2024-03-17 - A Precise Registration Experiment by a Great Doctor

A Precise Registration Experiment by a Great Doctor#



This article is from the WeChat official account: Economic Observer (ID: eeo-com-cn), Author: Zhang Ling, Cover image from: Visual China

This article introduces the precise registration experiment initiated by Zhao Xiaojing, the director of the Department of Thoracic Surgery at Renji Hospital, Shanghai Jiao Tong University School of Medicine. By establishing a precise appointment registration platform, Zhao Xiaojing successfully changed the situation where it was difficult to make appointments for expert consultations. Patients no longer need to find "scalpers", but can make appointments through the platform and provide medical records for review. After implementing the precise appointment mode, the number of patients in Zhao Xiaojing's outpatient clinic decreased, the consultation time for each patient increased, and some problems that ordinary doctors could solve were also solved.

• 💡 The problem of difficult appointments for expert consultations is solved through the precise appointment platform, and patients no longer need to find "scalpers".

• 💡 By reviewing medical records, "scalper" appointments and wrong appointments are filtered out.

• 💡 After implementing the precise appointment mode, Zhao Xiaojing can focus on the diagnosis and treatment of difficult and critical patients, improving patient satisfaction.

"In the past, patients would spend 2,500 yuan to buy my 300 yuan appointment from 'scalpers'. Now, this situation has disappeared," Zhao Xiaojing told the Economic Observer.

Zhao Xiaojing is the director of the Department of Thoracic Surgery at Renji Hospital, Shanghai Jiao Tong University School of Medicine. He is not only a top thoracic surgery expert, but also the initiator of a precise registration experiment.

A few years ago, at noon, an 80-year-old woman walked into his clinic and said, "Dr. Zhao, it's very difficult to make an appointment with you, it's like a 'flash sale'."

Zhao Xiaojing asked, "How did you manage to 'flash sale'?"

The old woman replied, "Your outpatient appointments start at midnight. I mobilized my whole family, including using iPads, phones, and computers, to grab them together. In 10 seconds, more than 100 appointments were taken."

Zhao Xiaojing had always wanted to change this situation. His outpatient clinic was always full, and many patients complained about the difficulty of making appointments, but many of their problems could be solved by ordinary doctors.

Since November 2019, he has reclaimed 90 out of 120 expert appointments spread across multiple registration platforms and put these 90 appointments on his own precise appointment registration platform.

The following year, he reclaimed all 120 expert appointments and required outpatient patients to apply for appointments through the precise appointment registration platform. When making an appointment, patients not only need to authenticate their identity and describe their medical history, but also provide an essential document: medical records.

This is different from the traditional registration method used by most hospitals. Traditional registration usually only requires real-name authentication, filling in patient information, phone numbers, and verification information to make an appointment, and once the appointment is successful, the patient can receive treatment.

The precise registration mode requires four to five staff members to review, and the hospital does not allocate a budget for this work. Every year, Zhao Xiaojing uses his own income to provide subsidies to the graduate students involved in the review.

In 2020, one year after implementing the precise appointment mode, the number of patients in Zhao Xiaojing's daily outpatient clinic decreased from over 100 to 40-50, and the consultation time for each patient increased from about 5 minutes to 10-15 minutes.

Like many famous doctors, Zhao Xiaojing often had people greet him to make appointments through personal connections, and some even tried to profit from it. Now, Zhao Xiaojing's relatives and friends know that they don't need to greet him anymore. They can make appointments through the precise registration platform and get appointments for difficult and critical patients.

  1. No need to find "scalpers" anymore

Usually, expert appointments are distributed through various channels such as hospital official accounts, local health registration channels, and third-party registration platforms, with varying quantities. As a scarce resource, many expert appointments are often "sold out" as soon as they are released, and desperate patients have to turn to "scalpers".

For a long time, Zhao Xiaojing couldn't figure out where his 120 daily appointments were distributed among various platforms, let alone how many appointments each platform could get.

In the second half of 2019, before deciding to reclaim the appointments, Zhao Xiaojing conducted an investigation. He first learned from the outpatient office of the hospital how many appointments were released on each platform, and then had the department doctors conduct a survey to understand the satisfaction, no-show rate, and participation of "scalpers" on each platform.

"Scalpers" can be divided into two types. One type uses technical means such as automatic appointment programs to swipe appointments online using patients' ID cards, while the other type holds exclusive appointment sources and charges higher fees.

Zhao Xiaojing also asked some patients who came to the clinic through "scalpers". They usually gave their phone numbers to the "scalpers", and the "scalpers" would make agreements with them, such as "I will make an appointment for you at midnight today, you must stay awake and send me the verification code in time."

"I will eliminate platforms with many 'scalpers' and high no-show rates," Zhao Xiaojing said.

