGS have little reference value. According to the routine, it is more accurate to detect the pathological slices 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 have a blood test first.
(2) Adopt wonderful second-line treatment plan: pemetrexed, erlotinib, oxaliplatin, capecitabine and tamoxifen, which is an unprecedented treatment plan 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 taxane regimen. At present, it is considered to be one of the most effective treatment methods, and the cost is low. However, after forcibly replacing it with 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 therapy is almost completely ineffective for advanced tumors. Therefore, the state has repeatedly banned the charging of NKT treatment and limited it to free clinical research. Dr. Lu tried his best to induce the patients' families to receive treatment, telling them that it would have a good effect and let them borrow money for this treatment. In the end, both money and money were lost. You know, this money is the patient's hard-earned money, and it takes more than 1 year to save 30 thousand 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. In the hope of controlling and curing their illness, they gratefully send special products to Dr. L. How did Dr. L repay them?
(4) Auxiliary drug abuse: Dr. L prescribed many auxiliary drugs, such as Ridaxian. Of course, Ridaxian itself is a good medicine, 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 the money was spent. Dr. Lu began to ignore it until the patient died, and his survival time was very short. Although the prognosis of AFP-positive gastric cancer is indeed worse, if standard second-line treatment is adopted, the survival time is likely to be longer and the cost will be much lower.
What needs to be explained is: I only wrote Dr. L, not because no other doctors have done so, but actually there are cases that I think are worse, just because the first evidence is insufficient and the second pressure is too great. 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 blame such dark events, but I really can't help it. If the state does not strictly control them, innocent patients will definitely lose their lives.
I want to ask a similar doctor for help. Don't do this kind of thing again. 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. 4+7 quantity procurement has reduced drug prices, increased doctors' medical fees and improved doctors' treatment. These are very good and important measures. If the country does not reduce the prices of many cancer drugs, the abuse will certainly become more rampant. This is a smart move, but it's really not enough. Expect the country to clean up the roots and rectify bad medical behavior. I hope that doctors can abide by the basic norms of tumor treatment and take patients as the center in the future.
Monitor, monitor, monitor. As long as there is no effective supervision in the medical industry, doctors who hurt patients or even take risks will not be eliminated. Please pay attention to the relevant state departments. In the medical industry, this is the most important thing and what the people expect most.
As a doctor, the most important quality is to cherish the life of every patient. Although patients can't be equated with their families, we should realize that patients' lives are precious, and we need to take every patient seriously and do 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 role models for our generation, not doctors who have made a lot of money by bad medical practices. They should be spurned.
Also, as I said before, I expect medical fairness, fairness to patients and fairness to doctors. Doctors treat patients wholeheartedly and take pride in curing them. Patients can understand, cooperate and understand doctors to achieve the best treatment effect. Why shouldn't the doctor-patient relationship be improved? It is not the medical mistakes I pointed out that damage the doctor-patient relationship, but the doctors who make bad medical behavior to patients, and they are the culprit. Only by curbing these behaviors, punishing bad behaviors according to law, so that every doctor can see a doctor well, I believe that our doctors will definitely gain greater trust and real respect from patients.
I hope everyone can speak freely. If everyone is afraid of retaliation and turns a blind eye to this bad behavior, or even thinks it is irrelevant, it is a big mistake. In the end, it is not one person who is injured, but each of us, 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. Please finish it as soon as possible without delay. Only in this way, when people walk into the hospital, they will not be afraid of being treated unfairly. I really hope to work in a better medical environment in the future. The focus of a doctor's work is always to treat patients rather than others. Doctors and patients are kind to each other and fight against diseases together.
I hope more people will see this article, which will cause a curse. Everyone should know what is right and what is wrong.
I hope my efforts to make this sound can get more support. A single spark can start a prairie fire.
I hope that the medical care in our country will become the best medical care model in the world.
Zhang Yu 2021April 18