It's a paradox.

First, at present, with national investment in public health services, village doctors practicing in most areas have stipulated specific practice locations and constructed village health offices. The Regulations on the Administration of Medical Institutions and their Implementing Rules, and the Regulations on the Administration of the Practice of Village Doctors all stipulate that practice activities are to be carried out in the location and scope of practice. This means that no diagnostic and treatment activities other than first aid may be carried out outside the place of practice. Clinical activities not carried out in the place of practice are illegal, the fight against the illegal practice of medicine includes the content of the clinic. The reason for this is that there are huge risks associated with treatment outside of the place of practice, and the conditions and requirements for accident management are not in place.

Secondly, with the development of society, all kinds of social business services are developing in the direction of detailing, and door-to-door service greatly facilitates the service needs of the public. Door-to-door service is in great demand in the field of medical services and is also considered by the public as a legitimate social development need.

This issue is a contradiction between the establishment of the rule of law system and the convenience of service in the medical field. There is an urgent need to establish a justification in terms of scientific norms and people-friendly services. I personally believe that the content of medical services with little risk, including a specific range of home infusion should be supported to solve the public's medical convenience needs. However, for allergies, programs with a high incidence of infusion reactions should still be implemented in organizations with certain emergency conditions. However, this is a long process, if we reach the point where the public can enjoy most of the door-to-door medical services, our country should have already realized the great renaissance of the Chinese nation.

Door-to-door infusions can actually be refused as a matter of law:

In reason, door-to-door infusions are extremely risky

The clinic's refusal is also based on the fact that it is from a medical point of view:

I. Allergic reactions, febrile reactions, circulatory overload, air embolism, etc.; errors and accidents; and sudden changes in condition. These inevitably occur during infusion.

Second, many people react differently to the same medications due to the different body types of patients. Medically, adverse reactions between drugs and patients are unknown and uncontrollable. Fear not, fear not. Some patients although the infusion of the same drug, he may be the first day, the second day or even the third day is fine, but the fourth day but suddenly had an adverse reaction, then, if the patient in the hospital, the doctor will be able to make a better treatment, in the home obviously do not have these conditions.

Thirdly, the door-to-door time is limited, and the patient can only be accompanied for 20 or 30 minutes after hanging up the needle, unlike the case in clinics where the patient is on call until the infusion is completed. Also due to the lack of medical knowledge of patients and their families, theWhen patients experience symptoms such as chest tightness, shortness of breath, palpitations, shortness of breath, etc., family members accompanying the patient but tend to ignore the patient's feelings, thus delaying timely correction.Once a problem occurs, resuscitation is again delayed accordingly by location and time.

Fourth, in the clinic, there are a variety of medical equipment to do security, really a problem, the doctor can respond to make timely treatment, the main body of responsibility is also the clinic. However, when the doctor comes to your home for infusion, you may not even be able to carry a simple first-aid kit, and you may not be able to take effective rescue measures in case of emergencies.

Yu law: home infusion is illegal to practice medicine

How is a clinician visiting a patient for infusion defined in the health care sector? What is the attitude of the health administration towards this? Has a circular been issued to prohibit physicians from making home visits for infusion?

In response to these questions, BinCheng District Health Bureau of medical administration staff gave the answer.

"Physicians to the patient's home infusion, is a diagnostic and treatment behavior, and medical institutions management regulations clearly put forward, physicians engaged in diagnostic and treatment activities must be carried out in the place of obtaining a medical institution license, which is clearly contrary." The staff introduced the infusion process, the patient may be different because of the constitution of the drug allergic reaction, and the patient's home does not have the conditions of salvage, will delay the rescue time, which led to medical disputes.

"There was a previous incident where a physician made a house call for an infusion and an elderly patient had an adverse reaction that resulted in death. The patient's family pestered the physician not to let go, and ultimately paid compensation for the matter." The staff said that although the health department of Bin Cheng District did not issue relevant documents, notices prohibit physicians home infusion, but this behavior "should not exist", and can be characterized as "illegal practice of medicine".