In November 2019, Zhao Xiaojing coordinated multiple departments inside and outside the hospital to reclaim more than 90 out of 120 expert appointments that were spread across various registration systems such as Shenkang, Wei Yi, and Haodf, and unified them on the precise appointment registration platform of the Department of Thoracic Surgery at Renji Hospital.

In November 2020, Zhao Xiaojing approached the hospital's emergency department and proposed to reclaim all his expert appointments from various channels. The director of the emergency department joked, "Dr. Zhao, you are too ruthless. You don't give out a single appointment."

Now, patients who want to see Zhao Xiaojing only need to enter the registration page through the self-service menu of Renji Hospital's official account, find Zhao Xiaojing's name among the department doctors, and make an appointment. Unlike the "Appointment" button below the names of ordinary doctors, the button on Zhao Xiaojing's page says "Precise Appointment". After clicking on it, a rule introduction will pop up:

Precise appointment is an emergency appointment channel opened for difficult and critical patients, prioritizing patients' conditions and accurately matching them with experts who specialize in corresponding diseases. Due to limited appointment sources, patients who do not meet the criteria are advised to make appointments with other available doctors or make appointments at the general thoracic surgery outpatient clinic.

The traditional registration method usually only requires entering the name, ID card, contact information, verification code, and other information to make an appointment. The principle of this type of registration is "first come, first served" rather than "those who should come, get the appointment". "Scalpers" can get appointments by fully utilizing this rule.

The precise appointment registration platform adds an additional pre-screening process. After patients obtain Zhao Xiaojing's virtual appointment, the backend system will remind patients or their family members to submit relevant medical history materials. The online review team will carefully review these medical history materials and even communicate with patients' family members online to obtain sufficient medical history materials for analysis.

"We have to be extremely careful with the review of each patient. The first priority is to avoid rejecting patients with problems because misdiagnosis and missed diagnosis are very dangerous," Zhao Xiaojing said. "The second priority is to avoid approving patients without significant problems."

Zhao Xiaojing believes that the most important attribute of a patient should not be their ID card number or phone number, but their medical condition. This additional pre-screening process can filter out "scalper" appointments and wrong appointments as much as possible.

After patients obtain Zhao Xiaojing's virtual appointment, Zhao Xiaojing and his team will initially divide the patients into two categories: one category is for those who have obtained formal appointments and need further diagnosis or surgery at the outpatient clinic; the other category is for those who have not been approved, who often only need follow-up observation, additional tests, or treatment at the general outpatient clinic. These patients can be redirected through online answers.

In this additional online answer redirection process, a small-scale triage is completed. After triage, for patients who do not need offline consultations, Zhao Xiaojing's team will still inform them of appropriate treatment plans via text message. "In fact, these patients have the opportunity to receive free online medical consultation," Zhao Xiaojing said.

In December 2020, after multiple rounds of pilot testing, Renji Hospital opened the precise appointment channel for expert outpatient clinics and extended the precise appointment mode to 15 departments in the entire hospital. By March 2021, more than 60 experts at Renji Hospital had enabled the precise appointment function.

Zhao Xiaojing revealed to the Economic Observer that after the precise appointment mode was promoted throughout the hospital for some time, some experts insisted on using it, while others gradually stopped using it. Zhao Xiaojing analyzed that the doctors' choices may involve various considerations.

  1. Who is affected? Who benefits?

After implementing the precise appointment mode, because he only needs to see about 40 screened patients, Zhao Xiaojing can precisely control the time each patient arrives at the hospital, and there is no longer overcrowding and congestion outside the consultation room. The outpatient hall has become very quiet.

Inside the consultation room, Zhao Xiaojing can discuss the patient's condition and emotions, provide detailed instructions on future diagnosis and treatment directions and measures, and explain the possible patterns and forms of the patient's disease.

Zhao Xiaojing conducted a survey and found that the patient satisfaction rate for those who made appointments through the review process was 97.1%, while the satisfaction rate for those who did not pass the review was 93.7%. The main reason for dissatisfaction among the former was the cumbersome registration process, while the main reason for dissatisfaction among the latter was "why wasn't I allowed to see a famous doctor".

When the precise appointment mode was first implemented, Zhao Xiaojing personally reviewed the medical records of each patient. He often studied the patients' medical history during breaks in surgeries. Later, young doctors in the department and Zhao Xiaojing's graduate students participated in the review, but he still controlled the quality of the review and gradually delegated authority.

In the past, out of hundreds of outpatient patients, only 10-15 patients needed to be admitted for further diagnosis and treatment. Now, because the patients are more precise, an average of 20-30 out of 50 outpatient patients need to be admitted, increasing the admission rate from 10% to 40-50%.

After rejecting patients who don't need expert appointments, the number of patients in Zhao Xiaojing's outpatient clinic has significantly decreased, and the income from outpatient services has decreased noticeably. "I haven't calculated it carefully, but my monthly outpatient bonus may be reduced by one or two thousand yuan," Zhao Xiaojing said.

