Just try to be quick, "respond to every request", and start Internet diagnosis and treatment chaos: the first illegal diagnosis in Beijing | doctors | Internet
"Physicians need to have real name authentication before receiving medical treatment" "It is strictly prohibited to use artificial intelligence to automatically generate prescriptions"... At present, the Beijing Municipal Health Commission is leading the development of the Beijing Municipal Internet Diagnosis and Treatment Supervision Implementation Measures, which is seeking public opinions.
However, the investigation by reporters found that irregularities such as first diagnosis and instant prescription still exist, bringing many risks and hidden dangers to patients.
Consultation
Different diagnoses of the same disease in the first diagnosis of violations
"Registering to the hospital is too troublesome, and buying medication directly may not be right, so online consultation is quite convenient." Zhao Lin recently coughed and had phlegm. When she saw an advertisement on the online platform saying "Third class doctors, 30 second consultation", she clicked on it and tried it out. After briefly describing the symptoms, duration of illness, and submitting basic patient information, she was matched to the respiratory department by the guidance assistant. After paying the diagnosis fee, a respiratory internist immediately received the diagnosis.
"I can see the doctor's personal profile, but because it's a visual consultation, I don't know if it's me on the screen." Zhao Lin didn't have time to think too much, and the doctor's questions were already following one after another.
"Do you have nasal congestion and runny nose?" "No." "Do you have a sore throat?" "No pain." "Do you have a cough or phlegm?" "Phlegm." After just three rounds of Q&A, Zhao Lin only wrote a total of six words, and the doctor replied directly: based on your description of symptoms, the preliminary diagnosis is an upper respiratory tract infection. ". Do you need me to recommend medication for symptomatic treatment?
Based on simple conversations and online consultation with doctors, the first patient is diagnosed
"The whole process took less than a minute, it was incredibly fast." Zhao Lin noticed that the doctor did not ask her if she was the first patient to be diagnosed, nor did she provide any outpatient medical records.
"For the safety of your medication, please reply to the following question... If not, please reply with 'none'." Zhao Lin just replied with 'none' when she received a message: 20 milliliters of Feili cough mixture should be taken three times a day after meals. Under the electronic prescription issued by the Internet hospital, Zhao Lin saw four big words: "Buy immediately". "The pharmacy information shows that this is prescription medicine, but with this electronic prescription, you can buy it as long as you pay."
Zhao Lin felt uneasy and chose another platform called "Ask Doctor". In addition to routine questions, the doctor asked an additional question, "Do you feel that the sputum is in the throat or trachea?" Zhao Lin replied to "trachea." The doctor gave a diagnostic conclusion: based on the information and symptoms you provided, it is currently highly likely that bronchitis is present. Afterwards, prescriptions for levofloxacin tablets and compound dextromethorphan hydrobromide syrup were issued.
"The same symptoms, two doctors' diagnoses are completely different, and the medication prescribed is also completely different. Who should I listen to?" Zhao Lin couldn't help but question the reliability of online consultations. "Levofloxacin tablets are antibiotics, and the doctors didn't even allow the tests to be done, so they let me take them for 5 to 7 days."
The same patient receives completely different diagnoses on different platforms
For such online consultations, Shi Dongmei, the general director of the Xueyuan Road Community Health Service Center, also feels that it is too hasty. "If it is an offline clinic, the doctor will check whether the throat is red and swollen, listen to the heart and lungs with a stethoscope, and make judgments based on blood routine and other laboratory results. These are not things that patients can describe clearly in just a few words."
In the Measures for the Implementation of the Supervision of Internet Diagnosis and Treatment in Beijing, it is clearly stipulated that "patients should provide medical records with clear diagnosis when they seek medical treatment, and the receiving physician should retain the relevant data and judge whether they meet the conditions for future medical treatment." It is also required that "when the patient's condition changes, this visit is judged by the physician to be the first visit or there are other circumstances that are not suitable for Internet diagnosis and treatment, the receiving physician should immediately terminate the Internet diagnosis and treatment activities, and guide the patient to see a physical medical institution."
Prescription of medication
Prescription medication is given first, and medication can be prescribed randomly
Compared to online consultation, online medication is more focused on the word "fast". With the same cough, Chen Lei didn't even think about asking a doctor. Instead, based on his impression, he searched online medication platforms for azithromycin tablets he had taken three years ago.
"At that time, the cough was also quite severe. After seeing the medication taken in the hospital, he finally managed to control it and felt that it was quite symptomatic." After finding the corresponding medication, Chen Lei realized that it was a prescription drug and chose "Ask the pharmacist" at the bottom of the page.
"The so-called pharmacist assistant is a bit like those intelligent customer service representatives who automatically ask once according to the template, and even if the condition collection is completed." On the consultation page, Chen Lei can only see the pharmacist's surname Hou, and cannot view more information. "It shows that the qualification has been reviewed, but the specific name of the pharmacist and the number of the practicing certificate cannot be seen, so it is impossible to verify whether the pharmacist really has the qualification." What shocked Chen Lei even more was that this pharmacist, who has only been in the industry for three years, consulted 47473 times, and the average response time was only 0.2 minutes. ".