The regulations governing medical institutions clearly state that physicians must conduct their diagnostic and therapeutic activities on the premises for which they have obtained a medical institution license, which is clearly contrary to the regulations. In other words.A doctor's place of practice can only be in the place of practice at the time of registration, otherwise it is illegal to practice medicine.

Thank you for the invitation! Individual clinic doctors, township health center doctors, community doctors to go out for people to diagnose the disease infusion is very common in the past, they can also be for the big hospital doctors prescribed infusion infusion, so it is really convenient for the masses, especially those old and sick and disabled inconvenient groups can be home to get the service to reduce the pain of the disease, it is really a good thing to do good things!

But as the years go by, the infusion must have a large infusion certificate, most of the operation of the infusion is carried out by nurses, and the infusion of drugs relative to tablets have a high likelihood of medical malpractice, although rare, but there is always, so there are some laws, the law of practicing physicians, the regulations on penalties for health care institutions ... so that of course, doctors do not dare to infuse for the homebound patients, not only do not infuse for the homebound Not only do they not give fluids to patients at home, but some small hospitals and individual clinics are not able to give fluids, which is of course inconvenient, and they will slowly get used to it.

As for this provision is good, the benevolent see benevolence, the wise see wisdom, this phenomenon can reduce disputes between doctors and patients, reduce medical accidents, and promote social stability, but remote rural areas and inconvenient groups do not get timely treatment, thus causing loss of life also, I do not know how to pinpoint! Since there is such a provision there is always reasonable. (I'm just chatting)

When you are not understanding and sometimes angry with your doctor, please never forget:During the new coronavirus in 2020, no matter how cold or hot it was, if it wasn't for the doctors and nurses who stepped up to the plate, you wouldn't be able to tell where you would be cooling off?

First of all, doctors are human beings, not gods!

I hope the Chinese never forget all the doctors and nurses who put their lives on the line for us in 2020.

SO, don't be too hard on yourself, put yourself in your shoes!

I do understand, nowadays the doctor-patient relationship is so serious, coupled with the number of medical malpractice blackmail doctors, who dares to home infusion? Who would want to come to the house for infusion? Now that the village doctors have been abolished, we don't have any doctors anywhere to sit in the clinic anyway! There are no medicines and no instruments, and it's all Western medicine that saves lives. If something goes wrong after the infusion, who's responsible? Who's responsible? It's not like there's a family doctor on call!

The people's hospital in our town, a little problem still let you run to the county hospital to see a doctor? The other night at 10:30 pm, my son had a fever of 40 degrees and vomited when I fed him medicine, so I went to the town's People's Hospital, and the emergency room doctor said that there was no way to hang up bottles of fluids here, and that there was no pediatric fever-reducing plugs. If you are not sure, you can run to the county people's hospital! 💔 listen to the heart of my heart ah, so big a hospital, even pediatric fever plugs are not.

It can be seen that it is difficult to see a doctor in the countryside nowadays, and there are few doctors who can see patients! The state should pay attention to these problems, the better medicine in the city province. The better doctors are more than a thousand miles away. The people's medical problems, when the country can really solve?

I'm sorry to say that in this case, but in the current climate, a home infusion or clinic for the dying elderly is a luxury. Like the suburbs of Shanghai where I am (now as urban areas, large urbanization, however, our cars here only on the Shanghai C license plate, is already urban but can not drive into the original urban areas) elderly even if the mobility is not convenient, with a headache only call an ambulance to the hospital a way, because the market economy, anyway, no matter what, out of pocket is the king of the road, you want to save a bit of convenience, the market economy is not this door. Contact the general practitioner also has, said to be able to visit the clinic, but there must be all kinds of tests, the general practitioner can not carry a lot of equipment to, that is, a blood test can not be done, the results still have to go to the hospital, the general practitioner is also virtually non-existent, I have not seen the old man to ask the general practitioner to come to the clinic.

Since the marketization of healthcare, mutual trust and reliance in the toxic doctor-patient relationship has disappeared, and both sides are walking on the edge of the law, and excessive examinations have been created, which doctor dares to omit the same examination, and in the event of a medical malpractice, the omission of an examination is enough to check the doctor's doom!

