Patients or customers? New models for medicine – 把患者叫做“客户”的新型医生 – English

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Obstetrician Gong Xiaoming believes that medical services are just like other services in the industry, and overseas, the relationship between doctors and patients is a service relationship. Only by truly serving the patients well and treating them as clients can we truly “feel that doctor is a respected profession.”

Text: Chen Siming; editor: Wang Yaping

Gong Xiaoming says: ‘unless they can prove me wrong (that cervical erosion is not a disease), I will just have to keep saying it.’

Gong Xiaoming, a former obstetrician at Peking Union Medical College Hospital in Beijing, joined the Shanghai First Maternal and Children Hospital in 2014,because the later promised him he could ‘practice more’. And so, without even inquiring about the wage, he just ‘transferred’ from thousand miles away.

Gong Xiaoming does not want to share the same identity as traditional doctors – authoritative, without a sense of service, rigid. That is the ideal he is struggling for.

He loves the medical profession.

When I took college entrance exam, my dad wanted me to do medicine, because he felt that my personality was not suitable for the political career, learning medicine on the other hand was learning life-saving skills, which warranted a comfortable life.” He recalled his internship. At first, I was in internal medicine and saw with my own eyes many patients arrived when they were already in advanced stage. The physicians were helpless and the patient proposed to look for qigong masters. “At that stage, the physician in charge could not refuse, so he had to agreed.” He did not like this feeling of helplessness, and hope to find a quick and complete solution to the problem, so decided to be a surgeon, and finally took the opportunity to join the country’s well-known obstetric and gynecology hospital.

He began working in 1998, and at that time, discovered a US website devoted to gynecology and obstetrics while China had no similar website. So in 2000, he created one, “it was the era of personal space, so I made a personal website, also applied for a top-level domain.” After 10 years, the site became a domestic obstetrician’s portal. Almost all obstetricians and gynecologists in the country know about this professional website that grants them access professional information and peer exchanges.

When Weibo and Weixin came out, he actively explored them, and used them to interact with patients. When weibo launched public accounts, he became the first doctor in China to open a Weixin work platform,making use of WeChat public platform to give the public popular science and obstetrics knowledge. Not long ago, he sent a public message asking patients who had had surgery with him to give him the time, place of surgery and the recovery progress so that he can easily provide them follow-up service via his personal WeChat.

The American health care system had a great influence on Gong Xiaoming. In 2003, he received from Beijing Union Medical College Hospital an opportunity to participate in an exchange study program with Los Angeles Obstetrics and Gynecology hospital。”At that time, I really started appreciating what kind of profession medicine is, and how doctors should approach it. In reality, healthcare is a service industry, and overseas, the relationship between doctor and patient is a service relationship.” 。He discovered that only by truly serving the patients well and treating them as clients can we truly “feel that doctor is a respected profession.”

Since then, he has been practicing the concept of “healthcare service.” Studying abroad again in 2012 led him to realize that the gap between Chinese and American healthcare was actually the physician training system. In order to improve the training of young doctors, he moved his focus on young doctor training and tried hard to change the existing system. He found that “multi-point practice” was a good way out. China’s policy encouraged this practice in 2008 and 2009, “but it has not been implemented properly.” Therefore, when Head of the First Maternal and Children Hospital of Shanghai, Duan Tao, invited him, he agreed。

Now he spends half a day every week visiting private outpatient clinics and returning to Beijing once a month to see previous patients. “很多人抱怨的地方就有机会,目前医疗行业就是如此,我在前面先做些尝试,来探探路。”

In addition to “multi-point practice”, he is also looking into online medicine. The website created in 2000 turned commercial in 2006, and the company he founded has evolved into a team of nearly twenty members and is now preparing to launch a Medical Software targeting pregnant women in 2015 called Hyacinth.

“The ideal state would be to form one’s own medical team, form a Group between doctors, develop healthy competition, and give good service.”

San Ming Zhi: You’ve been working with Weibo and Weixin since very early on. How did they help doctors in their practice?

Gong Xiaoming: I’ve found that they are useful tool to convey scientific information to more people. Journals on cervical erosion published by the end of 2012 were read by a total of more than thirty thousand people. I see a maximum of 30 patients in an outpatient clinic, how many days would it take to reach the number of 30,000 people? Weibo and WeChat can now give everyone the right opinions, they have benefited a lot of people and prevented excessive medical treatment, to me, this is a good thing.

