/kloc-in the summer of 0/992, I was admitted to the thoracic surgery department of the municipal hospital due to illness. One day, several fellow villagers came to the ward: one of them was a patient, still unstable and staggered by two people. Followed by several people, one of the women cried her eyes red and swollen, still crying. She was comforted that she was in no hurry. After a while, my brother came out of the operating room, so I let him watch. He couldn't stand it, and the director ... the woman sobbed: whoa ... there are old people and young people in our family, and they all earn their wages by him. If I cut off my arm, I can't go to work to earn money in the future. Who will feed our family of six? ……

As soon as I heard that my accent was from my hometown, I asked what was going on. It turns out that the woman's husband is a maintenance worker in the county reducer factory. When repairing the machine, a steel plate on the machine suddenly broke. Under the great thrust of the spring under the steel plate, the broken steel plate opened an L-shaped hole in the palm of the left hand. Sudden massive bleeding. After emergency treatment, the factory doctor sent it to the county people's hospital. After being treated there for half a month, the wound grew, but the palm was swollen like a bear's paw. Finally, the left arm was swollen and dizzy with pain. I throw up everything I eat these days. If I don't eat, I will feel dizzy and nauseous. Some doctors in the county said that they would amputate their limbs to save their lives, while others said that they would cut open their palms, dig up rotten meat, and cut off the black little finger and ring finger, depending on the situation. If not, cut off their hands. Because of his wife's resolute opposition, he quarreled in the factory for several days. He was introduced by the old factory director and went to the city hospital to see his son.

After a while, the attending doctor came over to change clothes after the operation. After careful examination, the director was invited again. The two made a treatment plan, first diminishing inflammation, controlling the systemic symptoms caused by infection, and then debridement as appropriate.

That night, the patient stopped crying and didn't shout that his hands and arms were suffocating. On the third day, the color of the arm returned to normal, and it was no longer black and blue. Five fingers can also move. On the fourth day, a debridement operation was performed, and a large number of foreign bodies such as scrap iron and cotton yarn were taken out. In the afternoon, he played poker with several accompanying workers and put the cards in his fingers. The nurse found him and taught him a lesson. He also smiled: My illness is cured! Don't say I was scolded, just give me a beating!

Two days later, he and his wife happily said goodbye to everyone and went home from the hospital. Go on, less than a week.

The first level is the first level! I can't refuse to accept it!

Hello, everyone, I am a medical worker. The answer to this question is naturally different from different angles (medical staff and patients). Let me make an objective analysis from the perspective of medical staff. You are welcome to express your opinions in the comments section.

I collectively refer to county and township hospitals as "primary hospitals", that is to say, patients in primary hospitals do not get better for several days, but soon become optimistic in large hospitals. Is it a technical reason? My answer is that most of the reasons are yes. Let me analyze which ones are not suitable for you one by one.

First, the status quo of patients seeking medical treatment in China.

Perhaps ordinary people have the most say in this. It is difficult and expensive to see a doctor, and countless heroes have been tripped up. Large hospitals are overcrowded, and primary hospitals, especially health centers, are overcrowded. The root cause is the uneven distribution of medical resources.

Why is there such an uneven distribution of medical resources? Friends who have medical staff around them should know that doctors have a long growth cycle. Municipal hospitals basically require graduate students, while provincial hospitals have no scientific research projects. The doctor may not get in. A better county-level hospital will have graduate students, and the number of medical students will be more than that of other majors 1 year, plus standardized training for residents. Many people have been in the clinic for 30 years, and such talents are definitely unwilling to go to primary hospitals, including treatment and working environment. Therefore, compared with large hospitals, primary hospitals lack core competitiveness, so from a technical perspective, primary hospitals have been killed. How's the atmosphere? There are many professors and tutors in big hospitals, clinical and scientific research cities, and there is a shortage of talents in grass-roots hospitals, so the learning atmosphere is relatively poor. I don't have to say much about the results of many factors.

Second, the introduction of hospitals where ordinary people see a doctor.

Many people have a characteristic, especially in economically developed areas, minor illnesses must also be seen in provincial hospitals. Some patients once told me that this is a kind of face, and this is an ethos. In fact, there is no need to follow the fashion at all, just seek truth from facts.

