Uterine Prolapse

病人进了手术室，医生却索要3000元“专家费”不给不做手术？卫健委回应 医生索要“专家费”这个事已经过去了好几天，但该事件带来的深刻讨论远没有结束，我们需要一个明确的指导。 先来回顾一下事件。 10月10日，四川广元一名网友发视频爆料称：我母亲在广元市中医院做手术时，该院心血管内科的安医生向家属索要了3000元现金红包，不给就不做手术。 据爆料人徐先生描述，9月3日凌晨，其母亲出现呕吐、肚子疼等症状，随后紧急送往广元市中医院急诊科，诊断为因感染出现严重脱水，当即住院治疗。治疗9天后，医院通知可办理出院手续，在其准备办理出院时，患者出现心跳加速的症状，医生表示心脏有问题，必须立即手术。 徐先生说道：“事发太突然，我和家人来不及询问究竟是什么病，母亲已被护士推进了手术室。手术前，我和父亲被叫到一间医生办公室，安医生要求我们准备3000元现金，是额外的，我要求手机转账，安医生说必须是现金，不能转账。” 为确保手术顺利，徐先生的父亲随后给了安医生3000元现金。爆料的视频清晰记录了安医生收取现金和清点现金的全过程，在确认是3000元后，装进了白大褂口袋。收取现金后，患者手术顺利进行，术后3天出院。 9月18日，徐先生给母亲办了出院手续，事后越想越气。他说道：“我就不明白，这3000元是什么费用？当时医生也没有告知我们，电子票据上显示，母亲住院费用合计80596元，3000元没有列入其中。” 10月10日上午，为了搞清楚3000元的用途，徐先生拨打了安医生的电话。安医生在电话中称，徐母住院时心脏不好，在病情稳定后需要做心脏射频消融术，收取的3000元是专家费，不是红包。随后安医生在电话中骂徐先生“你这人怎么这样，你是有神经病吧”。 在这次通话不久，一名自称广元市中医院领导的男子给徐先生打电话称，医院会处理此事，也会给他一个答复。 下午，该医院工作人员向徐先生提出，“可以退还3000元，但删掉视频。”徐先生未答应。 舆论发酵后，广元市卫生健康委员会工作人员进行了回应，表示会向广元市中医院核实此事，并详细调查事情缘由，如果属实，会对医生进行相应处理。 据了解，广元市中医院是广元市唯一集医疗、教学、科研于一体的国家三级甲等中医医院，涉事的心血管内科安医生为副主任医师，2020年驰援湖北武汉为抗疫做出过贡献。这3000元到底是不是飞刀费？如果是合乎规定的飞刀费，不应被指责卫健局曾认定收取飞刀费无过错！ 这一事件引发了极其广泛的关注和讨论，人们首先困惑的就是医生为什么会要这3000元专家费？专家费到底是什么意思？要把钱给谁？ 四川广元当地一名网友表示：“大家不要再多想了，我清楚得很，所谓的专家费就是飞刀费，钱是给请来的专家的。如果是大城市很好的专家请过来做手术，那3000元真的很便宜了，飞刀也是被允许的。如果没有请大医院的专家，那就不能收飞刀费。现在要查的是，给这个患者做手术的专家到底是不是请来的！” 成都一名自媒体大咖直言不讳地说道：“人心难测呀！所谓的红包，就是外请专家的费用，这个费用，大夫肯定和患者家属提前沟通过，具体要多少钱也都讲明白了。这名患者家属当时肯定已经答应了，所以不存在什么‘母亲躺手术室，医生逼要专家费，不给不做手术’的情况。” “人心险恶呀，既要享受专家手术，又不想出钱。你要是不愿意让专家做手术，就别答应，把机会让给其他人，或者你觉得贵，可以出院去上级医院自己住院。但是，你既然答应了，专家都来了，又搞这一套！你一人耍赖，恐怕要断了以后这个医院外请专家的路，受害的是整个广元的群众！” 江苏一名网友则表示：“我们现在需要医院明确告诉我们这3000元是不是飞刀费！如果是飞刀费，那就没问题，并且我们还会帮着医院谴责这名不诚实、想占便宜的患者家属，并勒令他向医院、向安医生赔礼道歉，并恳请某音等平台封掉这个家属的账号，因为他涉嫌造谣诋毁。因为飞刀很常见，在飞刀之前，医患双方都是知情并同意的，在小医院看病，我们巴不得大专家过来给我们做手术呢。如果这不是飞刀费，医院没有请外来的专家过来，当事医生竟然众目睽睽之下索要现金红包，那这就是犯罪、违反医德医风，就请卫健部门狠狠地、顶格处罚这名医生！” 这件事的逻辑一下子清晰了，正如江苏这名网友所说的，这3000元到底是不是飞刀费？如果是飞刀费，在双方知情同意、合乎规定的情况下，这名网友做出此种姿态，是不诚实、不守信、破坏规则的行为，理应向当事医生和医院道歉，并受到网友谴责！如果这3000元不是飞刀费，而是实打实的、见不得光的、没有任何依据的红包，又或者患者事先对飞刀并不知情，医生没有解释，单方面开展飞刀，那医生就应该受到最严格的惩处。 事实上，涉及到飞刀，只要合乎规定，我们一般都是支持的。 2024年01月17日，郑州疾控中心就发表了一篇题为《飞刀手术缘何屡被投诉？如何破解飞刀难题？》，其中表明了自己的态度。 郑州疾控中心表示，此前报道，河北李先生投诉某县级医院，称“其母亲因子宫脱垂住院，手术麻醉后，医生要求其现金支付13000元专家费。” 医院回应表示：这次手术是外聘专家(即“飞刀”医生）进行的，收费合规，并且明确告知该费用是直接以现金的方式给专家，不能报销，不通过医院，患方表示同意。 随后，当地卫健局调查后认定：医院不存在过错行为，合法合规！ 在评论医生“飞刀”时，郑州疾控中心就在文中表示：“目前，社会和医疗界大多认为医生飞刀现象是患者、医院、医生三方共赢的局面，但这个看似一举三得的方案，却屡屡成为医患矛盾的催化剂和医疗事故的导火索。如何破解这一难题？依法执业是关键！”近3成医生飞刀过，说不清的飞刀，未来我们该如何面对？ 飞刀，离我们医生太近了，凡是大三甲的专家，都可能接触过飞刀。 在一项针对3000多名医生参与的调查中，55％的医生称所在医院的医生飞刀现象普遍，近三成医生表示自己曾经飞刀过。 其实，医生“飞刀”的情况建国以来发生过多次变化。 在《中华人民共和国执业医师法》尚未实施之前，代表医生职业身份的只有职称和医师资格证，没有执业证，更没有对执业地点的限制。也就是说，医生在哪里都可以执业，那是医生们“飞刀走穴”最自由的时期。 1999年，情况变了，新施行的《执业医师法》确立了我国医师的注册制度，它将医生与公立医院紧紧地捆绑在了一起，医生只有通过国家统一考试，才能获取执业资格，无法自由选择行医的机构，只能在一家医疗机构注册，否则就是非法行医。 在《执业医师法》出台前，医院对待医生外出飞刀的态度，总体以支持为主。《执业医师法》出台后，“飞刀走穴”正式成为了非法执业行为，院长的态度也发生了微妙的变化，一般都不支持。 这是因为《执业医师法》规定，医师必须在注册的执业地点执业，医生若去其它医院会诊、做手术，必须要拿到会诊单。如果医生私自“飞刀走穴”，不出现意外倒还好，一旦产生医疗责任，则由医师所在的医院承担，于是院长们变得非常谨慎。 随着中国加入WTO，经济飞速发展，不同地区的医疗资源也出现了不平衡，民众开始极度渴望大医院的专家飞刀进入小医院，呼声很高。 