I'm from a hospital, the higher hospital doesn't recognize any tests done by the lower hospital, firstly, the higher hospital's medical equipment is more sophisticated than the lower hospital's, and the results are more accurate, secondly, they're afraid of medical disputes, because if you get the results done by the lower hospital, the higher hospital won't do the test again, and they'll just give you the treatment, in case there's a problem, the higher hospital won't be able to produce any evidence, because the tests were done by the lower hospital, and the family members will blame the hospital, why didn't they do the test again? Of course, they'll blame the hospital for not redoing the tests, and the family will just say, "We don't know anything about it," which will suffocate the entire medical staff.

Thanks for the invite!

As a doctor in a provincial hospital, Dr. Liu often sees patients referred from county hospitals. The situation described in the title that provincial doctors do not recognize the diagnosis of county hospitals and refuse to refer to it, and prescribe a whole bunch of tests as soon as they come in does not happen in my case, or in our hospital. The following points need to be talked about with you.

First, the examination and test results as well as the diagnosis and treatment at the county hospital are particularly informative.

As physicians, when we were first introduced to clinical practice as undergraduates, especially when we studied medical diagnostics, our old professors taught us that we must pay attention to the 'progression of the disease as well as the patient's diagnostic and treatment history'. I bear this in mind. In fact, the medical record writing standard also requires doctors to do so! As the patient's first hospital, the county hospital must be familiar with the patient's 'first-hand information' and know the patient's morbidity. And these things can be reflected in the tests prescribed by the doctor as well as the diagnosis considered.

In many cases, the diagnosis made by the county hospitals is not a problem, but the patients often ask for referral to a higher level hospital because they cannot tolerate the 'long' recovery time. Of course, there are also times when the treatment methods in the county hospitals are not advanced enough and the treatment equipment is not as good as that in the provincial hospitals, so the treatment results are worse than those in the provincial hospitals.

Second, come to the provincial hospital and prescribe a bunch of tests?

This is a doctor-patient communication problem, which is the result of many provincial hospital doctors did not communicate fully with the patient (in fact, many doctors in provincial hospitals are too busy, he could not explain one by one). But today Dr. Liu wants to tell you, the county hospital inspection and laboratory tests, and the provincial hospital doctors think no longer need to review, certainly will not repeat the prescription.
In reality, this is not very common, and most of the time it is the provincial hospital doctors who feel that the examination equipment in the county hospital may not be as good as the county hospital's, and therefore they need to do a re-do to make sure. More often than not, Dr. Liu believes that there are many diseases that are progressive, and doctors need to determine the patient's condition through the latest examination and test results. There are also some tests that that are required by the hospital's medical records and are 'mandatory' for every patient's admission, such as stool routine, blood routine, urine routine, electrocardiogram, and even chest X-ray. So, to summarize, the provincial hospital doctor had to prescribe many tests for you.

Dr. Li is a gastroenterologist at a provincial tertiary hospital, let me answer your question.

First of all, Dr. Li told you very clearly that many doctors in provincial hospitals will refer to the diagnosis of county hospitals and also ask carefully about the medication used in provincial hospitals as well as the examination results, which is not like what you said. But in most cases, they will redo some tests to achieve a clear diagnosis before further treatment.

Why would you do another check?

Doctors in large hospitals will make judgments based on the examination reports, diagnostic opinions, and medication used in the county hospitals, but at the county level, the equipment is limited and the level of medical skills of the doctors varies. Since you chose to come to the provincial hospital, it means that the local county hospital is not able to solve your problem, and that you have chosen a better medical environment. The hospital doctor has to be responsible for you, he has to re-diagnose you clearly to see if there is any misdiagnosis or omission.

Let's take ct for example, there are many kinds of Ct, first of all, the brand of the problem, the equipment is imported and there are domestic. It's not that Dr. Li favors foreign goods, it's just that most of the current medical equipment, foreign equipment is more advanced and more durable. Foreign brands of equipment, its imaging effect is very good, compared to other county hospitals use slightly backward ct, certainly the provincial hospitals ct, more clear. In addition, the ct used in provincial hospitals are some high-resolution thin layer ct, many use 64 rows, the ct used in county hospitals is very low resolution, and only 16 rows. In the same situation, a chest sweep, 64 rows of ct can sweep many layers, can find 2mm lesions, but 16 rows of ct can only see greater than 8mm lesions, this is the difference. The equipment of hospitals with poorer conditions has no way to find the lesions at all, but only to the provincial hospitals with advanced equipment, under the same circumstances, can find the lesions.