Medical profession needs a humanistic spirit, and doctors must communicate effectively the likely outcome of each decision, thus avoiding conflicts. For patients who read my articles, they can understand my treatment better, communication between us is more effective, hence we can save time, which is good for both sides.

Previously, due to the loss of contact information, it was relatively difficult to revisit (my patients). Now, my personal WeChat account specially stores information on my previous patients. If they have any small questions to ask me, send a WeChat text to me and I can reply when available. After surgery, I can not abandon the follow-up. I have to know the recovery process. This brings a deeper meaning to my job.

China30s: User feedback on their experience is also very important for medical practice.

Gong Xiaoming: One day, I also told our Head of the hospital that our questionnaire revealed patients’ satisfaction level is more than 95%, but to really understand the feelings of patients, at the same time, we also need to check for public comments on reputable medical websites about their experience with our hospital. Only if we understand patient’s real concerns can we do better.

China30s: Your argument of “cervical erosion is not a disease” is indeed very successful, are you worried about hurting some people’s benefits?

Gong Xiaoming: I don’t worry about it, because even more people will benefit. There’s no need for the patient to spend so much money on unnecessary medical treatment. Unless they can prove me wrong, I have to say it.

The Chinese medical community has been slow to update their medical knowledge. 30 year ago in Taiwan, cervical erosion was already considered as a non-disease, the same goes with Europe and the United States. In China there are still 80% of doctors treating cervical erosion as a disease, this is a waste of resources.

其实医学知识发展很快,尤其是新的理念、技术、设备更迭特别快,所以医生得不断地去学习。两年前我做切除子宫的手术,我可能不会切除输卵管。但是现在出现了新的证据证明输卵管伞和卵巢癌发生的关系,所以现在我做切除子宫的手术,我会把输卵管一起切掉。这些新的东西需要医生不停地去学习,才会让病人受益。

China Thirties: Why did you originally go to a private hospital in the US to practice more?

龚晓明:为推动医疗的改变,现在的老百姓对医疗都是一大堆的抱怨,背后的问题是在于医疗市场的开放不够,医疗如同上世纪70年代的餐馆和酒店行业,只有国营的,消费者不满意,只有进入真正的市场化后,老百姓的生活才变得丰富起来,医疗也是需要同样的过程,公立医院做保底的事情,让私立医院去做好差异化的服务,让更多老百姓可以享受医疗,而非被医疗所折磨。多点执业是件好事,值得推动,我想要正大光明地去执行,只有更多的医生在私立医院的平台服务患者,我们的医疗的满意程度才会提高。

China30s: How do private hospitals feel different?

龚晓明:当时去美中宜和出门诊虽然能够养得活自己,但是自己的病人一下子少了很多,毕竟愿意多化很多钱去私立医院看病的老百姓不多。目前老百姓并没有去私立医院看病的习惯。我花七块钱在公立医院挂个号能看到你,那我就没必要去多花钱去私立医院看病,而且过去的私立医院给人的印象都是不太可信,水平不高,那么就需要我们更多医生去推动改变,私立医院无论如何,在医疗品质上必须要有保证,不能以过度医疗牺牲病人利益作为代价。

三明治:与公立医院的价格比起来,私立医院确实在价格这方面缺乏竞争力。

龚晓明:其实我认为价格在这个不是最重要的因素。

举个例子,二十年前麦当劳刚来中国的时候,那个时候包子店两块钱就可以吃顿饭,也很少人愿意花二十几块钱去吃一顿饭。但是你看现在,不仅仅是麦当劳,下午茶、西餐,几百块钱大家照样买单,当你从来都是2块钱吃饭的时候,有20多的你就会觉得贵,但是当你习惯多化10多倍价格在饭店吃饭的时候,就不会觉得是问题。这个就是一个消费习惯问题。但是在这个习惯形成之前你得让老百姓知道去私立医院能够吃到好的面包、有好的医生、医生能够以你的利益为出发点,这样才能重建老百姓对私立医院的态度。

中国的医生的分布是不均,由于欠缺完善的医师培训体系,各地医师差距较大,所以第一步就是解放医生,把好医生释放出来,允许多点执业,推动医疗改革。目前中国医疗体系没有市场化,医生的收入也是定好的,收入少,因此缺少积极性。

China30s: in 2003, you went to the US for an internship, is there anything you can share?