于是，情况又变了。2009年，新一轮医改正式启动，医改方案中，探索“注册医师多点执业”在社会各界引起广泛关注。这是一个重要的时间节点，医师“多点执业”政策一度被不少人认为是“飞刀走穴”问题的解决方案。 2017年，《医师执业注册管理办法》出台，其中规定，医生在其他医疗机构执业，只需备案即可，再也不需要获得原单位的批准。此后，卫健委又多次发文支持“多点执业”，鼓励“医生兼职”。 到2019年，全国范围内注册多点执业的医师为11万，医生飞刀也越来越普遍，越来越阳光化，各级行政管理机构正试图将“飞刀走穴”纳入行政管理体制。 尽管飞刀已经很普遍，社会和民众需要飞刀，也接纳了医生飞刀，但是迄今为止，没有任何一个官方文件能明确表示“飞刀”这种行为是合规的还是不合规的，它有点说不清。 现如今，在大医院一床难求、名医一号难得的情况下，飞刀是普通人接触到顶级专家最简单的方式。 对于患者来说，不用人生路不熟地跑到外地排队等病床，不用抢号、挂号、重复检查，更重要的是，患者在自家门口就能得到更好的治疗，实在省钱、省心、省力；对于医生来说，飞刀去外地，既治了病、救了人，又在经济上获得了一定报酬，只要精力和时间允许，这完全就是一种兼职，可以尝试；对于医院来说，专家过来手术，既提高了技术和水平，收获了患者满意度，拓展了品牌和影响力，又完成了“大病不出县”的分级诊疗任务，何乐而不为呢？对于医保来说，因专家高质量的手术减少了患者并发症，提高了治疗效果，总体上减少了病人医疗费用报销的支出，也最终获益。 可以说，飞刀是一件多方获益的好事，但由于需要患者额外出钱，不能报销，总让患者觉得这是“红包”、是医生的“灰色收入”。 其实，医生飞刀是实实在在的兼职，医患双方互相知情，心甘情愿为之买单，飞刀费本质上是非常阳光的。 总之，飞刀现象是医疗资源分布不均的产物，需要在法治的轨道上规范运行。只有为飞刀正名，使飞刀阳光化，摆脱污名化，飞刀如今面临的困境才能减少，优质的医疗资源才能共享，各方人士才能共赢。 撰文 | 阿拉斯加宝 编辑 | 阿拉斯加宝 ●Nature重磅：饭吃“六分饱”和间歇性禁食能延寿，但是要付出代价的！谷歌旗下抗衰老研究公司最新发文 ●哀悼！近期两名顶级科主任突然离世！享年均为59岁！15岁考上大学、天才医生、风湿免疫专家、糖尿病防治大咖！我们无比惋惜悲痛 ●每一口外卖、瓶装水都影响生殖健康！柳叶刀子刊：微塑料恐侵入并损伤男性生殖系统，尤其是不粘锅涂层 版权说明：梅斯医学（MedSci）是国内领先的医学科研与学术服务平台，致力于医疗质量的改进，为临床实践提供智慧、精准的决策支持，让医生与患者受益。欢迎个人转发至朋友圈，谢绝媒体或机构未经授权以任何形式转载至其他平台。 点击下方「阅读原文」 立刻下载梅斯医学APP！

Pelvic organ prolapse affects over 50% of people with a uterus in their lifetime. INTIMINA and dr Margo Kwiatkowski explain this condition, who is at risk, and the treatment options. NEW YORK, April 17, 2024 /PRNewswire/ -- Pelvic organ prolapse (POP) is a common condition affecting over 50% of people with a uterus in their lifetime. Ligaments, fascia and pelvic floor muscles support the pelvic organs. When these support systems are compromised, one or more of the organs can shift out of position into or out of the vaginal canal. This shift can affect the bladder, rectum, uterus, urethra, or small intestines. INTIMINA's medical expert, Margo Kwiatkowski, doctor of physical therapy shares insights into pelvic organ prolapse and treatment. Who is at risk? Continue Reading Pelvic organ prolapse affects over 50% of people with a uterus in their lifetime. INTIMINA and dr Margo Kwiatkowski explain this condition, who is at risk, and the treatment options. The support structures for the pelvic organs can be compromised by acute trauma, such as vaginal childbirth, or by long-term pressure-management issues, as seen in people with chronic constipation. The most significant risk factors for developing POP are vaginal childbirth, family history, chronic constipation, chronic cough, and higher BMI. "Age is also identified as a risk for developing prolapse, with a higher likelihood in perimenopause and menopause. Symptoms of prolapse vary depending on the organ affected but commonly include a sensation of heaviness in the vagina, a bulge present in the vagina, urinary or faecal incontinence, incomplete bladder or bowel emptying and lower back or groin pain", says Dr Kwiatkowski. Treatment Treatment options vary and depend