Pediatric medical treatment is so difficult, how to tier diagnosis and treatment?

This is the 4776th article of Da Yi Xiao Hu

Over the years, "shortage of pediatricians and difficulty in seeing a doctor for children" has attracted much attention. How to break the dilemma? At a time when the country encourages the birth of second and third children but the fertility rate is still facing challenges, pediatric medical care is also facing a severe situation of upgraded demand in the "shortage of pediatricians". In 2023, pediatricians, nurses, children and parents have gone through the most difficult and difficult year together. Everyone hopes to find an effective model to break this difficult-to-break dilemma of contradictory cycles as soon as possible! Promoting tiered diagnosis and treatment is an important measure for the country to strengthen the grassroots and promote the construction of pediatrics. The author agrees and has worked hard to explore this for many years. In clinical practice, he is committed to the discussion of "letting pediatric tiered diagnosis and treatment start from the community and family."

1. Popularize parenting knowledge and start pediatric graded diagnosis and treatment from the community and families

Understanding children is the basic skill that pediatricians cultivate in their day-to-day clinical diagnosis and treatment work. Loving children and doing it for children is the common emotion and wish of both pediatric doctors and patients. Over the years, the shortage of pediatricians has attracted much attention. The contradictions between the difficulty of children seeing a doctor and excessive medical treatment, the tense doctor-patient relationship and the rigid demand are prominent, and it is urgent for the whole society to work together and actively resolve them. The biggest problem in the pediatric dilemma is that a large number of children with common diseases are flocking to tertiary hospitals for treatment. Therefore, it is urgently necessary to strengthen the pediatric technology training of community doctors and the popularization of parenting science education for parents, guide parents to learn more about parenting science, and go to community hospitals for their first diagnosis, so that pediatric hierarchical diagnosis and treatment can start from community families.

There are many emergencies in children and pediatric emergencies. The onset is rapid and the changes are fast. Parents are anxious, doctors are afraid, and nurses are panicked. This is the characteristic of pediatrics! In busy clinical work, pediatricians often have to finish a pediatric diagnosis and treatment within 3-5 minutes for the whole family with many questions. Pediatricians summarize clinical experience and write and publish parenting science popularization, which can transcend geographical time and space and interpersonal gaps, and spread practical and scientific parenting knowledge and skills to the general public, so that parents who love children can treat children's growth and development diseases with a scientific and rational attitude on the basis of learning pediatric knowledge, and scientifically and rationally diagnose and treat and seek medical treatment, so as to better protect their children.

2. Community Pediatrics: Implementing the policy of “Let pediatric hierarchical diagnosis and treatment start from the community and family”

In order to explore feasible measures to "start pediatric graded diagnosis and treatment from the community and family", in May 2021, with the support of the Health Commission of Qingpu District, Shanghai and hospital leaders, the author established the "Pediatric Famous Doctor Studio" in the Xujing Beidaju Community Health Service Center. Through the "teacher-apprentice" method, the pediatric skills of community physicians are cultivated, and in clinical diagnosis and treatment, attention is paid to the promotion of pediatrics to parents, and parenting science books and articles are distributed. Through community pediatric medical services and popular science education, the ports for disease prevention and control and child health protection have been moved to the community and family, which has improved the level of scientific parenting among the public and put the "starting pediatric graded diagnosis and treatment from the community and family" into practice!

Time flies, and more than two years have passed in a blink of an eye! Over the past two years, with the support and encouragement of leaders at all levels, the team members have provided high-quality pediatric medical services to the residents, and have also been recognized and praised by the surrounding residents. The daily outpatient volume has quickly increased from the initial single digits to tens, and is now close to 100. In 2023, the Pediatrics Department of Beida Community received nearly 20,000 children, answered 20,000 questions about common children's diseases for parents, and also popularized scientific knowledge and skills of parenting.

The successful creation and operation of the "Community Pediatric Famous Doctor Studio" in Beida Residence has brought about good social benefits and partial economic benefits, and has been paid attention to by the leaders of the hospital and the Health Commission. They regard the construction of community pediatrics as a highlight project of the community hospital at your doorstep that is "closest to home and most intimate to you". They have invested in building a larger and better diagnosis and treatment environment. A children's playground full of childlike fun has also been built in the pediatric diagnosis and treatment area, which is currently difficult for many tertiary hospitals to do.

At present, it is difficult to get an appointment in the pediatric department of Xujing Beidaju Community Health Service Center in Qingpu District, Shanghai all year round. In order to ensure the quality of medical care, the pediatric famous doctor studio limits the number of appointments to half a day, and each doctor sees a maximum of 40 children. It is often necessary to open two consulting rooms and have two pediatricians see patients at the same time. This can reduce the number of children and their parents who have to wait in large hospitals far from home for at least 80-100 children every day, and also reduce the risk of cross-infection, bringing real convenience to surrounding residents.

Author: Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University

Pediatrics Chief Physician Xu Lingmin