Common diseases and frequently-occurring diseases can be handled in county-level hospitals. Because it is common and frequent, the treatment experience is already sufficient, and the treatment schemes in big hospitals are basically the same, which is very mature, and there is no need to go to big hospitals at all.

Rare diseases and rare diseases suggest going to provincial hospitals. Why, big hospitals are full of talents, advanced equipment and instruments, and have rich experience in diagnosis and treatment of this disease, so researchers aiming at this disease can do further research and projects. This is the role of large hospitals, not only to see doctors, but also to undertake scientific research, teaching, prevention, health care and other functions.

Third, answer questions.

Patients who can't do it in primary hospitals don't need to be told by their families, and doctors will tell you why. No one would be so stupid. For example, pregnant women with pulmonary hypertension must be a provincial hospital, and liver failure needs transplantation. The doctor can't leave you here, because if something happens, it's a medical accident.

Sometimes some devices are like this. Grassroots hospitals can't buy it, and there is no need to buy it. This project can't be carried out until it is upgraded, and so are some drugs. The hospital pharmacy doesn't have your symptomatic medicine at all. It seems that it will be transferred to a higher hospital for diagnosis soon.

Sometimes, I really pay attention to seeing a doctor. Why? Another function of provincial hospitals is teaching. There are many graduate students and doctors in the following hospitals. How do doctors learn technology? So maybe you go to the provincial hospital, and your knife may be made by a doctor under the guidance of a professor. If it's just a common disease, the director of the county hospital may operate on you. It is difficult to get to the big hospital in three minutes.

Summary: Reasonable medical treatment, minor illness at the grassroots level, serious illness in large hospitals, forms a virtuous circle, so that the three-level diagnosis and treatment can be implemented and the people can really benefit.

Because of the doctor's own problems, and the medical equipment is not as advanced as big hospitals, few people see a doctor. High-level medical graduates go to big hospitals. With the improvement of people's living standards, economic prosperity and health awareness, even minor illnesses will go to municipal hospitals, and the income of primary hospitals will be reduced, and the wages of medical staff will also be reduced. The monthly salary of municipal hospitals is tens of thousands or even tens of thousands, while that of primary hospitals is only several thousand yuan. Good doctors go to big hospitals.

County-level hospitals should be merged with municipal hospitals, and doctors from county-level hospitals can sit in municipal hospitals in turn. Implement equal wages and equal treatment. Patients can have surgery in hospitals above the municipal level and do post-treatment and rehabilitation in county-level hospitals, and the reimbursement ratio is the same. Through the merger or escrow of city and county hospitals, the salary of medical staff will be increased, and patients will enjoy the same medical conditions at the municipal level and the same treatment as doctors and experts, saving medical expenses and facilitating the families of patients.

Now all counties have access to expressways, many buses have entered the village, the number of private cars has increased rapidly, and the health awareness of rural people has improved. Besides Chang Gan, how many people go to the county hospital? It takes an hour to go to the county seat and an hour or two to go to the city.

County hospitals are merged or taken to municipal hospitals or managed by municipal hospitals. First of all, the income of medical staff increases, the cost of patients decreases and the medical level improves. It is also very promising to see a doctor in a primary hospital.

It is certain that people are not as good as others.

Give an example of experience to prove it.

That was in 2009. I attended the training in the Provincial People's Hospital. On the first day of rotation, I went to Pediatric Internal Medicine, and I met the director of the department. Very lively, nearly 30 people attended, including doctors, advanced students, interns, supervision students, international students, pediatric clinical graduate students, and us.

On the same day, the director came to the bedside of a six-year-old boy who was about to leave the hospital and introduced him: the child began to have a fever and went to the local county hospital for treatment for three days. The reason was not found. The child has a fever every day, and the highest temperature is more than 40 degrees. He had to be transferred to a tertiary hospital in the local city. After three days of treatment, it still didn't get better. The key is to transfer to our hospital before finding the cause of the fever. After consultation with several doctors in the department, it is carefully judged that a soybean-sized swollen lymph node found in the child's right armpit is the only valuable positive sign found in the general physical examination. After the operation, it was taken for biopsy, and other related examinations arranged at the same time found no abnormalities with special diagnostic value. Three days later, the physical examination report diagnosed necrotizing lymphadenitis, and the treatment plan was adjusted appropriately. Soon the symptoms eased, that is, on the ninth day of hospitalization, he was discharged from the hospital.