greatly on the severity of the prolapse and its impact on the patient's quality of life. Dr Kwiatkowski explains: "The first line of treatment should be pelvic floor therapy with a physical or occupational therapist. These medical providers have specialised training to treat pelvic floor muscles and organ disorders. Pelvic therapy treatments for prolapse include education about proper bowel and bladder health, strategies to manage abdominal pressure correctly, and strengthening exercises. Bowel and bladder health can often be well managed with hydration, dietary changes, using a stool under the feet during bowel movements, and improved breathing strategies during defecation. Learning how to manage intra-abdominal pressure involves improving posture, correcting lifting strategies, reducing habits of bearing down or breath-holding, and teaching proper core engagement while coughing and sneezing. Strengthening exercises a pelvic health therapist provides will be unique to the individual's needs. Some patients need to improve their pelvic floor strength and coordination; others need to prioritise strength in the abdominals and hips. Kegel exercises have not been shown to improve the anatomical severity of prolapse but can help with the management of symptoms, including stress incontinence.5, 6, 7, 8, 9 Isolated kegel contractions help increase pelvic floor muscle strength along with strengthening surrounding muscles to provide support for the pelvic floor further. A pelvic health therapist should thoroughly examine individuals with prolapse before beginning a pelvic floor muscle strengthening program. This is because kegel exercises are not necessary for some people with prolapse. Furthermore, it is important to have guidance on the proper performance of pelvic floor muscle contractions. Another treatment option for pelvic organ prolapse is using a pessary. A pessary is a medical device worn inside the vagina to support the pelvic organs. Pessaries can be properly sized and managed by a urogynecologist, gynaecologist, and some pelvic health therapists. Pessaries come in various shapes and sizes to achieve the best fit and support for a person's unique anatomy. Finding the best pessary can take a few trials. Some pessaries can be left in for months, while others need to be removed daily. Most people can learn to manage a pessary on their own at home. Pessaries are excellent long-term treatment options for those looking to avoid or prolong surgery. Studies have demonstrated that pessaries can improve prolapse-related symptoms, pelvic floor muscular support, and potentially improve the stage or severity of the prolapse. While pessaries are specifically fitted for the individual, some over-the-counter products work similarly and may be more easily accessible. " Estrogen Another treatment option for managing the symptoms of prolapse is the use of topical vaginal