Let's look at blood draws again. As you probably know, when you go to the hospital, blood is drawn in many cases. But what tests are there in a blood draw? Actually, there are a lot of items in a blood draw. General cold and fever, blood will do some routine blood, C-reactive protein, these items can help determine whether the cold is caused by bacteria or viruses, the county hospital can certainly do. However, if you go to the hospital for a checkup because you suspect that it is a tumor, the blood test will be different, and you may check for tumor markers and special genetic tests, which are not available in county hospitals.

In addition to blood tests and ct tests, there are also some county hospitals, which do not have MRI, pet/ct, electromyography, DSA, pathology tests, etc. Naturally, there is no way to compare the equipment conditions of county hospitals with provincial hospitals, which are poorly equipped and can only perfect better tests at provincial hospitals.

In addition to equipment, the education and qualifications of doctors in provincial hospitals are naturally much better than those in county hospitals. Most of the doctors in provincial hospitals are medical students graduated from prestigious universities, and most of them are postgraduates or PhD graduates. They have solid medical knowledge, wider apprenticeships, and exposure to a more advanced level of medical care, which is basically in line with the international standard; moreover, they have done a lot of researches, and they are very good at a certain field.

Most of the doctors in provincial hospitals have published a lot of papers internationally, and these are the results of their research, so the doctors in provincial hospitals have more doctors at the level of deputy director, director, and professor, and compared to county hospitals a lot of things are residents, attending doctors, and deputy director doctors are rare. So the level of doctors in provincial hospitals is very different from that of county hospitals, and every examination report and diagnosis is related to the level of doctors. Just like an EKG, CT and pathology examination, I believe that everyone will trust the report from the doctor of the provincial hospital rather than the report from a county hospital.

In short, Dr. Li believes that provincial hospitals have better medical resources. It is not that he does not believe in the diagnosis of county hospitals or refer to the examination of county hospitals, he is responsible for you. Since you went to a provincial hospital, it means that the local county hospital has no way to help you out. The tests he has you undergo are only to help diagnose, to better treat the disease and to provide you with better medical care.

Dr. Lee insists on sharing medical knowledge with you in the simplest language for your convenience. Follow Dr. Lee to tell you, discuss and learn health knowledge together, and comment in the message area if you have questions. Your likes and comments are the greatest support and encouragement to Dr. Lee.

I feel normal and understandable. Experienced a lot of things, now do not say that the county hospital, prefecture-level city of the three hospitals I do not believe, my grandmother, for more than a decade has been diagnosed with heart disease, perennial medication, the stomach also ate bad, and recently obviously feel uncomfortable, to go to the local three to see the doctor to do a check that you have this infarction, and it is very serious, you have to hurry to hospitalization, to surgery, we heard that hurry, the results into the operating room, open and found that the operation is not so serious, and not up to bypass conditions, well, the operation terminated, people suffer a lot, and then go to the provincial hospital. Not so serious, not up to the conditions of bypass, well, the termination of the operation, people suffered a big crime, and then go to the provincial hospital, the doctor took a look at the film, said you're good, have done a lot of tests do not have to do, and then cursed with profanity before the diagnosis of my milk to the doctor, and finally diagnosed with a mental illness, anxiety, go home and take medication to see the effect immediately. Then I, I high school for a period of time dizziness, and then went to take an MRI, there is a small white spot on the film, the doctor said that may have grown a thing, scared us feel on the provincial hospital, the expert look, said this is the angle of the shot problem, the brain well. Although the words are not good to listen to, but really both the quality of the doctor or check the technology of the county level, including municipal level of the whole is certainly not as good as the provincial hospitals. If you are in a position to re-do all kinds of tests, do, after all, health first.

I think this is right. Because the county hospital equipment accuracy than provincial hospitals, more importantly, most of the diagnostic results are not intelligent diagnosis, the county hospital doctors see relatively few cases, the accumulated experience is less, even if the check out the image is very clear, the diagnostic report of the county hospital is not necessarily very correct, see fewer or have not seen do not know, and you don't know strangers on the street, it is difficult to study and judge an accurate conclusion. It is difficult to draw an accurate conclusion, such as ECG, MRI, radiology, ultrasound and so on. Take our pathology department, a pathology section is typical of benign or malignant, this is easy to diagnose, but the development and regression of the disease has a process, sometimes it is in between benign and malignant boundary class lesion state, take the color to make an analogy, the red represents malignant, white represents benign, there is always a pink in the world. At this time, depending on the doctor's level, experience, or even emotional influence, if the pink color is said to be red or white, it is either too heavy or too light, and cannot accurately express the state of precancerous lesions. The list goes on and on.

There is another situation, a class of students after graduation to participate in the work, one in the provincial hospital, one in the county hospital, after working for ten years, the provincial can give the county as a teacher. Because some of the new programs, the province to carry out many years, the county still do not know that there is this test, not to mention the clinical significance of this test (like some new drugs is also the case, the provincial hospitals have been used for a few years, the county hospital doctors do not know the name of the drug). Due to the influence of the general atmosphere, the level of the provincial hospital group is also relatively high, and the knowledge of doctors is updated relatively quickly.