What does the director want to emphasize? Don't let go of every valuable sign found in the physical examination, even if it is not very eye-catching. If you want to get to the bottom of it, you should get something. Remember, in the face of diseases, most people are common and frequently-occurring diseases, so we should start from this aspect and don't always think about whether it will be incurable diseases, because there are too many incurable diseases you encounter.

Speaking of which, I have really been to that top three hospital in the city. There are several chief physicians in its pediatrics department, and their level is not low. What's the problem? I believe that pediatricians in county hospitals and city hospitals should have found this swollen lymph node when they examined their children. It's just that the doctor's thinking is somewhat bound by inertial thinking and always wants to find the primary lesion. Unlike doctors in provincial hospitals, he started with swollen lymph nodes and immediately identified the cause.

The topic returned to the pediatrics of provincial hospitals. At that time, * * * had eight chief physicians, who usually spent most of their working time in the clinic, but the clinic went its own way and needed rich personal clinical work experience and high technical level. It is very necessary to have a good first pass in seeing a doctor. Of course, there are also young and middle-aged pediatricians on duty in the clinic. Ward doctors are young and middle-aged doctors, and most of them have graduate degrees or above. At the municipal level, mainly undergraduates, with a small number of graduate students. At the county level, there are mainly undergraduates with mixed specialties. Doctors have different starting points, and the gap naturally forms. The ward advocates teamwork, with one or two top doctors leading the team, and many attending physicians and deputy chief physicians can be independent, so they can cope with daily diagnosis and treatment.

Compared with large hospitals, it is normal for primary hospitals to have obvious technical gaps. Grassroots doctors also want to improve their professional level, but they are limited by various objective conditions. Even with hard work, the ability to improve is very limited, and it is impossible to reach the level of doctors with the same qualifications in large hospitals.

I'm Dr. Kang, thank you for your attention!

This question is probably something that many people find strange and want to know more clearly. As a senior surgical director, let me tell you something.

1, if it is a common and frequently-occurring disease, the technology of county and township hospitals is similar to that of large hospitals. For example, common medical diseases: cold, hypertension, diabetes, acute gastroenteritis, acute bronchitis and so on. As well as common I and II operations and some tertiary operations, such as appendicitis, gastroduodenal perforation, simple intestinal obstruction, varicose veins of great saphenous vein, inguinal hernia, ureteral calculi, ectopic pregnancy, tooth extraction and other diseases. There is no technical gap between county hospitals and township hospitals with good conditions and large hospitals. Because these diseases are often treated in county and township hospitals, the medication is similar to that of large hospitals, and the experience is naturally rich, so there is no technical gap.

However, there are also some patients, such as some patients with acute bronchitis with fever and cough, or patients with stones. After several days of treatment in county and township hospitals, there is no obvious improvement, and it will be fine to transfer to a big hospital for a day or two. Maybe everyone will think that doctors in big hospitals are high-level and immortal. Actually, it's not, because the treatment and rehabilitation of the disease take some time. Most of them should be used in primary hospitals after a few days. In fact, the disease may have recovered to 7788, but patients and their families don't believe it. It's completely fine to transfer to a big hospital and take the medicine again. To make a metaphor, the predecessors planted trees, and later generations enjoyed the cool. If you go to a big hospital for treatment at that time, you may rarely see the above diseases being discharged after being hospitalized for one or two days.

2, difficult disease, serious illness, major surgery or big hospital technology is good. For example, patients with acute myocardial infarction and cerebral infarction may not be treated by thrombolytic therapy alone if there is no county and township hospital with intervention conditions. However, if such patients go to a large hospital for emergency intervention, they may get well soon. There is also a more complicated lithiasis, such as conservative treatment by injection in county and township hospitals, which is of little use even for a few days, and it will be solved by surgery in a big hospital.

