How to choose a doctor's son-in-law for cancer patients?, 1500 yuan for domestic drugs and 15000 yuan for imported drugs | Doctor | Domestic
Line up for a few hours, see a doctor for five minutes, the doctor's words are as precious as gold, the medical records are like heavenly books... Everyone will get sick, and everyone is afraid of seeing a doctor. Patients are not only afraid of the disease itself, but also of not knowing how to obtain useful medical information, how to communicate with doctors, and how to make correct judgments.
A doctor hopes to change this situation. He said that he is not only a doctor, but also a patient's family member, and even as a medical student, he has always believed that he has a certain disease since middle school, and is a senior "hypochondriac". It is precisely because of his multiple perspectives that he understands the misunderstandings and even doctor-patient problems that may arise between doctors and patients due to information asymmetry.
Dr. Wang Xing, attending physician of the Department of Thoracic Surgery at Shanghai First People's Hospital
He is Wang Xing, a Ph.D. in Oncology from Peking University, and an attending physician in the Department of Thoracic Surgery at the First People's Hospital of Shanghai. Wang Xing's previous book was called "Patient Family, Please Come Here". After winning many awards such as the 17th Wenjin Book Award Science Popularization Recommended Book and the 2022 China Excellent Science Popularization Book Award, he recently won the 2023 Shanghai Excellent Science Popularization Work Award. The new book "Doctor, What Are You Thinking" launched by Shanghai Translation Publishing House jumped to the top of the popular e-book rankings after half a day on the "Get" platform. "Doctor, what are you thinking?" Perhaps this book title alone has touched the hearts of many patients.
Wang Xing's two medical popular science books have been well received by readers
How to determine which department to go to after falling ill? How to choose between domestic and imported drugs? Is the conclusion of online consultation credible? How to raise medical and other needs with doctors to make them more easily accepted? Wang Xing uses easy to understand language to explain medical knowledge that ordinary people can use. And what he most wants to spread to the public through this book is not medical knowledge itself, but medical thinking that non medical professionals can also master. With this set of medical thinking, not only can one understand "doctor, what are you thinking" and communicate more efficiently and accurately with doctors, but it can also help oneself or friends make more reasonable medical decisions, as he wrote in the preface of his new book, "Medical thinking is the shortest distance between you and a doctor.".
"Doctor, What Are You Thinking?" is divided into five chapters, starting from doctors, diseases, treatments, patients, and values, to sort out various aspects of medical treatment and health management. In the new book, Wang Xing first shares his misunderstandings about doctors. In his junior year, he went to see a doctor after running a marathon due to a foot injury and felt that the doctor was really indifferent. As a medical student, Wang Xing prepared a whole set of arguments and wanted to ask the senior doctor to take a good look. When he entered the clinic, he felt that the other person had not been thoroughly consulted or examined, so he said it was okay. Even if he wanted to ask one more question, he received impatient customer orders. Coincidentally, upon entering clinical studies, this doctor became his mentor, and his wisdom, enthusiasm, and personal charm amazed Wang Xing.
Why can the same person have completely different attitudes? Later on, Wang Xing also became a doctor. He understood that when a doctor is in an outpatient department, his more responsibility is to quickly determine whether the patient is sick or not, whether to take medication or undergo surgery, and whether to be hospitalized. Simply put, it is "screening". "I did recover quickly without taking any medication at the time, and didn't waste a penny. From this point of view, the doctor actually completed the task with high standards. I didn't write this misunderstanding to indicate that the doctor should be indifferent, but at least it resolved my long-standing doubts."
Wang Xing analyzed that medical thinking, which has almost become a doctor's "instinctive reaction", includes several dimensions: rational thinking, and what is my judgment on a patient's condition? What is an effective medical treatment for him? How to choose the most cost-effective solution? Critical thinking, is it possible that this judgment is wrong? What are the reasons that do not support my judgment? Do scientific thinking and clinical guidelines need improvement? Is the new clinical findings feasible and credible? Is there a correlation or causality between a possible cause and disease?
"To be a empathetic doctor in China, one must not only understand humanities, but also secular customs." In 2014, Wang Xing was preparing for his wedding when his mother-in-law was diagnosed with stomach cancer. The surgical process went smoothly, but encountered a problem during postoperative chemotherapy - whether to choose imported or domestically produced chemotherapy drugs? Wang Xing has stayed in the department where his mother-in-law underwent surgery and knows that domestic medicine costs about 1500 yuan per cycle, while imported medicine costs 15000 yuan. In terms of effectiveness, authoritative journal papers have confirmed that domestic drugs are not inferior to imported drugs in terms of both efficacy and side effects. How should this "doctor son-in-law" with a monthly salary of less than 15000 yuan choose at that time?
Out of his basic desire for survival, Wang Xing chose imported drugs. As a result, his mother-in-law's chemotherapy response was significant, and he decided not to continue chemotherapy. On the one hand, it can reduce complications, and on the other hand, it is also because the assistance of adjuvant chemotherapy itself is not significant, so there is no need to take greater risks for smaller profits. The whole family accepted his suggestion and unanimously decided to bear the risk of cancer recurrence due to not receiving chemotherapy. Years have passed, and now everything is fine.
Wang Xing and His Son
Wang Xingqing: If we had chosen domestic medicine at that time, my mother-in-law would have had such a big reaction that we would have to switch to imported medicine; If imported drugs are used and the reaction is the same, the elderly will suffer another punishment; If you haven't vomited after switching to imported medicine, then I'll just kneel down and live my life in the future. This experience has given him a deeper understanding of the psychology of patient families, especially those of cancer patients.
