On August 1, 2012, the former Ministry of Health issued the Measures for the Management of Clinical Application of Antibacterial Drugs, which clearly stipulates that doctors who use antibacterial drugs in serious violation will have their practice certificates revoked, known as the “strictest antibacterial restriction order” in history. Now, two years have passed, the once abused antimicrobial drugs gradually tend to be reasonable and standardized, but far from the ideal situation. What role should hospitals, doctors and patients play in the “antibacterial restriction battle”? With questions, the reporter recently visited the Aviation General Hospital, which took the lead in eliminating outpatient infusions in Beijing. If you don’t want to get an infusion in the outpatient clinic, or if you don’t want to get an infusion without an infection, you can complain about it, and you are welcome to come to the theories. This is the new rule of the Aviation General Hospital of China Medical University. Since March 16 this year, the hospital has cancelled intravenous infusion in general outpatient clinics and clearly stipulated that outpatient doctors (except for pediatrics, emergency medicine and anesthesia) are not allowed to write prescriptions for intravenous medication. According to public information, this is the first hospital in Beijing to cancel intravenous infusion in general outpatient clinics. Currently in the country, there are two other hospitals that are explicitly outpatient without infusion, one is the Second Affiliated Hospital of Nanchang University in Nanchang, Jiangxi. The hospital’s president, cardiovascular specialist Cheng Xiaoshu, said it was his own decision. There are two reasons: one is that he has worked in foreign hospitals for many years and has personally experienced the cautious and rigorous use of intravenous infusions abroad. Secondly, there is a small thing that impressed him: there was an American foreign guest in Nanchang sudden onset of disease shock. The provincial leaders insisted that the patient be given fluids, but Cheng Xiaoshu insisted that “the cause of the disease is unknown, no fluids”. After the foreign guest woke up, his approach was affirmed. There is also Run Run Shaw Hospital in Hangzhou, Zhejiang. The hospital stopped outpatient infusions as early as 1998, and there is no infusion hall. The hospital was donated by the famous Hong Kong industrialist Run Run Shaw, and since its establishment, it has introduced the American model of management, one of whose consultants is the Linda University of Rome. Why did the Aviation General Hospital eliminate outpatient infusion? This decision was made by Professor Gao Guolan, a famous obstetrics and gynecology specialist and president of Aviation General Hospital. Before making this decision, the team she led weighed in for a little more than half a year. There were indeed many pressures involved, such as the management and knowledge update of doctors, the rationalization of hospital income to guide them, and the explanation of doctors to patients that it would increase their workload, all of which had to be considered in advance. What makes the hospital management feel uncontrollable is the pressure from patients – some of them say: I want infusion! In just three months, Jiang Longlai, head of the medical department of the Aviation General Hospital, has received more than a dozen patients who complained all the way up, “There was an old soldier who had participated in the self-defense counterattack in Vietnam, who slapped the table and quarreled with me; there was also an old couple whose wife was in a wheelchair and whose husband had suffered a stroke and felt numbness in the corners of his mouth. They said they had been given fluids every year and felt fine. Now that they are not allowed to have infusion, what if their condition becomes serious? I told him that both of them have cardiovascular disease, and infusion is not very useful to prevent this disease, and the money spent is not effective. And you (the old man) now have numbness in the corners of the mouth, irregular treatment will only make the condition more and more serious, but also mask the condition. Then the old man was persuaded by me and was hospitalized for examination and treatment.” In order to make patients understand the hospital’s decision, before the official implementation of this work, Aviation General Hospital promoted the study of “Ten Principles of Safe and Reasonable Drug Use” among all doctors in the hospital; the electronic publicity screen in the outpatient lobby scrolled the knowledge of reasonable drug use; the consultation desk and each doctor’s consultation room had a leaflet on reasonable drug use for patients to read. In July last year, President Gao Guolan went to Harvard University to study in the United States and visited many first-class hospitals in the United States. One big feeling is that many large hospitals abroad do not have infusion rooms. “The concept of infusion therapy for domestic people really needs to change,” said Gao Guolan, adding that the abolition of outpatient infusion can further regulate medical practices and rationalize treatment. Modern infusion therapy was introduced from the West, while Western medical infusion was initially only for rescue patients, and should be done with great care! The proliferation of outpatient infusions not only leaves our diseases untreated, but makes the body worse and worse – look at cold infusions, as long as it is a viral infection, infusions are actually ineffective, and most colds are viral infections. But when our children have a cough or a fever, whether it is requested by parents or doctors for “preventive” reasons, they will be infused with a large number of useless antibiotics. These antibiotics do not cure the cold, but bring antibiotic resistance. Some children need infusion, with a generation of antibiotics can not, the second generation of antibiotics can not, must use the latest antibiotics to be effective, this