Mountain grasshoppers in front of their homes to repair a little mountain road was sentenced to court judgment fine, this dumb loss to eat forever! No wonder Lin Daiyu into the Jia House, do not dare to say more than one word, do not dare to walk more than one step.

Who dares to take the fall for practicing illegal medical practice for a convenience? Everyone should just stay up.

Have to refuse, it's limited by statute, home infusion can only be set up as a home bed only, and the home bed requirement is not something you can achieve with your village doctor or clinic

In fact, according to the current regulations, home infusion is illegal, not promoted and should be prohibited.

But there are two items that make door-to-door infusions seem reasonable.

First, there is this demand, that is, there is a part of the patient can not go to the hospital infusion, such as mobility problems of the elderly, living in the community up and down the stairs are difficult, as well as in remote villages and cottages out of the mountains once the time-consuming and costly, the need for clinic doctors home infusion.

Secondly, if the rural health stations rely solely on government subsidies, it is only two to three thousand dollars a month, which is extremely overestimated, in fact, far less, then the health stations to support their families will inevitably have to make money, door-to-door infusion is a good service, although there is a certain degree of danger, but after all, it is very small.

It is the law of the market that determines what one wants to do. I think the health authorities are also aware of this and there is no need to intervene too much!

So why is it that clinicians village doctors are refusing to give infusions at home?

It's also twofold.

First, from the administrative department pressure, that is to say that they door-to-door infusion is illegal, people listen to the bad ear, change who are angry, wind and rain, door-to-door infusion and courier boy's service is almost hard, but also illegal, I quit!

Secondly, part of the reason comes from the patient's home, why? In the hospital infusion reimbursement, your clinic doctor home infusion no reimbursement is quite expensive (this is to see people, what price is someone said expensive someone said cheap, but a person said expensive also hurt the heart), something happened also heard that it is illegal, some people blackmail money, this is by no means a minority. It can be said that door-to-door infusion is really manipulating the heart of selling white powder to earn the money of selling cabbage!

Combining all these reasons, surely it's better for everyone to stay at the clinic and sell drugs!

All medical and nursing operations are risky, and their most serious consequences are well known to every healthcare professional who has undergone standardized training.

The provision of medical care services away from the registered place of practice is, strictly speaking, not in conformity with the normative requirements, except, of course, in special cases such as emergency rescue.

At present, some cities have opened the network of nurses door-to-door service is considered a new thing, some local health management departments can only follow up on the clear provisions do not allow the provision of infusion services. Nurses outside of normal working hours, such as non-hospital assigned, there is no relationship with the hospital, the hospital is no way to constrain the hospital can only emphasize that do not advocate, out of the dispute and the hospital has nothing to do. No one knows the business ability of the nurses who come to the door, and no one knows how to deal with the problems that arise, and relying only on a good service attitude cannot solve the actual problem.

There are reasons for clinicians and village doctors to refuse home infusion. It may seem that they are afraid of taking responsibility and trouble, but in reality, they are also thinking about the safe treatment of their patients, and once there are various kinds of adverse reactions in the infusion, especially when it comes to allergic reactions to medicines, they are caught unawares, and the consequences can be very serious.

Years ago, the local one year occurred a number of clinics infusion of serious adverse reactions, there are rescue deaths, the industry is clear that the same period occurred in the hospital infusion of adverse reactions do not know how many times the clinic, the hospital why not die, the reason is too simple, health care workers are very professional emergency treatment experience, manpower, rescue drugs and equipment, clinics certainly can not be compared. The health administration had to issue a special document to strictly control the infusion of fluids in clinics.

Clinic doctors, village doctors in their own place of work to give patients infusion are careful, how can go to someone else's home infusion, in case of serious adverse reactions, it will be detrimental to others and themselves. Encountered this kind of door-to-door help, the reasoning clearly on the line, can not take a chance, out of life and then say what is useless.

I am Dr. Kang, who is passionate about the promotion and popularization of health and health knowledge. Thank you for your attention, friends!

Image from the web

Visits by rural doctors for consultations and infusions have long been the norm in rural areas. However, in recent years, this approach seems to be no longer feasible, as many integrated rural community health care organizations no longer provide "door-to-door services" other than emergency care. To see a doctor or get an infusion, you have to go to the village health center. Does this mean that rural primary care has "regressed"? No, no, no, this is not a regression, but rather an improvement.