龚晓明:首先就是感受到的是美国医生的专业服务精神。刚到美国的时候,我很是兴奋。有一次在办公室跟国内好友讲电话讲了二十几分钟。挂了电话之后才听到了敲门声,一看发现主任在门外等我。后来我才知道原来主任已经在门外等了十几分钟了。这在国内是几乎不可能发生的,不论什么级别,人都很谦和。还有一个他跟着主任去病房查房,医院大多数患者都是穷人,那天正好有一个刚做完剖腹产手术的病人要下地,主任看到了立马向前去搀扶。和中国家长式的态度不同,我在那里第一次这么强烈得感受到医生的专业服务精神,无论病人贵贱贫富,都是以一个医生应该具备的职业素养去对待他的患者。医生是一个受人尊敬的职业,但是仍然是一个为患者提供服务的行业,我们其实就是乙方。

医生又比较特殊,只要我们把工作做好了,甲方都会非常感激。这一点在别的行业里很难体会到。现在很多中国医生还不太愿意承认医疗是服务业,好像觉得面子上过不去,降低了身份,但是事实确实如此。我鼓励中国医生多去外面看看,看看外面的世界是什么样子。

三明治:中国实现多点执业的困难在什么地方?

龚晓明:医生大部分属于事业单位,流动性低。单位是要管着你的,开展多点执业会损失单位利益,作为公立医院的院长通常是不愿意放自己的员工出去。还有就是目前中国医生的行医资格都是固定死的。不像考了驾照我能在全国范围内开车,你是这家医院的医生,那么你就只能在这家医院行医。想要去别家医院行医得先经过自己医院同意然后再审核一次行医资格。这个过程非常繁琐而且还有很多其他因素在限制你。

China30s: Do you enjoy being a web-entrepreneur?

龚晓明:挺好玩的。中国妇产科网站前四年都只是静态页面,非常简单。到2006年,我想网站以后怎么办呢?我也做了五、六年了,但要是来一个商业网站我肯定就完蛋了。所以我就想别的出路。那时候其实有人找我,愿意出50万谈合作,但是我怕太商业化就没答应。

后来我就自己成立公司,其实公司只有我一个人。成立公司主要是为了能开发票,好谈业务。当时经常自己一个人趁着周末就去谈合作。我记得第一笔生意是一个四、五万的合同,当时高兴得不得了。想着自己从一个人维护开始,做到现在有四五万的合同了,就很开心。不过公司到了2008年才有的第一个正式员工,2009年底有了自己网站的办公室,现在有合作伙伴了,我管得少了,团队也发展到了近二十个人。我们现在算是抓住移动互联网的机会,但这纯属无心插柳之举。创业仍然是有风险,但是非常有意思,看病只能一个一个病人地看,效率低效,互联网影响到的却是一个群人,非常高效。

China30s: Will you be releasing a mobile application next year?

龚晓明:对,叫风信子,它主要针对孕妇。中国每年有1600多万的新生儿,孕妇是个很大的人群,并且这个人群目前得到的服务并不太好,由于在公立医院里面孕妇多,就诊时间短,有很多问题得不到医生直接详细的回答,我们希望可以通过移动互联网的工具,为孕妇和医生搭建起来一个沟通服务的平台,我们网站拥有了全国几乎所有的妇产科医生的群体,所以我们第一个服务的群体会是医生和医生服务的孕妇们。

China 30s: Do you still love this profession?

龚晓明:我知道很多有情怀的医生,慢慢在这个行业被消磨。我自己来说,我觉得我所做的事情能够为这个世界带来一点改变,就觉得很有成就感、很值得。一个人如果能把兴趣和职业结合在一起就是最好的。尽管目前医疗行业矛盾很多,但是我曾经有患者因为我到上海来上班,而从北京来到上海找我看病,过来开刀。我觉得这种职业的成就感在别的行业很难体会得到。

前几天我还看到一个新闻,说交大医学院的学生转系。现在的医生不受尊敬确实是个问题。想一想如果社会精英都不愿意当医生的话,其实是很可怕的。目前医疗行业整体方向是好的,但是不知道要经历多久才能改变。

I am still finding my path, and I want to tell my colleagues, it is possible to gain both respect and happiness.

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Source : China 30s

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