"Are there any other discomforts?" "No." "Do you have any medication or do you have any other medication at home?" "No." After a brief inquiry, pharmacist Hou recommended the medication, which included not only the azithromycin tablets that Chen Lei initially consulted, but also the honey refined Chuanbei loquat ointment. ". Click "View and Select" to automatically redirect to the pharmacy page. After comparing prices, you can "make a free prescription purchase".
"This is really a case of 'responding to every request'. The pharmacist will cooperate with the prescription of whatever medicine I want." Chen Lei asked pharmacist Hou about the difference between azithromycin and cephalosporin, and the pharmacist replied, 'They are both anti-inflammatory drugs with different antibacterial spectra, so azithromycin is sufficient for coughing.' As for whether it is necessary to go to the hospital for a blood routine test, the other party said, 'You can take the medication first. If the symptoms do not improve after 3 days, it is recommended that you seek medical attention at the hospital.' "
Speaking of antibiotics, Shi Dongmei sighed helplessly. "The abuse of antibiotics is too serious, and many people have to take antibiotics when they catch a cold, without realizing how serious the consequences are." Previously, Shi Dongmei once treated a diarrhea patient, and the test found that the blood count was particularly high. However, taking levofloxacin did not improve. "Later on, I communicated with him and found out that he often took antibiotics when he was a child. Over time, he developed resistance to antibiotics, and ordinary antibiotics were no longer effective for him."
Online consultation with doctors to prescribe antibiotics to first-time patients
Zhao Zhigang, Director of the Pharmacy Department of Beijing Temple of Heaven Hospital, also believes that there are many hidden dangers to the phenomenon of "instant prescription" online. "Pharmacists were supposed to play a role in the review process, but now they only focus on 'speed' and the review process is meaningless, which can easily lead to more medication risks. Even during the use of drugs for chronic diseases, regular reviews should be conducted to determine the efficacy, whether there are adverse reactions, whether adjustments to the type or dosage of medication are needed, and to monitor indicators such as liver and kidney function."
technology
Artificial intelligence assists rather than substitutes
How to achieve an incredibly fast online consultation and medication? The reporter contacted a network technology company providing Internet hospital system as the head of a hospital department.
"Automatic reply can be docked, and the reply content can be customized. If you want more intelligent AI, you can docked with GPT." The business staff said that GPT is the most advanced artificial intelligence. "In theory, it is infinitely possible. It depends on how you want to use it. I don't think it is necessary for our Internet hospital to conduct online consultation. Of course, this is my subjective view, and the specific function is up to you."
The salesperson also mentioned, "It is unrealistic and non compliant to have GPT communicate with patients about the condition. To provide a diagnosis or treatment plan, it is still necessary for the doctor to reply. Artificial intelligence can automatically reply in the early stage to understand patient information and save doctors time."
On another platform that provides a medical big language model, "intelligent assisted prescription" has become a major highlight. "Candidate drugs, usage and dosage can be recommended according to the patient's age, diagnosis of disease, historical medication, allergy history, contraindication and other information, greatly saving the time cost of doctors' online prescription..." The business staff reminded the reporter that "Internet hospitals are not allowed to make initial diagnosis."
Electronic prescriptions issued by Internet hospitals
When a reporter pointed out that some Internet hospitals are still providing the first diagnosis service, the other side said, "Those that were not checked, the data of the docking supervision platform was not managed before, and the past has passed. From the second half of last year to this year, the policy of Internet hospitals has become more and more strict. Some platforms do not need their own Internet hospitals to write prescriptions, but other Internet hospitals provide prescription services, and if problems occur, they can also clear the responsibility."
Liang Zhigang, director of the Information Center of Xuanwu Hospital of Capital Medical University, said that the reason why Internet diagnosis and treatment only focus on patients who need to return to the hospital is that the first patient is complicated and diagnosis is crucial. "The cause of the same symptom may vary greatly, such as abdominal pain. Patients may not be able to express the specific location and type of pain clearly. If seeking medical treatment in an offline hospital, doctors will check the patient's vital signs, conduct physical examinations such as palpation and auscultation, and if necessary, combine laboratory tests such as blood routine or imaging examinations to identify the true cause."
In his opinion, in Internet diagnosis and treatment, doctors have very limited information from patients, and patients sometimes miss some hidden or atypical symptoms, which is likely to lead to misdiagnosis. "Even artificial intelligence can only analyze based on the information provided by patients. No matter how advanced the technology is, there is a possibility of misjudgment due to inaccurate information obtained."
Liang Zhigang believes that technologies such as artificial intelligence should play an auxiliary role, such as reminding doctors to pay attention to drug interactions when prescribing, and assisting pharmacists in reviewing medication to reduce patient medication risks. "Artificial intelligence is not yet mature enough to replace doctors and pharmacists, and it must be viewed rationally."
