Chongqing’s ＂driver’s license＂ management drug system radically cures ＂big prescription＂

"If you don’t pay attention, you will lose two points. Now you should be more cautious!" Wang Peng (a pseudonym), a young doctor from Chongqing Southwest Hospital, said regretfully in front of reporters on December 6. He was the first participant in the third training course of "driver’s license" management doctors’ rational drug use in the country. Because he was scored 6 points, he was stopped from studying prescription rights for a week.

The reporter learned from the hospital that there are 34 doctors from 11 departments studying with Wang Peng. Although some doctors feel wronged, most of them think that "it is necessary to return to the furnace." In fact, since the implementation of the "driver’s license" management of rational drug use, the hospital has been warned by 760 person-times, one person has revoked the prescription right, 75 people have been suspended from attending training courses, and three department directors have admonished and talked. The "scorecard" is directly linked to the term evaluation, professional title promotion and year-end rewards and punishments of doctors.

"driver’s license" to manage doctors’ rational drug use

In order to make doctors more cautious in prescribing drugs, Chongqing Southwest Hospital pioneered the "driver’s license" system to manage doctors’ rational drug use in the country. A doctor’s prescription right is just like a driver’s license. If a scoring system is implemented, doctors who use drugs unreasonably will be penalized. Once they are deducted 12 points, they may be punished by demotion, suspension and so on.

Zhang Hongyan, deputy director of the Medical Education Department of Southwest Hospital, told the reporter that in recent years, the hospital has taken the lead in giving quantitative scoring management to the personal medication of the prescribers in the hospital with the help of information technology. Each doctor has only 12 points. According to the degree of unreasonable drug use by doctors, the deduction standard is divided into Class I, Class II and Class III errors. "In the whole hospital, no one enjoys the privilege. From the third-level old experts and professors to the general attending doctors, there is a standard." He said.

The reporter saw in the hospital that the deduction standard of the doctor’s personal scorecard for rational drug use is very detailed: 0.5 points are deducted for a class of mistakes, mainly including irregular prescription writing, course of treatment that does not meet the general regulations, etc. Deduct 1 point for class II errors, including inappropriate usage and dosage, long course of treatment, etc. Deduct 2 points for three kinds of mistakes, mainly referring to unconventional drug use, such as prescribing a single prescription with an amount of more than 1,500 yuan without justifiable reasons. The punishment is also divided into three levels: the first-level deduction is below 6 points. The hospital will send a text message to remind the doctor and inform the department director; The second-level deduction is over 6 points. Doctors will suspend prescription rights for one week, attend training courses on rational drug use at their own expense, and only after passing the examination can prescription rights be restored; 12 points will be deducted at the third level. Doctors will be demoted, suspended, etc.

"The adverse reactions caused by drug use are undoubtedly a risk for patients, and irrational drug use has increased this risk, all over the world." Guo Jiwei, president of Southwest Hospital, said that the purpose of using such a strict system to control doctors’ medication is simple, that is, to make doctors use drugs more rationally.

The cost of medicine per outpatient is greatly reduced.

"It’s nothing to spend a few hundred dollars in some slightly larger hospitals, most of which are tens of thousands of dollars. Who dares to go to the hospital casually!" When the reporter interviewed randomly on the street, many citizens expressed similar views to the reporter. Undoubtedly, the root of the contradiction between doctors and patients is mostly caused by the large prescription medical expenses prescribed by doctors.

According to the data disclosed by the first China Medical Rule of Law Forum, there were 115,000 medical disputes in China in 2014, and many hot topics of public opinion are the reflection of the increasingly complex relationship between doctors and patients in real life. With the development of commercial society, the doctor-patient relationship has changed from "life entrustment" to "money transaction", and the contradiction between doctors and patients has also become prominent. According to the statistics of the Chinese Medical Doctor Association, before 2014, the number of medical injuries in China showed an increasing trend year by year.

Some experts pointed out: "Pursuing the maximization of benefits, doctors act as a bridge between patients and pharmaceutical companies, and large prescriptions and multi-course treatment programs make patients miserable, which has become a major source of contradictions between doctors and patients." The "driver’s license" management medication system initiated by Chongqing Southwest Hospital seems to provide an effective prescription for easing the tense doctor-patient relationship.

It is understood that "driver’s license" management is not only a penalty deduction, but also a comprehensive control effect through training and assessment, simulation test, early warning and monitoring, real-time control and interaction management. Zhang Hongyan introduced that the prescriptions prescribed by doctors are monitored in real time. As long as there is a suspected unreasonable prescription, the system will display it to assist professional pharmacists to judge after reading it. Doctors who are not convinced will be judged by experts in the hospital.

According to Lu Changwei, head of the medical department of the medical education department of the hospital, after the implementation of the system, the drug cost per outpatient has dropped from 288 yuan per capita in 2013 to 256 yuan per capita at present; The cost of medicine per inpatient has dropped from about 9,600 yuan per capita in 2013 to about 6,500 yuan at present.

Step on the "emergency brake" for irrational drug use

Excessive medical treatment runs counter to the direction of medical reform and even weakens the fair effect of medical reform. According to industry insiders, this system can "slam the brakes" on irrational drug use, which is very necessary for the current public hospitals. A professor at Chongqing University told the reporter: "The reason for irrational drug use behavior is not only profit-driven, but also the lack of drug knowledge and the lack of correct drug use habits. Under the mechanism of supplementing medicine with medicine, doctors have developed many wrong medication habits, and even without economic incentives, they will prescribe medicine according to old habits. The deduction system can push the doctor’s medication behavior to the standardized track in a short period of time. "

Experts pointed out that the "driver’s license" rational drug use system can largely cut off the bridge role of doctors between patients and pharmaceutical companies, on the one hand, standardize the treatment behavior of doctors; On the other hand, it also reduces the financial burden and extra physical burden of patients, which is a great help to solve the contradiction between doctors and patients.

The reporter’s investigation found that since the implementation of the "driver’s license" rational drug use system, most citizens have supported it. They generally feel that the system can curb doctors’ behavior of obtaining benefits from patients in disguise and losing medical ethics, and at the same time, it can promote the standardized operation of the whole medical industry. However, some doctors worry that the implementation of this system will bring some troubles to doctors.

Dr. Zhang from a 3A hospital in Chongqing said: "Doctors have to take self-protection measures for fear of falling into endless medical liability disputes when treating patients’ diseases. That is to say, the pursuit of’ what can be checked or not must be checked’,’ one or two courses of medicine can be cured and three courses of medicine can be opened’, and’ large prescriptions can be cured’ is to avoid unnecessary risks. " In his view, it should not be possible to improve the responsibility identification mechanism for medical disputes between doctors and patients, otherwise the "driver’s license" medication system may make doctors feel at a loss.