However, after the admission rate increased, the absolute number of inpatients and the number of surgeries performed also increased, which means that the performance of the entire department has improved. As the department director, Zhao Xiaojing's performance is related to the department's performance. With the increase in hospitalizations, his performance has also improved, but not by much.

When the precise appointment mode was first implemented, there were also "scalpers" who made appointments by submitting false medical records, but they were easily identified by Zhao Xiaojing's online review team because the characteristics of thoracic diseases are distinct, and each patient has corresponding CT scans and reports that professional doctors can easily distinguish between true and false.

"With the evaluation process, patients will gradually realize that as long as they meet the requirements of the outpatient clinic, appointments will be available, and there is no need to find 'scalpers'," Zhao Xiaojing said.

After implementing the precise appointment mode for some time, a patient from Gansu wanted to seek medical treatment in Shanghai. They submitted a precise appointment application on Monday night, and it was approved by Zhao Xiaojing early Tuesday morning. The patient immediately bought a plane ticket and flew to Shanghai. They had a consultation on Wednesday and underwent surgery on Friday. Zhao Xiaojing felt that it was something unimaginable in the past for a patient to come from thousands of miles away to a strange city and complete the entire process in one go.

  1. Reform Inspired by Reflection

"Why did you do this? What was the opportunity?"

When asked this question by the Economic Observer, Zhao Xiaojing told a story: In April 2019, a doctor had a dispute with a patient who had jumped the queue. After the patient reported it to the police, the doctor wanted to continue seeing patients and proposed to go to the police station after finishing the clinic. After waiting for 20 minutes, the verbal summons from the police turned into a forced summons, and the doctor was taken away in handcuffs.

Zhao Xiaojing was the protagonist of this story. The on-site video was widely circulated on the Internet, and Weibo celebrities such as Hu Ge, Sun Li, and Wang Sicong also posted related Weibo posts. The "Zhao Xiaojing Incident at Renji Hospital" attracted great public attention.

After the storm subsided, Zhao Xiaojing began to reflect: Should our outpatient clinic be in the current state? Was this incident accidental or seemingly accidental but actually inevitable? Why can't some patients with real illnesses get an appointment with me?

For a long time, Zhao Xiaojing had to see about 120 patients in his outpatient clinic for 8-10 hours a day. He had to work without eating or drinking, and couldn't even move his buttocks until he finished seeing all the patients. However, the average consultation time for each patient was only about 5 minutes.

Outside the consultation room, the waiting time for patients in the queue was very long, and the time for communication with the doctor after entering the consultation room was very short. The most common things Zhao Xiaojing said to patients were either "surgery" or "no surgery".

Zhao Xiaojing asked himself, is this kind of communication straightforward and in line with medical ethics? Is it in line with human care? For a lung cancer patient, spending only 5 minutes from entering the consultation room to leaving, is this respectful to the patient?

"The patient tells you their innermost thoughts, but you rush them in 5 minutes," Zhao Xiaojing said. "Especially for patients who come in through 'scalpers' and spend so much money to get my appointment, how can they not feel resentful in their hearts?"

Like many well-known experts, Zhao Xiaojing has encountered various patients who try various ways to see him. In addition to finding "scalpers", there are patients from other cities who wait outside the clinic for seven or eight hours just to get an additional appointment, and there are patients who try to make appointments through various channels by leveraging their connections, just to get an appointment.

Although there are many patients to see, and each of them finds it difficult to make an appointment, grab an appointment, and wait in line, the daily statistics show that there are only about 20 patients who really need Zhao Xiaojing's attention and his expertise, and sometimes even fewer.

The expert outpatient clinic, which was originally established for difficult and critical patients, was not being used in the most reasonable and effective way. Zhao Xiaojing saw that due to the lack of precise triage and treatment, ordinary people often had no way to seek medical treatment, while those who sought treatment in the wrong department complained. Some patients waited in line for 5 hours, only to be seen for 5 minutes. Before they even had a chance to sit down, it was already the next person's turn, and they would leave the clinic complaining that Zhao Xiaojing was being arrogant. Some patients heard that they didn't have any problems and immediately changed their attitude, demanding to cancel their appointments: "I wasted my appointment, you have to refund me." Zhao Xiaojing compared the traditional registration method to a blind marriage and dumb marriage - going through great difficulties with high expectations, only to find out that the person is wrong.

In pain, Zhao Xiaojing decided to change the current situation of expert outpatient clinics. Several months later, after preliminary research and contemplation, he established China's first precise appointment platform.

"The patients are really suffering, and this kind of suffering may be difficult for us medical professionals to imagine, because seeking medical treatment for ourselves and our loved ones is relatively simple," Zhao Xiaojing said. He believes that behind this suffering is the fact that China's medical system is not strong and perfect enough. It is difficult to completely change this "macro environment" in a short period of time, but he is willing to make efforts to change the "micro environment" of his department.

This article is from the WeChat official account: Economic Observer (ID: eeo-com-cn), Author: Zhang Ling

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