Deepening the reform of the medical and health system, promoting the service model of provincial hospitals with county hospitals and the service system of orderly medical care, provincial hospitals and county hospitals have become medical consortia, regularly sending doctors to check on county hospitals to perform surgeries. Now some county hospitals have also implemented remote consultation, that is, in the county hospital to do the examination, uploaded through the network, difficult cases are provincial experts to make conclusions. Therefore, I think the county hospitals in the examination is not worse than the provincial hospitals, you see a doctor at home, enjoy the treatment of provincial hospitals. The proximity is convenient, but also meets the requirements of the triage medical system, the threshold is low out-of-pocket expenses, high reimbursement ratio of health insurance, is very affordable.

From the perspective of the patient or the patient's family to answer this question is more inclined to universal, from the economic point of view to save money, of course, the higher hospitals are more focused on scientific confirmation of the diagnosis, more specialized.

First, county hospitals are almost all second B hospitals, do the examination should be common throughout the country, the higher hospitals do not recognize, the reason is inaccurate, if the higher hospitals found inaccurate, the health authorities to the county hospitals issued qualifications is problematic, anyway, there is one is not right, can not all physical examination can not be used, can not be referred to it?

Secondly, the provincial hospital doctors do not recognize the county hospital diagnosis, or the amount of prescription and inspection of the layer of blame, at least for a reference can always it, with a comprehensive examination? But there is also the problem of instruments and equipment, the most important is the problem of medical skills, provincial hospitals doctors high level of business is an indisputable fact.

Thirdly, we should follow the example of the banks, which are connected to the Internet throughout the country. This is technically feasible, as the C-store, the ultrasound and the remote diagnosis of the patient's medical records can be done on the Internet, for sure.

To solve the problem of difficult to see a doctor and expensive doctor-patient conflicts, hanging on to the lips is not enough, you have to rely on the system of regulations, have to be placed on the conscience.

It is generally believed that as long as a patient has undergone examination and diagnosis, he will not be examined again when he visits a higher-level hospital. In fact, it is not, limited to the technical level of secondary hospitals and equipment generation difference, there will be a big difference in the conclusion of the examination. The author found in the outpatient clinic abdominal pain turned sideways in a case, three second-class hospital ultrasound showed 0.3Cm stones in the lower end of the right ureter. After dilation of the ureter, diuresis was ineffective. The ultrasound was then redone in the tertiary hospital, and the ultrasound report did not reveal any stone. Further examination was paid for orchitis and spermatic sheath effusion. In another case, CT reported renal tumor, which was actually a subhepatic cyst. There are many similar examples. Therefore, the examination reports of lower hospitals are generally not referred to. Moreover, hospitals have implemented electronic management, from the patient registration into the computer. All kinds of imaging, laboratory tests have entered the electronic layer sequence. All your tests are displayed in the computer, no matter to any department will pull out all the information. When you go to a higher level hospital, the purpose is to diagnose and treat the disease, and the doctor will do the appropriate tests according to his own thinking, in order to find the basis for further diagnosis and treatment. If you are here, you are here, so listen to the doctor.

It may be that the medical equipment at the provincial level is so advanced that they can understand the condition more directly and effectively by re-taking diagnostic films, checking blood and laboratory tests, and so on. And it's not uncommon for the diagnosis at the county hospital to have changed over the past day or two.

The community hospital in front of our neighborhood can only be considered a first-class hospital. Son two months ago pneumonia shot diagnosis. The morning shot, the community doctor let me go to the city hospitalization, our children's hospital is a tertiary hospital. In the afternoon to the hospital, re-checked the blood, the film was not taken, with the community hospital film, the children's hospital doctor said, the film is very clear, there is no need to shoot again, a waste of money... In the community hospital side of the mycoplasma, the children's hospital also do not give the test, said side of the side is fine, there is no need to spend extra money.

So there are some places that don't disagree with all diagnoses. Large hospitals, especially when hospitalized, a messy flurry of tests is really a significant expense, and many people tend to feel that the first day of the examination fee of the first day of this one or two thousand is actually quite unnecessary, but the hospital is almost always this process.

As a patient, you can only follow medical advice.

If so, the subject said that provincial hospitals do not agree with the diagnosis of county hospitals is understandable, after all, the level of medical care, and the level of doctors are divided into three, six, nine, etc. Otherwise, you will not run from the provincial hospital to the county hospital. Otherwise you wouldn't run from the county hospital to the provincial hospital.