estrogen. "In perimenopause and menopause, estrogen significantly declines. Estrogen is responsible for many bodily functions, including vaginal blood flow and natural tissue lubrication. A similar effect happens as long as a person is lactating after childbirth. This lack of estrogen creates an environment in the vagina where prolapse symptoms are more noticeable due to dryness and a loss of tissue elasticity. Topical vaginal estrogen can be used to replenish the vaginal tissues without affecting the body as a whole. By reducing dryness and improving blood flow to the muscles and other soft tissues, prolapse symptoms can improve significantly", says Dr Kwiatkowski. Surgery Surgery is another treatment option for prolapse. Surgical intervention will vary depending on many factors, including the prolapse's severity, the patient's age, which organs are affected, and co-morbidities such as a genetic hypermobility disorder. Dr Kwiatkowski continues: "A person's native tissues can be used for repair, or a surgeon may recommend using mesh to augment the tissues. The mesh used in current vaginal prolapse repairs is different than the abdominal mesh used in pelvic surgeries decades ago and no longer poses the same risks. Most surgical intervention involves elevating the organs into their anatomical position and fixating them in place. Successful surgery is determined by the patient's satisfaction regarding symptom resolution, not simply if the anatomy has improved. Prolapse repairs can fail; some need revisions after ten to twenty successful years. A person may consider surgery if their prolapse is significantly affecting their quality of life and conservative measures have not been successful." "Prolapse is a common diagnosis, but it does not mean that symptoms associated with it are "normal." Many people falsely assume that their lives must change drastically following a POP diagnosis. On the contrary, many people continue to live highly active lives with well-managed symptoms. Many younger women go on to have more children without worsening prolapse and with good recovery postpartum. The key to living a fulfilled life with prolapse is finding the best tools for your unique body. For some individuals, this means closely managing constipation and weight gain; for others, it might mean regular full-body and pelvic floor muscle strengthening. The diagnosis of prolapse does not need to interfere with a person's quality of life, as there are excellent medical providers to help navigate the many treatment options available", concludes Dr Kwiatkowski. Photo - Logo - SOURCE INTIMINA