3. Of course, the medical level in different regions is different. For example, some township hospitals in a few developed areas are already top three hospitals because of the introduction of a large number of talents and hospital construction, and their level may be stronger than that of municipal hospitals in a few backward areas. Moreover, even if they are all top three hospitals, the level of provincial top three hospitals is definitely much higher than that of county and township top three hospitals in the same area. In addition, there is a gap between different hospitals and different specialties; And even the level of doctors in the same hospital is different. Therefore, to see a doctor, we should not only find a hospital, but also find a suitable doctor. Of course, as long as you usually contact more hospital medical staff or inquire about the patients who have been treated, these situations will be easier to know.

In short, it is suggested that common diseases and frequently-occurring diseases should be seen in county and township hospitals, and difficult, severe and major operations should be seen in large hospitals. Know more about the hospital when you are free. Once I need to see a doctor, I can see a doctor accurately.

I am a doctor, as the title says, is it medical technology that can cure patients who can't be cured in county and township hospitals in big hospitals? There is indeed a factor, but it is not entirely true.

The foreshadowing effect of primary hospitals is like a fever. If you are a patient with recurrent fever, go to the county hospital first. According to the routine, the elimination method is the most commonly used and contagious. Non-infectious? Or the cause of the tumor? Autoimmune reasons? Or an infectious disease? After a few days of inspection, the results came out and the family watched it for a week. The examination fee alone cost me so much money, but I can't find the reason. So I transferred to the superior hospital, which looked at the examination and treatment plan of the lower hospital. Alas, there is no reason for the routine, which requires experience. Is it malaria? Or arteritis? Or infective endocarditis? Or some special blood system diseases? It reduces the waiting time in front, and the superior hospital is the first with experience in this kind of intractable disease, and there are many means of equipment inspection, so it is quick to find out the reason and treat the symptoms.

For example, there is a case of pesticide poisoning or other toxic poisoning in nephrology, which may require hemoperfusion. As it happens, this basic hospital can't even carry out this technology. After several days of hemodialysis, the effect is not good, and it will get better soon after being transferred to a higher hospital for perfusion.

For another example, let me make a comparison with nephrology. Here comes a patient with acute glomerulonephritis, who may need hormone injection to be effective. Alas, primary hospitals have no experience in this field. What if you die suddenly? Alas, a small dose was used. When the family members saw it, the treatment was still not good for a few days. When they see it, they will be transferred to a higher level hospital. This obviously requires shock treatment. At this time, I told my family that shock treatment is effective, but there are risks.

For example, a patient with recurrent chest pain is highly suspected to be caused by coronary artery stenosis in CTA scanning in primary hospitals, but after all, this is only a silver mark. I don't have an interventional room, so I can only use some vasodilators, but this will cure the symptoms, not the root cause. When the patient sees it, it's useless. He won't see a doctor right away. Well, the doctor also considered coronary artery stenosis, so what are you waiting for? Go to the intervention room for angiography immediately. This is the gold standard. Angiography showed that there was indeed vascular stenosis. Well, with a stent, the patient will no longer have chest pain and chest tightness after discharge. He is still a skilled doctor in a big hospital.

Summary: The above is just a brief list. In fact, it combines many factors. There is no denying that the technology of big hospitals is definitely better than that of primary hospitals. Otherwise, there would not be so many people flocking to big hospitals to see a doctor, but it is difficult to solve the problem. The country is also vigorously promoting tertiary diagnosis and treatment. Only when the tertiary diagnosis and treatment really plays a role can it be possible to improve the problem of people's difficulty in seeing a doctor. It's a long way,

This disease has a course,

It's not impossible,

Experts know best.

As a general practitioner, I have worked in several 3A hospitals, worked as an intern in several county hospitals, and also worked in primary hospitals. Have a certain understanding of county, township hospitals and provincial top three hospitals. Next, I will talk about my personal opinion.

Speaking of the overall level of medical skills, of course, the top three hospitals are higher than county and township hospitals. This is an indisputable fact. The top three hospitals can crush county and township hospitals in terms of talents and equipment. The top three hospitals at the provincial level have gathered the best medical talents and the most advanced medical equipment from all provinces, and the overall medical skill level is of course higher than that of county and township hospitals. Now even if graduate students graduate, if they are not famous universities and have no scientific research achievements, they will not be able to enter the top three hospitals. Therefore, doctors in large hospitals are basically graduate students or above, and there are countless doctors. Even many of them have study abroad experience. Can their medical skills be low?

