According to news reports, a woman named Wagner in Germany was arrested because.The back pain is unbearableShe went to the hospital for many times, and the attending doctor made a variety of diagnosis and treatment plans for her, but all of them had little effect.
Seeing that conventional treatment was ineffective, Ms. Gewana came up with the idea of radical cure of back pain through surgery. However, after many operations in the plastic surgery hospital, Ms. Gewana’s back pain has not eased, but has become more and more serious.
According to a report in the German weekly Der Spiegel,In two years, Ms. Gwana underwent six major operations and treated 26 spinal positions.. However, complicated surgery still can’t completely solve Ms. Wagner’s back pain. Now she is 80 years old and has to rely on a walker to walk.
In fact, cases like Ms. Wagner are not uncommon. According to the data, in 2020, there were 387,000 back operations in Germany, 71% more than 14 years ago, and more and more spinal interventions can be paid separately in each operation. In this regard, many medical experts began to question the rationality of such operations.
By analyzing the data of more than 7,500 people from 2015 to 2021, German doctor Michael Belal and his colleagues concluded that,Less than 5% of the suggestions for back surgery are reasonable. This means that most spinal interventions are unnecessary, and about 95% of cases have experienced "over-medical treatment".
Many people have had shoulder back pain and low back pain. The main reason why back pain is common is that,Back pain is usually caused by muscle strain caused by poor sitting posture or muscle weakness caused by lack of exercise, which leads to "neck, shoulder and back pain". Especially smokers over 40 years old, because nicotine is absorbed into the blood, it will cause vasoconstriction and spasm, reduce blood supply, and affect the blood circulation outside the intervertebral disc. The symptoms of back pain may be more serious.
It can be seen that not all back pain problems require surgical intervention. Pain doctor Michael K thinks:"In the back treatment, filming, puncture and cutting are particularly profitable. As a result, there are too many such operations. "
In fact, in addition to the back pain caused by tumor, smokers suffer from chronic low back pain. If they quit smoking for a period of time, they will find that the pain has improved. Exercise to strengthen the function of the back muscles through swimming and other sports is also helpful to exercise the back muscles and spinal joints and relieve the symptoms of back pain.
In China, overtreatment also exists.Former Vice Minister of Health Huang JiefuI once bluntly said at a meeting: "Many medicines should not be taken, but they are being taken; Many treatments are not needed, but they are still being done; Many operations will only make patients more painful, but they are also being done."
Huang Jiefu appealed that the phenomena of "ineffective medical treatment" and "over-medical treatment" in China need to be reflected. Is every treatment necessary? We need to re-examine the problem.
Excessive medical treatment is a diagnosis and treatment behavior that exceeds the actual needs of diseases, which usually manifests as excessive medication, excessive examination, excessive hospitalization, excessive consumables, abuse of surgery and antibiotics, etc., which will lead to a huge waste of social medical resources.
The most direct disadvantage of overtreatment is thatIncrease the burden on patientsThe emergence of "expensive medical treatment" has caused some people to look down on the disease. According to the data, the waste of medical resources can reach 20%-30% due to the abuse of drugs and inspections by medical institutions.
Secondly,Harm the health of patients, resulting in an increase in iatrogenic diseases.. For example, the data show that the cases of drug-induced liver damage in China are increasing at a rate of 3%-4.5% every year, and there are often cases in which patients with hepatitis B get worse or even worse after blindly using traditional Chinese medicine compound.
Overtreatment may alsoDamage the doctor-patient relationship,Affect social harmony. Random inspections, arbitrary charges and the appearance of "sky-high medical care" have greatly damaged the image of medical institutions and medical personnel.
1. Cervical erosion
The term "cervical erosion" has been abandoned at present, and it has been replaced by"Ectopic columnar epithelium of cervix"Nouns. The so-called "cervical erosion" is essentially the eversion of cervical columnar epithelium, which is exposed to the external cervix. The columnar epithelium is arranged in a single layer, and there is a rich vascular network under it. The columnar epithelium fuses with each other into villi or granules to form a rough appearance.
In the past, because many doctors lacked a correct understanding of "cervical erosion", clinical overtreatment or improper treatment often occurred and was quite serious. This is not only the problem of antibiotic abuse, but also the abuse of loop electrode resection in many hospitals to treat "cervical erosion", which leads to women’s health problems such as cervical adhesion, decreased cervical secretion, cervical endometriosis and cervical incompetence.
