Author: Zhong Le (Zhuo Zheng pediatrician)

Introduction: I resolutely left the public hospital to join the private clinic, and I am very glad that I made the right choice. But that doesn't mean this road is also suitable for you. But I hope I can help you understand the path I have taken and help you know the path you should choose.

It has been one year since I came to Zhuozheng Medical, and friends and former colleagues often ask curiously, "How does it feel to work in a private high-end clinic?" This is not clear in one or two sentences.

During this one year, I participated in interviews with more than 1 pediatricians who were interested in Zhuo Zheng. I found that although many doctors are dissatisfied with public hospitals and full of longing for the world outside the system, they have not carefully thought about what changes they will face after joining private clinics.

Finding a job is somewhat similar to getting married. If you don't know enough about your future husband and future marriage life, it's hard to guarantee a happy marriage life. Therefore, I wrote this article, using the thinking and analysis of an experienced person to help you understand private high-end clinics and what kind of changes pediatricians will need if they jump out of the system.

In private high-end clinics, it is easy to think of elegant environment, orderly medical environment, sunny and high salary ... This is just the appearance of a "husband". Let's take a look at the most important part of "married life"-clinical work.

High-quality and demanding clients

Most clients in private clinics are of high quality, and there are few rude insults to staff. They are polite. From time to time, they will send thank-you cards, flowers and cakes baked by themselves, and send their praises to the clinic to friends and Weibo to express their gratitude sincerely.

Their medical literacy is also good. They will retrieve information before and after seeing a doctor. Please help to verify the truth, and you will also verify the truth of what you said. During a child care clinic, my mother and grandmother asked me why the order of adding complementary food I suggested was not consistent with the popular science done by a well-known professor. I explained the reasons and told them that both American and Canadian guides recommend this. Grandma nodded and said, "well, the guide is higher than the expert's opinion." OMG, what a high understanding this is.

On another occasion, some media published an article "Experts call for stopping the abuse of azithromycin". Not long after, a father asked our pediatrician why he gave azithromycin to his children with mycoplasma pneumonia. We were surprised that parents should pay attention to such academic issues. The use of azithromycin in mycoplasma pneumonia is in line with the indications, not abuse. After our explanation, parents were relieved, but this incident made us realize that the diagnosis and treatment must be standardized and need to stand up to scrutiny and doubt.

customers of private clinics are not satisfied because of the good clinic environment, short waiting time and sufficient consultation time of doctors. They demand high-quality medical services, so doctors need to have enough professional qualities to meet their needs.

Wider diseases

Although common diseases and frequently-occurring diseases are the main diseases in private clinics, common diseases in other specialties, such as labia minora adhesion, eczema, acute otitis media, nasolacrimal duct obstruction and so on, need to be handled in a standardized way. Therefore, when doctors join private clinics, they still need a lot of study to master the guidelines of these diseases that were rarely dealt with before.

Evidence-based inspection items

click the "Inspection" drop-down menu, and select "Click"-Done! Is it that simple to open an inspection?

When you were in a public hospital, in order to protect yourself, you might rule out complications with a probability of only 1%, but now, you need to try your best not to overtreatment and delay diagnosis and treatment. It is not easy to do this, which requires you to make a judgment based on the patient's individual situation on the basis of mastering the diagnosis and treatment guidelines; This requires you to pay more attention to tracking the changes of symptoms rather than relying on the test results.

In the past, you might have followed the examination of your colleagues and superiors, but now you need to know the evidence and diagnostic value of each examination. Maybe you have given a head CT or MRI to a child with simple febrile convulsion, maybe you have given a food allergy-specific IgG test to a child with suspected food allergy, but you can't do it again in a private clinic. Excessive examination will not only damage yourself, but also damage the reputation of the clinic.

More standardized diagnosis and treatment

After I joined Zhuozheng, the biggest shock I felt was-"I can't believe I won't see a cold!" In fact, this is not appropriate, it should be a sudden awakening to "I can't see a cold in the first place." I am not the only one, and many colleagues have similar feelings.

In public hospitals, the standardized diagnosis and treatment of common cold, which is self-limited, is not valued. I have seen thousands of colds, and cold medicine, ribavirin and cough medicine are handy. However, after studying the cold guide again, I have almost no medicine to prescribe ... But in the face of anxious parents and children with high fever, runny nose and frequent coughing, how can you make them go home with satisfaction without taking a drop of medicine?

On that business study day, pediatricians and physicians studied and discussed the diagnosis and treatment of upper respiratory tract infection together until after midnight. For doctors, it is much more difficult not to prescribe medicine than to prescribe medicine. We are discussing what patients and parents are worried about the cold and what expectations they have for the course of the disease. How can we calm their worries, explain the natural course of colds, and explain the functions, side effects and reasons for not using drugs? How to do a good job in patient education, so that they can learn to observe the changes of their illness at home and learn to relieve various symptoms; How can we strengthen follow-up to relieve their anxiety ... Drug therapy doesn't work, but "speech therapy" can be put in place.

Apart from colds, I gradually found that there were misunderstandings in the diagnosis and treatment of common diseases such as constipation, diarrhea, thrush, eczema and allergic rhinitis. We have studied almost all diseases again. This year in Zhuozheng is the year when I consulted the most English materials, read the most and wrote the most notes.

If you want to come to a private high-end clinic just to relax, you will be "marrying the wrong man"; If you want to be a "pure doctor", you have come to the right place. Although it takes time to read clinical data, it is not bitter, and it is much more exciting than reading scientific research documents and writing fund applications. Moreover, standardized clinical work will make you feel more substantial, practical and valuable.

Seeing that the management of the clinic attaches so much importance to the study of the guide, are you worried that Zhuo is training doctors to be "Zhao Kuo" on paper? Don't get me wrong, this kind of management just allows doctors to check the latest medical information from reliable sources such as guide library or uptodate when they encounter problems, instead of looking through outdated and incomplete teaching materials; Let doctors realize that medicine is a science that is constantly updated and corrected, and accept new information openly.

Doctors' experience is very valuable, so they will use their knowledge flexibly and always be alert to diseases such as measles, leaflets and Kawasaki when watching the common cold. However, doctors' experience is limited, so they need to believe that the disadvantages of using cold medicine for children under 4 years old in the study report outweigh the advantages without observing serious side effects. The combination of knowledge and experience is the most basic quality of a good doctor.

Efficient work efficiency

One of the important reasons why I left public hospitals. After studying in the United States and returning to China, I very much hope to apply the American child care system in China, but I am struggling in public hospitals. After I joined Zhuo Zheng, my first task was to build this system. To my surprise, everything was so easy!