Why did country doctors make "house calls" in the early days?

In the early years, why did rural doctors make "house calls"? Not for the so-called "thoughtful service", but the choice of last resort. In the early years, transportation was inconvenient, and the roads in some mountainous areas were even more "difficult to get to."...... Under such circumstances, it was obviously unrealistic to send patients to health offices far from their homes, so they could only let rural doctors "make house calls" or go to certain remote areas on a regular basis. Door-to-door service", or regular visits to certain remote areas. Nowadays, rural roads are open to every village, not to say that every family has a car, at least an electric car or motorcycle should not be too much of a problem, the transfer of patients has long been no difficulty, unless the emergency, there is no need for rural doctors "door-to-door service". This is not a "regression", but a manifestation of the economic development and progress of rural areas.

Home infusion is too risky

In the eyes of many people, "hanging water" is a very common thing, and will not be associated with death. However, it is precisely the infusion that some people think will not kill, when there is a serious reaction to the infusion, it is possible to kill people! The fever caused by infusion is considered mild, because the infusion speed is too fast to trigger pulmonary edema, air embolism and adverse drug reactions, etc., if the rescue is not timely, the consequences are quite serious. Infusion in the village health center, in the event of an accident, village doctors have readily available emergency equipment, emergency drugs, but there is plenty of time. But if the infusion at home, even if the village doctor arrived at the first time with equipment, medicine, may miss the best emergency time.

This is only the purely technical aspects of things, in today's medical environment, the village doctor let you home infusion, in the event of an accident, he / she to take lawsuits, bad luck is almost unavoidable! If you were a rural doctor and it wasn't a life-threatening situation requiring emergency care, would you take the risk? Nothing is fine, but when something goes wrong, it's all the doctor's fault. ...... Have you seen fewer cases like this?

The law doesn't allow it.

In addition to the risks, the law of the country is also an important aspect. The Law on Medical Practitioners clearly stipulates that licensed medical practitioners and assistant medical practitioners can only practise in their registered place of practice and within their scope of practice. Except for the special circumstances stipulated by the state, practicing outside the registered place and scope of practice can be characterized as "illegal practice of medicine". Although the rural doctor with a rural doctor's license does not belong to the category of licensed physicians and assistant physicians, the state also has relevant regulations, in the prescribed place of practice, within the scope of practice, the effectiveness of this certificate is basically equivalent to the assistant physicians. In other words, rural doctors holding a rural doctor's practice certificate must also practice in the prescribed place and scope of practice, otherwise they are also suspected of "illegal practice of medicine".

This is the case in a society governed by the rule of law, where there is no explicit law, i.e., there is no violation of the law. On the other hand, if there is an explicit provision in the law, regardless of whether or not you have "extenuating circumstances", it is illegal! The place of practice of a rural doctor is the rural community medical institution where he works, and it is illegal to go to a patient's home to give the patient an infusion, no matter whether the rural doctor is doing it for the sake of profit or for the convenience of the patient. In the early years, there were many cases of "home infusion" because there was no way to comply with the law or the management of rural doctors was not strong enough. With the improvement of rural community medical institutions, everything is bound to return to the right path. If there is a law, there must be a law! This is a manifestation of social progress, some common diseases simply do not need to infusion, even less need to infusion at home, otherwise the country spends a lot of effort, large cost of construction of rural community health care institutions and what is the meaning of existence and the need for it?

To sum up, the fact that rural doctors do not give infusions at home is not only not a "regression", but also a manifestation of the economic development and progress of rural areas and of the increasing improvement of the systems and institutions of rural community medical institutions, which is a manifestation of social progress. To this day, if rural doctors still go to patients' homes to give them infusions, it only shows that the rural community health care system in the region is not perfect and sound enough, does it not?

Door-to-door infusion should not be advocated, the medical institution prescribed liquid other medical institutions medical staff to lose, if an allergic reaction and other accidents are very troublesome, some areas of the competent authorities expressly stipulated that the village health station, etc. are not allowed to infusion therapy.