Later, during the consultation process, he encountered a similar scene. A cancer patient needs immunotherapy, with domestic drugs costing 3000 yuan per cycle and imported drugs costing 15000 yuan per cycle. The difference in effectiveness is not significant. He asked the patient's daughter what kind to use, and after hesitation, the other party discussed with his sister. After a long phone call in the hallway, he came back and confirmed repeatedly whether the efficacy was really similar. "I repeatedly expressed that there was not much difference between the two drugs, but she still struggled to tell me that they had agreed to choose imported drugs. I agreed that imported drugs need to go through a process, and it will take about three working days before they can be used." The other party instantly felt relieved and said, "Then let's use them quickly."
Wang Xing was genuinely happy for the other party, shifting the question from choosing expensive or cheap to choosing fast or slow. "This also greatly touched me, finding a new way of communication."
In Chapter 5 of "Doctor, What Are You Thinking", "Values: People are the Scale of Everything", Wang Xing explains various "non medical" factors that affect medical decision-making and outcomes, such as the patient's psychology, economic conditions, social attributes, etc. It is not only a psychological preventive shot for patients to communicate with patients, but also a measure of the values that this profession should have from the perspective of a doctor.
"When you board the boat created by the author of this book, you and the doctor become teammates," said ophthalmologist Tao Yong, who wrote recommendations for "Doctor, What Are You Thinking?".
"I have no intention of standing in the air and criticizing the behavior of doctors and patients, but rather speaking in plain language from the perspective of a frontline doctor and giving you advice from the perspective of your friends." Wang Xing said, "I only hope to pass on what I think is' effective and learnable 'medical knowledge to you through my shallow knowledge and experience, help you build your own medical thinking, and then discuss with you topics about diseases, medical treatment, and' effective healthcare '."
Dialogue with Wang Xing: "The anxiety caused by pulmonary nodules needs to be addressed, not nodules."
Looking at the news: "Doctor, What Are You Thinking?" is based on the "Everyone's Disease Class" you taught on the "See Ideal App." What kind of feedback do people who listen to this class have?
Wang Xing: The subtitle of this course is "Common Knowledge, Thinking, and Decision Making in Medicine". A listener said that he has dispelled his previous thinking about "thinking so" about seeking medical treatment. Another listener said that when she later lay on the hospital bed in the operating room, because she had listened to this course and knew what the people around her were doing, she felt particularly secure and eliminated the fear caused by the unknown.
In fact, when we go to a hospital for medical treatment, we will encounter many people. During surgery, there are caregivers, anesthesiologists, nurses, and resident chief physicians... I hope to break down the hospital's structure, so that ordinary people can understand the logic of hospital division and know what department they should attend when entering the hospital.
Looking at the news: The thing that most people feel scared about when they enter the hospital may be that the doctor appears strict, lacks patience, and is afraid that they may not ask the right direction
Wang Xing: The doctor is very gentle with you, maybe your illness is quite serious.
Under the current system, outpatient clinics are more like filters, identifying people who need hospitalization for treatment. Outpatient clinics are not designed to make everyone happy and satisfied. For most outpatient doctors, the time allocated to each patient is for discovering problems, rather than providing emotional value. However, from my personal perspective, what do I think about giving some emotional value? Is it possible to further optimize the outpatient process and enhance communication and understanding between doctors and patients in the future?
Why do you enjoy doing science popularization?
Wang Xing: Doing science popularization is actually an extension of the work of doctors. I am a lazy person and not very familiar with hot topics. The form of writing a book is relatively stable, and I hope to output a stable system that will benefit readers who can accept it.
Looking at the news: You have always mentioned "effective healthcare". What kind of healthcare is effective?
Wang Xing: For some diseases, if you come to the hospital for examination and medication, you will recover; Some diseases can still be cured without treatment. You have done a lot of tests, taken a lot of medicine, and when you recover from the illness, you may think it is effective, but in fact, it may not be so. Sometimes, without spending money or prescribing medication, it is actually a better treatment.
Nowadays, with more advanced technological means and more channels for information dissemination, there is indeed a situation of excessive medical treatment. For example, there are many nodules, such as pulmonary nodules, thyroid nodules, breast nodules... Many people choose immediate surgical treatment. In fact, the more you pursue high precision, the better. Because of the anxiety caused by pulmonary nodules, what you need to solve is anxiety, not nodules.
Looking at the news: Indeed, more and more people have "hypochondria", which means they suspect they are sick.
Wang Xing: I also wrote about my own experience in the book. For a period of time, no matter how I ate, I didn't gain weight, only about 110 pounds. I would suspect that I was anemic, hyperthyroidism, and had tumors... The disease I got was actually called medical student syndrome. I have experienced such a process, so I fully understand the situation of "hypochondria", which is very normal and there is no need to mock it. We can take some measures to eliminate some diseases, but we should grasp the degree and not walk into a dead end. I want more people to learn and understand the thinking of doctors, and I also hope that everyone can be more rational and objective when looking at their health problems. After understanding "effective healthcare", they will no longer pursue excessive medical care.
In fact, healthcare involves many aspects such as economy, society, and public health, making it difficult to achieve absolute fairness. I hope everyone can find the most effective solution for the individual, and one of my goals in writing this book is to enhance some doctor-patient relationships.
