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刚出生婴儿要查艾滋病梅毒等花费近6000元
2010-07-12 07:58:00 来源: 南方日报
出生不到一周的婴儿，79小时内做189项检查，其中包括艾滋病、梅毒、类风湿、糖尿病等项目，花费近6000元。
昨日，初为人父的家长雷旭（化名）觉得被医院骗了。当记者向院方咨询时，院方道出无奈，这些检查大多包含在一个套餐里，即便没必要，医生也无权将其从套餐里剔除，名目繁杂的检测费用无法避免。
“无法剔除”背后，折射出“临床路径”这一仍处于试点阶段医疗新模式在实践中遭遇的尴尬。
3天查了189个项目
6月27日，雷旭的宝宝在广州番禺出生，随后患上新生儿常见的肺炎、消化道出血，经过几天的治疗，病情渐趋平稳，但胃里还有少许咖啡色物质，医生认为可以喂食母乳，并建议他将宝宝留院观察几天。
7月2日，雷旭将出生不到一周的儿子转至广州某儿童医疗中心。入院不到一小时，还没来得及做任何检查，院方就告知宝宝患有肺炎、消化道出血、黄疸，需要进入重症看护室。
雷旭很快收到“病危通知书”。颤抖着手，他签下数张同意书。5日下午，雷旭再次接到院方通知，“宝宝由于凝血功能缺陷，需输新鲜冰冻血浆”。
雷旭向其他医院儿科医生咨询，得知如果没有手术和大量出血，输血并非必须。
当天下午，他决定让宝宝出院。可没想到，短短三天，宝宝却花费了近6000元的医药费，其中光检查就做了189项。
这些检查项目以专业的学名出现在清单上，“外行人根本看不出检查目的，医院也不给我们解释”，通过向朋友咨询，雷旭才得知孩子在这几天中接受了艾滋病、梅毒、类风湿、糖尿病等项目检查。
“乱收费”还是常规检查
雷旭对记者说，。当初转院只是为了给孩子复查，为什么会进入重症监护室？
对此，该儿童医疗中心黄姓主任对记者表示，接收新生儿时，他们对其病情不甚了解，“新生婴儿病情可能稳定，也有可能随时恶化，因此必须进入重症监护室”。
对于雷旭质疑某些检查的必要性，黄主任解释，医院有必要对宝宝身体进行全面检测查，以确认婴儿是否患有其他疾病，以便及时治疗。
“从另一个方面说，如果出现漏诊的情况导致新生儿出院后发生事故，医院需要担负责任”。黄主任说。
院方表示，患者进入监护室前，家属会获得一份《病情告知书》，上面详细列举“可能要做的某些检查”,而雷旭本人已签字同意该告知书。
针对这一情况，记者咨询珠江医院儿科副主任医师兰和魁。他表示，在签署类似文件时，家属有不明白的项目应该及时咨询医生，如果时间允许且没有紧急救治任务,医生也应该向家属详细解释。
广东中泽律师事务所周玉忠律师接受记者采访时表示，根据法律规定，医疗机构及其医务人员不得违反诊疗规范实施不必要的检查。判断该儿童医疗中心对新生儿的检查项目是否合法，主要在于其检查是否符合诊疗规范，而这个判断只能“由专业医生说了算”。
临床路径越绕越“长”？
出生不到一周的宝宝接受繁杂的检查，家长莫名其妙，医院也有无奈。该医疗中心黄主任透露，即便存在一些没必要检查的项目，医生也无权将这些项目从套餐里面剔除。
兰和魁告诉记者，医院的套餐检查是根据“临床路径”制定出来的。所谓“临床路径”，是指针对某一疾病建立一套标准化治疗模式与治疗程序，目的在于规范医疗行为，降低成本、提高质量。今年1月起，此模式在部分省和医院展开试点。
在广州某儿童医疗中心新生儿科，记者询问了3位患儿家属，他们无一例外地绕上了这条路径，花费的检查费在5000至10000元之间，而这些检查和他们孩子有什么关系，他们也不清楚。
廖新波：检查项目有无必要看医德
省卫生厅副厅长廖新波对记者表示，临床路径既能降低单病种平均住院日和医疗费用，又能达到预期治疗效果的诊疗标准。但实践中，却要避免临床路径变相为医院“乱检查多收费”的借口。
廖新波认为，治疗诊断疾病，医生除了执行“临床路径”相关规范，也要运用临床经验判断某些检查项目是否有必要，并明白告知病人或其家属，“这既涉及医生医术，更是医德问题”。
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Babies born to HIV, syphilis and other investigations spent nearly 6,000 yuan
2010-07-12 07:58:00 Source: Nanfang Daily
Infants born less than a week, 79 hours to do 189 inspections, including AIDS, syphilis, rheumatoid, diabetes and so on, to spend nearly 6,000 yuan.