The level of county hospitals is also good. Many county hospitals are almost comparable to the top three hospitals in equipment, and many county hospitals with good conditions are almost graduate-level doctors. Of course, there is still a big gap between county hospitals and tertiary hospitals in economically underdeveloped areas, whether it is equipment or talents.

The level of township hospitals is far behind. Many township hospitals are short of doctors and medicines, with poor conditions, low salaries for doctors and heavy work. Doctors are also responsible for public health and poverty alleviation in rural areas. How can talents be willing to go to towns with low wages and heavy work? Of course, villages and towns also have their own positioning. Villages and towns are mainly responsible for providing residents with the most basic health protection. If the patient needs it, he can also be transferred to a higher hospital. Therefore, the positioning of township hospitals determines that its overall level is definitely worse than that of hospitals at or above the county level.

The technical level of different levels of hospitals varies greatly. What impressed Dr. Hao most was several patients with lung cancer and colon cancer. Doctors in local hospitals think that there is no chance of operation and suggest conservative treatment to prolong their lives. Later, the patient went to Shanghai and the operation was successful. Some of them are still alive today.

Several of them have a relatively high level of education. They carefully recorded their illness and the treatment methods of doctors in Shanghai, and brought them back to communicate with Dr. Hao, which benefited a lot.

Doctors need to study many diseases in their life. There was no good method last year, and there may be a breakthrough this year.

Like this old man, he used to have chronic obstructive pulmonary disease, his lung immunity was lower than that of normal people, and he was infected with Nocardia.

The virulence of this bacterium is very weak, but the mortality rate is very high! Moreover, it is insensitive to commonly used antibiotics, and even exceeds 30% if it cannot be effectively controlled early. Fortunately, he was in the provincial hospital, and the respiratory doctor noticed that he had hypoproteinemia. Considering the infection, sulfanilamide and linezolid were added, and the condition improved obviously after one month:

If it is in a relatively small hospital, due to the limitation of technical level, it is likely to miss the opportunity of early treatment.

Don't listen to gossip, but listen to the professional guidance of the doctor. Every hospital has a business backbone, and small hospitals also have many artists. Don't kill them with a stick.

For example, many readers leave messages on the Internet, saying that a hospital is not up to standard and will not go. People inside the hospital know doctors best, and any doctor with high professional level has a good reputation.

Like this left lower lung cancer, 8.4 cm, many neighbors said not to treat it. Such a big lung cancer can't be cured, and it's easy for people and money to be empty.

However, the patient underwent surgery in a local hospital for more than 5 years, and there was no recurrence:

Patients and their families have the right to know. No matter what level of hospital you are in, the doctor will tell you in detail. Generally speaking, the level of big hospitals is higher and the cost is more expensive, but it is not absolute. For example, common gastric cancer, small lung cancer, small liver cancer, breast cancer, etc. If the local hospital can treat it, there is no need to go to a higher hospital. Nearby treatment, convenient nursing and high reimbursement rate.

I'm Dr. Hao from the Imaging Department. Welcome to pay attention!

Some patients have actually been cured in county hospitals. Because their families are too anxious to think about the cure, they always complain that it doesn't work. Doctors are inexperienced and always change their dressing. The disease got worse and worse, so they had to be sent to a higher hospital. The superior doctor looked at the medical record, and the used medicine was no longer used. Try to narrow the scope of medication, prescribe the right medicine, and the disease will be fine. The son of a doctor in our county hospital is ill. I was hospitalized for half a month, consulted many times and changed my medicine many times. His illness became more and more serious, so he had to be transferred to another hospital. Municipal hospitals dare not accept it, depending on the situation. Sent to the hospital in the province, the doctor saw the medical record, made an examination and was hospitalized for observation, but he didn't take medicine, no matter how urged by his parents, he just said observation. I didn't take medicine for seven days in a row, and I was discharged on the eighth day and recovered.