Clinically, gynecological examination found that the outside of the cervix was red, striped or granular.Local cleaners do not need treatment at all.; If there is purulent secretion, it can be treated by local vaginal plugging for several days; If the area is extremely large and there is no obvious improvement after local treatment, cervical cytology and HPV-DNA detection should be done, and artificial cervical cancer screening is the correct way if necessary.
2, thyroid nodules
Among thyroid nodules, 80%~90% are nodular goiter, which belongs to thyroid tissue hyperplasia and degenerative diseases, not to tumors, and there is no surgical indication.Only 5%~10% of thyroid cancer may need surgery.
However, due to the low level of ultrasound and cytology diagnosis in some hospitals in China, it is impossible to distinguish the benign and malignant nature of nodules before operation, so that some doctors operate on all patients with thyroid nodules, which not only wastes a lot of medical resources, but also causes different degrees of damage to the appearance and function of patients.
Experts say that more than 80% of thyroid nodules are benign, and under normal circumstances, they have no obvious impact on human health, just need regular observation. Benign nodules generally do not require surgery, and only have symptoms of oppression such as dysphagia and dyspnea, or are found.The rapid enlargement of nodules in a short time and suspicious lymph node metastasis under the condition of unchanged nodule size indicate that the lesions are progressing continuously and should be treated surgically.
3. Heart stent
In 2013, the American Medical Association released a report saying that stents are one of the most frequently abused medical interventions. In this regard,Hu Dayi, Chairman of Cardiovascular Branch of Chinese Medical Association.The professor said: "The problem of heart stent abuse in China is not more optimistic than that in the United States. Few patients abroad need more than three stents. But in China, many patients have been placed with 5 to 10 stents, which is obvious over-medical treatment. "
Professor Hu Dayi said that some patients did not meet the indications of interventional therapy, but were placed with one or more stents. Because they did not take medicine on time after operation, they developed thrombosis, which led to more serious myocardial infarction.
Before considering stent surgery, patients diagnosed with coronary artery obstructive disease should focus on lifestyle changes, such as not smoking, eating a healthy diet and exercising according to regulations. This also means that this group of people should receive a variety of necessary drug treatments, such as aspirin to prevent thrombosis, beta-blockers to slow down heart rate and control blood pressure, and statins to lower cholesterol levels.Paying attention to preventive lifestyle changes and drug treatment are often the best methods for patients with coronary heart disease.
4. Cancer screening
Han Qide, an academician of China Academy of Sciences, once pointed out at the "Medical and Humanities Summit Forum" that heIt is not recommended that healthy people do cancer screening.
He explained that "early cancer" and "lazy cancer" hidden in people’s bodies do not matter even if they are not found and not treated. This has also become his questioning point about the universal cancer early screening technology and early detection and early treatment strategy that are highly praised by the medical community at present. He believes that after cancer is screened out, it may have a negative impact on the screened object: if early intervention is carried out, such as removing early lesions or gene regulation, but a large number of them will eventually develop into severe diseases, it is equal to "getting a knife in vain."
"Early detection and early diagnosis and treatment are beneficial to cancer patients" does not violate logic, and it has become a consensus in the medical field. But cancer screening is different from clinical medical treatment, and not all people and all tumors should be screened. Tumors suitable for screening should have the following characteristics:High incidence, and it is "high incidence in a certain population (high-risk objects)"; Severe prognosis (high mortality); There is a detectable "subclinical stage".
"No disease, excessive inspection, minor illness, serious illness" not only increases the economic burden of patients, damages their health, but also seriously affects the relationship between doctors and patients. It is not only a technical problem, but also a moral problem and a social problem. Only by improving the guidelines for diagnosis and treatment of various diseases, formulating standardized diagnosis and treatment processes, and establishing indicators and management systems for quality control and evaluation of medical services can we achieve "reasonable examination, rational drug use, reasonable treatment and reasonable fees" and let modern medicine benefit the majority of patients. # Questions and answers about chronic diseases #
References:
[1] Mars. Ineffective medical treatment can’t afford injury [N]. Science and Technology Daily, 2016(12).
[2] Liu Bin. Analysis of the safety and countermeasures of clinical rational drug use [J]. International infections diseases (electronic edition) .2020 (01)
[3] Zhang Dayan. On the harm of antibiotic abuse and preventive measures [J]. Psychological Monthly, 2020(08).
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