is the terrible antibiotic resistance. There are also some elderly people who are keen on infusion to prevent chronic diseases, obsessed with “infusion can pass blood vessels”, every winter and summer, infusion on 5-7 days of fluid, infusion is finished, the heart is also solid. In fact, the theory of relying on infusion to prevent disease itself is untenable – infusion is a treatment tool, and for cerebrovascular disease, infusion may be needed in its acute stage, but for prevention, there is no evidence that it is effective. Moreover, if you have the first signs of cerebrovascular disease, and you don’t go to the hospital for examination and treatment, but you just want to rely on infusion to “unblock” it, you will lay a great hidden danger to your body! It is not unheard of for a cerebrovascular patient to become paralyzed after receiving an infusion. Three months after the abolition of intravenous infusion in general outpatient clinics, things have not been as “terrible” as expected, and can even be said to be effective: the overall drug ratio has dropped by 3 percentage points, the proportion of antibacterial drugs used in outpatient prescriptions has dropped to 7.61%, and the adverse drug reaction rate has dropped by 51% year-on-year. In more general terms, the meaning of the above data is that the patient’s drug cost burden has been reduced, less antibiotics are used, and the safety of medication has been improved. In the reporter’s interview, some experts from departments that once sounded as if they were often “linked” to infusions were actually in favor of “not giving injections if you can take medication, and not giving infusions if you can give injections”. ”90% of the treatment in dentistry does not require infusion, and tooth extraction does not necessarily have to be anti-inflammatory.” The Department of Stomatology is a key department of the Aviation General Hospital, and the director of the department, Zhao Qiang, is good at painless and minimally invasive complex tooth extraction, oral and maxillofacial surgery and plastic surgery, and has considerable experience. He said that many oral problems, as long as the root of the disease is solved, the inflammation will naturally disappear. For example, if a diseased tooth is extracted as early as possible, the inflammation will follow; the same is true for abscesses, which can be treated with drainage rather than infusion to reduce inflammation. “I almost all do not prescribe infusion, in our hospital before the ‘no infusion’ rule, our department also rarely prescribe infusion.” The reporter can feel the confidence in Zhao Qiang’s words. Of course, not all oral diseases are not infusion. Encountered an acute inflammatory attack of the oral cavity or serious infection, or to promote treatment with infusion. And Wang Qiuyue, deputy director of the Department of Pediatrics at the Aviation General Hospital, whose son is 20 years old this year, has not had many infusions. “I wouldn’t give him an injection either. Fever, see his mental state is quite good, so give him some medicine, physical cooling. The process of a cold is 5 to 7 days, as long as there is not yellow sputum, high white blood cells, the emergence of infection, injection and infusion are useless.” However, Wang Qiuyue also encountered resistance. Once her son had a fever that hadn’t gone down by the seventh day, the elderly in the family were so anxious that they urged her to get an injection. She herself felt unable to hold back and thought, “If the fever doesn’t go away tomorrow, I’ll give him an infusion.” The next day, her son’s fever subsided, and she breathed a sigh of relief. “Nowadays, many families have one child and several parents are taking turns, so doctors can’t do anything about it. This is not only true for patient families, but also for our own families. We have a colleague, the child has a fever, did not give an infusion, the elderly secretly hold the child a, go to another hospital to infuse ……” When leaving the aviation general hospital, the reporter made a point of looking at the hospital is located in the first and second floor of the outpatient building respectively “before” infusion hall. A more than 70 square meters, a more than 150 square meters. It is said that before the abolition of outpatient infusion, there were long queues here every day and it was difficult to find empty seats. Now these two infusion halls, one has been transformed into a rehabilitation training room, where some patients are doing rehabilitation training; the other will also be added as an “emergency infusion room”, where the seats will be replaced with a more comfortable bed for emergency patients to stay for infusion. Every year, 200,000 people in China die from adverse reactions to infusions, and the 2012 annual report of the National Adverse Drug Reaction Monitoring statistics show that the rate of adverse reactions to injections is as high as 56.7%, and the risk of intravenous safety is quite high. To change the status quo, I’m afraid we really need to do something real. ”I’m doing this (eliminating outpatient infusions) also because of an inner complex.” President Gao Guolan said she has always believed that she should do her best to return to the essence of medical care. What is the essence of medical care? In Gao Guolan’s opinion, it is to help people with physical and mental problems to restore their health. “It is to help, not to replace.” President Gao stressed with the reporter. We all have immunity, and even if we are sick, we have the ability and foundation to restore our health, and medical treatment can only play a supplementary role. However, in a national situation where the country has eight bottles of infusion per capita per year, too many and unnecessary infusions interfere with and even destroy our otherwise strong enough body functions. “May health return to health and medical care return to medical care.” These words still echoed in the reporter’s mind as he walked out the door of the Aviation General Hospital.