Why difficult implementation is the operation graded

Why difficult implementation is the operation graded
Why difficult implementation is the operation graded
Staff reporter's side red Wu has defended red Wu just for many years, the differentiated control of operation is pursued in some medical organizations, but fail to get very good implementation all the time. Someone says, because hierarchical according to the professional title unfair by itself; Somebody says, count hindering doctor's growing up in grades according to the operation example; Also someone thinks, the differentiated control of operation is not isolated, the supplementary measures of various fields do not keep up with at present Where on earth to implement the difficult point? View that please see a doctor - -Should clarify basic conception first Sun Jian ( Medical matters of the People's Hospital of Guangdong Province place vice section chief, surgical associate professor of treatment of hepatobiliary pancreas) : Issue the hierarchical standardard management of operation on one hand for guaranteeing operation's security and operation quality, prevent malpractice; On the other hand save medical resources, raise and serve efficiency. Ministry of Public Health " whether hospital manage annual the intersection of activity and scheme 2008 " propose every hospital want, work with " the the intersection of operation and risk assessment " institutionalized " operation check safely ". Every hospital should make the concrete procedure according to the situation of our institute. Roughly there are more than 70 items in the index that medical quality quantizes management, among them has especially proposed the operation risk degree. Through adopting the common one in the world " The operation risk is graded " The method, not only can find out about the risk intensity of operation, can also compare " position infection rate of operation " between every hospital accurately Disparity,if you can't make horizontally, compare as world level. Set out since medical treatment safely, the attending physician can't make the operation of a high professional title. But what is the major operation on earth? What is to hit the operation? What is the minor operation? There is no very clear definition in a lot of places. So, should clarify basic conception first. If the concept is not clear, the operation is not known where to begin in grades. Still lack the objective evaluation index Liu MuBiao ( Deputy Director of southern gynaecology and obstetrics of Pearl River hospital of medical university) : Making the operation will have objective evaluation indexes to grade the standard key, are still relatively deficient in this respect at present. Compare for the moment the principle followed is to see the age and service seniority, but the depth of qualifications is not equal to horizontal level, the high one level of the qualifications might not be high, but the low one of qualifications may know the most advanced technology. For example create the operation a little, those young doctors returning from abroad have grasped the advanced achieving technology a little most, but the old doctor with high age and service seniority may not master. So confirm the hierarchical standard of operation is not just and sound only according to the qualifications. In addition, some hospitals pursue the hierarchical system of operation now, have certain subjectivity, the authority of entrusting the head of the department is too big. If who head of the department have a good prospect, even if this person is not enough for the upgrading standard, can upgrade too. On the contrary, if heads of the department do not gear to this person, then he wants to upgrade and estimate that there is some trouble. So, how many operations are done to upgrade on earth? The country should let every hospital have regulations to abide by to this setting-up more objective quantized index, avoid the blind and subjective factor. Let the doctor grow up more orderly Wang ChuanSheng ( Associate professor of treatment of second affiliated hospital of Xinxiang medical college) : Any thing has a dual character, it is no exception to grade the operation. Can make to grade low age and service seniority and high age and service seniority doctor in operation each performs its own functions, absorbed in the work one's own field, help to progress, to reducing the medical dispute, improving the relationship between doctors and patients, promotes doctors and patients to be harmonious and play a positive role too. Some doctors think it is beneficial to the patient that the operation is graded, unfavorable to the young doctor and grow up. Indeed, this will be meaning the young doctor's course of growth becomes relatively long. But can't for create a medical talent fast, and in order to sacrifice the patient's life security as the cost. Fundamentally, the operation brings the doctor's growth, Cheng Cai within more scientific orbit in grades, help the whole improvement of doctor's level. However, the most basic crux is that the operation is graded, must implement the system strictly in realistic operation. Only in this way, ability tries to get the developing on a large scale most of medical talents on the premise of guaranteeing common people are healthy. Train medical talent, maintain common people to be healthy, two must hold concurrently, win, every can't both give up. Under this kind of situation, it is that a kind of reality is chosen too to advance the differentiated control of operation. Would rather let, train medical paces of talent to be slower, in order to fully maintain patient's interests. This is a demand of the common people, and should be the value orientation of the medical trade too. Not very suitable for the hospital at county level to launch Liu XiaoLin ( Zhongshan University attaches to the Vice President of the first hospital, micro- traumatology department professor) : It is the developing direction that the operation implements the entry system, but there are many questions in medical treatment at present, it is not still mature to issue the differentiated control of operation. Perform the operation and classify developing dynamically at first. Medical technology is being developed constantly, the operation classification should keep up with its development trend. Secondly, this system should not be spread out in the whole country. For example every hospital at county level is in the face of hundreds of thousands, up to a million crowds, if the hospital doctor limits the operation to the county, may make it unable to do some operations actually on the doctor in short supply, the patient's demand can not be satisfied. And China has so many counties, if all carry on the differentiated control of operation, unrealistic. Can do in some areas such as Guangzhou, some specialities slowly. Whether in addition, the operation is done well, see the basic training, should see the clinical experience too. Young people operation make might beautiful than the old comrade, and the old comrade is experienced, good at dealing with the operation accident, the patient's trust is relatively high too. In fact our present medical treatment system and norm can well solve the safe problem of medical treatment, just implementation is not enough. For example the tertiary system of making the rounds of the wards if carries out strictly, can avoid a lot of potential safety hazards. Issuing the new system if carries out and does one's best, will still have a safe problem of a lot of medical treatment. Supervise and do one's best to become a mere formality Wang YuFeng ( Associate professor of treatment of specialized department of backbone of institute of traditional Chinese medicine of Guangdong Province) : Really have such a phenomenon in some hospitals: Just do two or three ordinary operations, begin to make having a big risk, operation with high difficulty. It is very apt to go