Many doctors said that the patient's failure to follow-up has become a major problem that has plagued China's clinical medical research; in the long run, it is likely to affect clinical medical technology improvement, innovation, and the overall level of improvement. This reporter Tang Wenjia was a doctor at a tertiary hospital in Shanghai. Xiaochen, recently received a paper "Repaired" from the SCI journal. In general, "repair" means that if it can be modified according to the review opinion, the publication of the paper is more likely. However, when Chen finished reviewing the comments, he sighed again: “Foreign review experts want me to provide a larger number of cases... this is no big deal.”

Requesting "providing a larger number of cases" is roughly thesis that the paper was "suppressed" by the SCI. This is in the domestic clinical medicine community. Everyone understands and has no choice but to meet the requirements. Because it is difficult to follow patients in China, it is more difficult to accumulate large numbers of samples and long-term follow-up records.

"If a Chinese patient is sick, he wants to be far away from the hospital. No one wants to go again?" This is reality. Outside the medical circle will not think that the resulting "difficulties in follow-up", to a considerable extent, ignoring the development of clinical medicine in China.

A lot of patients, a small number of cases Chinese doctors engaged in clinical medical research is still afraid that the number of cases is not enough?

At present, Shanghai's hospitals, especially tertiary hospitals, there are always many of the "big cows" of the foreign medical community relaying to run "points", some people as "visitors", there are many people do not care about the title, but also not take points. They stay for a few months and participate in case diagnosis and discussion. Doctors in China understand that "the doctors of the ocean" have another purpose: to collect and accumulate cases, in addition to their "obligation to do good." "There are so many patients in China. Some of the common diseases here are in the United States. They are rare diseases."

However, Chinese doctors are more aware of the fact that although there are many patients, the number of cases is very small because of the study. It is because the follow-up is too difficult.

Follow-up, more accurately, is "a doctor followed up the patient's follow-up." There are two types of follow-ups, one of which is that the patient is willing to come back to the doctor. For example, after oncological treatment and high-dose chemotherapy, patients generally have more severe adverse reactions after 10-14 days. According to the current domestic average of 7 days of hospitalization, the patient has already returned home. So the doctor will remind the patient to visit the hospital for time to see the postoperative response, and the patient is willing to cooperate.

Another type of follow-up is for doctors to actively seek out patients for research needs. They send investigation letters or interviews to target patients. Such patients had poor compliance with the follow-up from the very beginning, and even left a wrong phone number and home address, allowing them to “check out this person”.

Dr. Xu Zhiwei, director of Cardiothoracic Surgery at Shanghai Children's Medical Center, told reporters that many years ago, their department had sent a postgraduate full-time to do the follow-up. "For several months, the student rushed to the follow-up. According to the patient's data, he made a follow-up call and sent a follow-up letter. He asked the patient to fill in all the contents of the post-surgery case. The final response was less than 1/10. ”

At present, Shanghai hospitals are mainly followed up by telephone. Doctors who have made this call complained: "A call is called by the hospital. Some people feel guilty. They immediately hang up; Some are impatient, casually perfunctory, and say something. Reliability is doubtful."

In addition to the telephone follow-up, if the patient is expected to return to the hospital to review some of the indicators, it has become an "impossible task." The doctor calculated a bill for the reporter, the patient went back to the hospital for follow-up, CT, blood tests and other items have to pay for themselves, and the foreign patients also have to pay for the return-to-roller fee and the accommodation and accommodation fees in Shanghai, so he must of course: "What benefit does this have to me?" After thinking about it, he refused to come.

Difficulties in follow-up, medical research is difficult for patients to follow the follow-up, in view of many doctors, has become a major problem plagued clinical medical research in China; in the long run, it is likely to affect clinical medical technology improvement, innovation and overall improvement.

“Clinical medical research really needs a decade of sword-sharpening. For example, to demonstrate the effectiveness of a new surgical technique, it is necessary to have a certain number of cases and to follow up on the observation of curative effects for a long time, sometimes tracking patients for more than 10 years.” Sixth People The department headed by Zhang Changqing, director of the hospital's orthopaedic department, has accumulated 1,500 follow-up cases in the treatment of femoral head necrosis with free iliac bone grafts since 2002. This is an "astounding record" among peers. The record-setting team is a specialized follow-up team composed of statistics and public health professionals.

In order to accumulate follow-up cases, the hospitals each moved out. Some tertiary hospitals in Beijing, seeing a limited number of follow-up cases in their own homes, sought to “align” and “make up” cases with their counterparts, and jointly researched and published papers. "However, this matter has to be led by academic big cattle. Other doctors, especially young people, don't think about it!" said a young doctor at Peking University Affiliated Hospital.

In order to “bind” the patients, some large specialty hospitals have even come up with “overlord terms” such as “surrogate” case cards for non-medical insurance patients.

"Although some doctors have been eagerly followed up with utilitarian ingredients - in order to publish a paper. There is no large sample and long-term follow-up data to make arguments, the paper is untenable. But from another perspective, this matter is related to the development of clinical medicine." The deputy chief physician of the tertiary hospital told reporters.

“Because there are many patients in our country and doctors have many surgical operations, many surgical techniques have reached or even exceeded the international level. However, the operation is superb, perfect, and the success rate is high. It is only a short-term effect. After 5 years, 10 years and 20 years, the patient situation How to get out of the problem? Is there a problem with the disease? Must be followed up to understand.” Xu Zhiwei pointed out that follow-up is difficult to carry out, clinical treatment of “long-term effect” is difficult to grasp, and this is precisely an important reference to improve and improve the level of clinical treatment in accordance with.

Clinical therapy is to find problems in continuous follow-up, and then continue to improve. This is a benefit to patients.

Many doctors said that clinical medicine in China tends to follow the trend of foreign therapies. Improvements have been made in foreign countries. We will follow--"This is because it is more difficult for us to carry out clinical medical research. Even if we have innovation in practice, It is difficult to follow-up to confirm the effect and continuous improvement. In fact, due to differences in race, living environment, etc., foreign therapy may not be completely suitable for Chinese people, we should research and create local treatment methods."

Medical networking, or can bring a turnaround to doctors, foreign counterparts can follow-up, thanks to the family doctor system - the family doctor is "bound" with the patient. The patient seeking treatment in our country is still in an “unordered state”. It is often difficult to follow up with doctors who often “simply meet” and “do not say goodbye when they break up”.

In recent years, many large hospitals in China have begun to pay attention to follow-up. Departments have taken the lead to form full-time follow-up teams, and electronic databases are slowly being established. Prior to this, the hospital's data was mainly handwritten, and preservation and search were problems. Many hospitals had medical history and surgical records in the 50s and 60s of the last century, and now they have become yellow crispy old paper at the bottom of the box and have even been destroyed by water and fire.

The doctors saw hope: In recent years, Shanghai has promoted electronic cases and medical networking. This creates a good platform for future follow-up. In theory, the patient's medical records in Shanghai can be found on the Internet no matter which hospital they are in. After the patients returning from their homes, they are reviewed at the local hospital. The report can be sent via e-mail.

However, some doctors have pointed out that the establishment of a database is only the first step, and more importantly, doctors change their minds. “The difficulty in follow-up is not all because the patient does not cooperate. The medical authorities also have responsibilities. For example, some departments are filled with a kind of emotions, and they feel that the success rate of clinical surgery is high. For more than a decade, they have become classics – and there are still needs for improvement. With this kind of thinking, the follow-up is naturally not taken into account. When the patient is admitted to hospital, even the telephone number of the person is not seriously asked. Then where does the follow-up start?”