Yesterday, the parents of a father Lei Xu (not his real name) felt cheated by the hospital. When a reporter consultation to the hospital, the hospital Daochu helpless, most of these checks is included in a package where, even if not necessary, doctors have the right to remove it from the package inside, nominal cost of complexity can not be avoided detection.
"Can not remove" Behind the "clinical pathway" is still in the pilot phase of a new model of medical practice experience in embarrassment.
3 days checked 189 items
June 27, Lei Xu's baby was born in Panyu, Guangzhou, and then suffering from common neonatal pneumonia, gastrointestinal bleeding, after several days of treatment, his condition stabilized, but the stomach still a little brown substance, the doctor that you can breast-feeding, and suggested he would stay in hospital for few days baby.
July 2, Lei Xu, the son to be born less than a week go to a children's medical center in Guangzhou. Hospital less than an hour, not enough time to make any inspection, the hospital will inform the baby with pneumonia, gastrointestinal bleeding, jaundice, need access to intensive care room.
Lei Xu soon receive a "notice of critical illness." Shaking started, he signed a handful of consent. 5 pm, Lei Xu, again, the hospital received notice, "the baby as coagulation defects, be infusion of fresh frozen plasma."
Lei Xu, consult a pediatrician to other hospitals, that if there is no surgery and heavy bleeding, blood transfusion is not required.
In the afternoon, he decided to let the baby was discharged. I did not expect, just three days, she has spent nearly 6,000 yuan medical expenses, which ray will do 189.
The inspection items to the professional scientific name appears in the list, the "outsiders do not see the purpose of inspection, the hospital does not give us an explanation," through friends advice, Lei Xu, only that children receive in these days of AIDS, syphilis, rheumatism, diabetes and other items check.
"Arbitrary charges" or conventional check
Lei Xu told reporters. The children had transferred only to review, why would enter the intensive care unit?
In response, Huang, director of the Children's Medical Centre, told reporters, receiving newborns, they do not understand their disease, "newborn infant disease may be stable, they may deteriorate at any time, it must enter the intensive care unit."
Lei Xu, questioned some of the checks for the need, Mr. Huang explained, hospitals need to check your baby to conduct a comprehensive inspection to confirm whether the child suffered from other diseases, so that timely treatment.
"From the other side, if the situation there missed the incident led to newborns after discharge, the hospital need to take responsibility." Mr. Huang said.
The hospital said the patient into the intensive care unit before, and the family will receive a "truth telling book" untrusted "may do some checking," while Ray Xu I have signed the informed written consent.
In view of this situation, the reporter of Pediatrics, Zhujiang Hospital, deputy director of consulting physicians Lan and Kui. He said the signing of similar documents, the family did not understand the project should consult a doctor promptly, if time permits and there is no mandate for emergency treatment, doctors should explain to the family.
Guangdong Ze Zhou Yuzhong law firm lawyers told reporters that according to law, medical institutions and medical clinics regulations will not violate the unnecessary tests. Determine the child care center on the legality of the newborn examination items, mainly in checking whether their treatment standard, but the judge only "by the professional doctors the final say."
The more clinical path around the more "long"?
The baby was born less than a week to accept complicated inspection, parents were puzzled, hospitals have no choice. Mr. Huang said the medical center, even if there is no need to check some of the projects, doctors have no right to remove items from the package inside.
Lan and Kui told reporters, hospitals, package inspection is based on "clinical paths" developed out. The so-called "clinical paths" refers to a disease for the establishment of a standardized treatment modalities and treatment procedures, the purpose is to standardize medical care, reduce costs and improve quality. Starting in January of this year, this pattern started in some pilot provinces and hospitals.
Children's Medical Center in Guangzhou, a neonatal, a reporter asked the three children with family members around them, without exception, on this path, take the examination fee in 5000 to 10,000 yuan between, and these checks and what their children relations, they do not know.
Liao Xinbo: Check whether the project is necessary to see medical ethics
Liao Xinbo Provincial Health Department deputy director, told reporters that both clinical pathway reduced the average length of stay single disease and medical costs, but also to achieve the desired therapeutic effect of treatment standards. But in practice, clinical pathways have to avoid the hospital disguised as "random checks and more fees" as an excuse.
Liao Xinbo that the disease treatment and diagnosis, a doctor in addition to the implementation of "clinical pathways" relevant norms, but also from clinical experience, we judge whether there is Bi Yao Shi Fou inspection items, and to inform patients or their Jia Zhu Ming Bai, "This not only involves medical skills, even more is the issue of medical ethics . "
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