wrong like this. The operation is made from these behaviors of a certain degree norm in grades, but if supervise and do one's best, mean becoming a mere formality. The our academy has made already for more than two years in grades the operation, my experience is: If you want to let this system move forward healthily, must supervise in place. The our academy stipulates very concretely, it is the operation examples of speciality, professional title and participation of combining the doctor that are counted and fixed. Take I as examples, I am a specialized associate professor of treatment of backbone, if bear the treatment of the wound, according to the wound operation case participated in in the past, can only do some simple four limbs fracture wound operations, it is equivalent to the level of attending physician with specialized wound, but the operation that can be operated in joint is lower in rank. Stress, turn on window with the intersection of waist and intervertebral disc marrow nuclear to excise skill as example, 2 assistant make 15 more than surgery totally at least on request and then, it is qualified to rise to an assistant; The example that an assistant needs to accumulate is counted more, could consider Work as operator and doctor, it also must be the above professional title of the attending physician at the same time. Could operate the operation independently formally after three examiners examine and sign after reaching the above-mentioned standard. If you are only a resident, even if you, as the operation which an assistant participated in more, can't operator walk, make window marrow nuclear to excise skill either. To some doctors, will slow down the step of growth slightly. Pass certain example after all to count and could make the operation with higher difficulty. But on the other hand, should say this kind of method is all kind to the patient to the doctor, do not restrict personal development. If has not reached the entry qualification, but bypassed the immediate leadershipping does the operation, even if the operation succeeds, also will be punished. If has appeared the surgery complication, punish heavier, such as will lengthen and promote time or low to engage etc.. The operation name of our academy was sent by oneself by an operation doctor in the past, such a loophole was, because the supervisor might not have very deep training knowledge, it is difficult to judge doctor's rank of competent operation of operation clearly, and the chance of the operation of making some doctors bypass the immediate leadership. Later on we implemented the operation code system, there is a fixed code in every operation, the intersection of surgery and doctor can only write to write surgery according to encoding operation names corresponded to while recording, can be found on the computer out very clearly so where rank operation each doctor can make, have stopped to bypass the immediate leadership and do the phenomenon of the operation from procedure. The criteria for classification of operation obviously lags behind Take care of palm borning, Wu Wei ' Central hospital of Huzhou of Zhejiang Province) : The differentiated control of operation runs in the our academy for a few years, has been approved by most medical workers. But what made us feel puzzled is, the criteria for classification of operation that health authorities made in early years has not obviously met the medical engineering level now, some new operation ways fail to be graded, achieve operation and fail to include in differentiated control. So we hope urgently the relevant department adjust the hierarchical standard of the operation classification as soon as possible, make corresponding management, in order to promote the operation differentiated control standardization. Combine our experience now, have a talk and implement the operation to grade the question that should be paid attention to. 1.Should be by " technological entry management group of medical treatment " But not the head of the department examines and approves doctor's operation entry. Such as according to the complexity of this technology, require the doctor to receive a training for appropriate time (should generally be in above 3 months) through going out Carrying on corresponding training, the assistant becoming the same operation in our institute is no less than for 50 times, can apply to launch this technology independently. 2.Manage according to different operation classifications. The persons who satisfy the requirements file an application, discuss to be agreed to according to the opinion of every operator and doctor in the department, managed the group by the entry finally to pass through discussion, award its qualification. 3.Want the casual inspection, verify each doctor " Operate the register in operation " ,Verify the professional and technical personnel regularly every year. 4.There should be punishment measures. If launches the operation or has something to do with and operates, will cancel the operation qualification according to properties or delay the professional title to promote if not possessing the person of the corresponding qualification. The key is to see real clinical ability Xu ShouXiang ( Affiliated hospital of Yantai of medical college of bank state) : The operation is managed in grades, it is a very beautiful imagination of administrative department of hygiene of higher level. But it is difficult to do well, it is difficult to be difficult in practical operation. In the practical work, do not totally promote horizontally according to the doctor in promotional practice of our country. It is mainly to read education, qualifications and thesis,etc. to promote the condition. In clinical work, education can not equate with ability. Because our country has gone through some special periods, some doctors dipped in the light improved in era. Some have not graduated yet and was educated in the university by recommendation junior middle school, have graduated three years later, become graduates of workers, peasants and soldiers. Some through teaching by correspondence, graduate at TV university,there are diligent very on except that some people, many people can not reach the regular competence of graduating from university, but they all promote advanced qualifications. And some high school students, after resuming college entrance examination, been admitted to a university the training, though is very outstanding, but they do not qualify for promoting exactly tallly. They will certainly than recommend into junior school student, teach by correspondence people that graduate to be getting bad that is educate in the university? No. But lost and promoted the advanced chance because there are no undergraduate course education. Another is regional difference. Some regional tertiary hospitals are intensive, the major operation generally concentrates on the hospital that the masses relatively believe in, and the other hospitals have few opportunities to do the major operation. Such a hospital may have qualification that does the major operation, but can't be competent. There are some second hospitals instead, because good because of living in the geographical position, manage the apt norm, the clinician has high quality, willing to study, often launch the major operation instead, and grasp very consummately. The intersection of operation and ability of people differ too, the intersection of theory and competent person, it operates ability to be might not right away high; On the contrary, the theory is poor, operating ability might not be lack of. Some experts give lessons everywhere, but the operation is done generally; Some doctors will not talk, it is very beautiful but do the operation. So, can't only watch qualifications such as professional title, education,etc., should watch real clinical ability in focal point in differentiated control of operation.


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