TORONTO--( BUSINESS WIRE )--Cosm Medical proudly announces FDA clearance for Gynethotics™ Pessaries, marking it as the first personalized pessary available to patients. This milestone follows a recent Health Canada clearance and marks a significant advancement in pelvic care, emphasizing Cosm’s commitment to enhancing patient outcomes and revolutionizing treatment options for women worldwide. Gynethotics™ are the first pessary to be FDA cleared in about 5 years with almost 10 million pessary configurations that clinicians can conveniently order online. That is compared to about 100 configurations that are offered by other commercially available pessaries. The benefits of personalized Gynethotics™ Pessaries were demonstrated in a pilot study completed at Sinai Health Systems and published in Urogynecology, the Journal of the American Urogynecology Society, in 2023. “Our vision is to become the world leader in precision gynecological devices for unique bodies and needs.” said Derek Sham, Founder & CEO of Cosm Medical. “With our first FDA clearance, we are one step closer to realizing this vision and making a meaningful impact on the lives of over a million patients by 2030. This will set a new standard of care in gynecology like the established billion-dollar markets of custom orthotics, dental and hearing.” Half of all women will experience a pelvic floor disorder such as prolapse and incontinence in their lifetime. “Aging and women’s health are both severely underserved markets with high clinical unmet needs, demonstrated by the fact that Femtech and Agetech are both projected to be growing at over 15% CAGR.” said Ivneet Bhullar, Investment Partner at Fusion Fund and Cosm Board Member. “It’s been great supporting Cosm over the past 2 years as they’ve achieved major milestones towards driving precision care into gynecology.” Beyond pessaries, Cosm has signed a strategic partnership with the University of Alabama at Birmingham to work with Holly E. Richter, Ph.D., M.D. and Max Cadena, M.D. on a novel design and indication for Gynethotics. “We look forward to improving surgical outcomes and are currently completing Phase 1 of a clinical study with the goal of implementing a new paradigm for impacting post-operative healing,” Richter said. “This is especially important as there are limited evidence-based options for augmenting vaginal native tissue repairs.” About Cosm Medical Based in Toronto, Canada, Cosm Medical is personalizing gynecological devices for precision care because every woman is different. Cosm’s digital gynecology platform leverages novel diagnostics, AI, cloud software, and 3D printing to create patient-specific gynecological devices for unique bodies and needs. For more information, visit: www.cosm.care About Fusion Fund Based in Palo Alto, California, Fusion Fund is a venture capital firm that focuses on backing early-stage entrepreneurs in building forward-thinking companies with technical and data advantages. Since 2015, Fusion Fund has invested in over 80 portfolio companies across the US and Canada in the healthcare, enterprise AI, and industrial automation sectors. For more information, visit: www.fusionfund.com