Provincial is should not believe that the county diagnosis, or delay the big event, this I speak with the facts, a month ago my wife in the county hospital to check the results of the breast is birads3, the doctor said it was fine, every six months to do an ultrasound to review it on the line, after less than 20 days to feel wrong to the municipal tertiary care hospitals to check the results of the big surprises is even 5 class, puncture to do the pathology of malignant tumors, the next week on Monday, the operation! If you listen to the county hospital doctors say it won't be long before the late stage, you say the big hospitals can trust the county hospital?

Going from a county hospital to a provincial hospital, where the provincial hospital is unwilling to refer to the medical records and test results of the lower hospital, and will prescribe a bunch of tests after coming to the hospital, exists in many places here, and is nothing new.

In the usual work of many families will tell me: these in our home hospitals have done, and open so many tests, I came to see the doctor, even the bottle of water did not hang only know to open the test ... ... However, complaining to complain, the doctor is too lazy to explain, and many people end up with people under the roof had to bow down to the psychology of accepting these tests. Why are provincial hospitals so arrogant?

Tertiary hospitals are the highest ranking hospitals

First, the county hospital's diagnosis was unclear or erroneous

In all fairness, county hospitals have developed over the years to serve the people of a region, curing one crop of patients after another, and have very rich experience in common diseases. Yet the fact that a patient's symptoms continue to fail to improve or worsen, requiring further consultation at a provincial hospital, suggests that there is a diagnostic problem to a large extent. The same symptom and complaint can be manifested in many diseases, such as the same chest pain, there are heart attack, pneumothorax, pulmonary embolism and aortic coarctation and other diseases. Therefore, the provincial hospital is not to be blamed for not referring to the county hospital's diagnosis, and he needs to make a new judgment.

Second, county hospitals have outdated and inaccurate examination equipment

There is a distinct feeling that the tests in the county hospitals are cheaper than those in the provincial hospitals. For example, if the same blood test costs 40 dollars in the provincial hospital, it may only cost about 10 dollars in the county hospital. This is because different hospitals purchased different kits, expensive kits naturally check the high precision, responsive, like the same buy binoculars, some can see a dozen meters, some can see dozens of meters. I once encountered a case: the day before in the county hospital to check the moderate to severe anemia, hemoglobin only 70 + g / l, to the provincial hospital for further examination. However, according to her medical history and physical examination, she would not have existed that severe anemia, so repeated check blood routine is only mild anemia, close to normal values. The reexamination avoided many unnecessary tests, because if the local tests had been accepted, this patient would have had to undergo a series of tests such as bone marrow aspiration to find out the cause of the anemia. Therefore, the doctor's redoing of the test was not redundant, but rather a deeper consideration.

Third, the long inspection time needs to be reviewed

The period between the onset of illness and treatment at the county hospital and then the visit to the provincial hospital is at least 5-10 days. The examination while hospitalized in the county hospital is a bit longer, at which point a review is needed. For example, if a patient with a lung infection is treated with antibiotics for a week or two, the doctor does not know if the condition has progressed or improved. Therefore, blood and tests are needed to assess the condition and guide the next step in treatment.

Fourth, the need for more comprehensive and precise examinations

A considerable number of patients, who visit provincial hospitals because their diagnosis is not clear, most commonly have fever. There are many causes of fever, and the tests that can be done in county hospitals are limited, even in provincial hospitals, and some tests need to be sent to Beijing or Shanghai to be done. Take fever as an example, most people think that it is infected with some kind of bacteria or virus, just use good anti-inflammatory drugs, no need to do so many tests. I once met an old man in his eighties who had a recurring fever that was not clearly diagnosed in the local city hospital and underwent a lot of tests, but after coming to the provincial hospital, he was found to have nasopharyngeal carcinoma by PET-CT.

PET-CT can detect tumor tissue with significantly increased metabolism

Fifth, hospital rules or subterfuge

In provincial hospitals, there is an unwritten rule, let's call it an unspoken rule! That is, all the patients hospitalized, have to do electrocardiogram and blood, urine and stool three routine checks. These items are considered the most basic checks, considered the threshold. In fact, it is not simply for the benefit of the hospital, but more importantly for the protection of the doctor himself. A complete medical record without ECG and some basic tests is very unfavorable to oneself when a medical dispute arises in the future, because it is likely to be the key to the problem. Nowadays, the relationship between doctors and patients is very tense, most doctors follow the rules, what should be there must be there, and what cannot be saved must not be saved, otherwise they are digging a hole for themselves.

Doctors are not robbers and hospitals are not shady stores. The medical industry has the order and rules of the industry to do things, the doctor has and the patient is not the same considerations. One thing is certain: both the doctor and the patient are trying to treat the disease quickly and well, so that each other have no psychological burden!