During the outbreak of COVID-19, 14,592 ordinary people in China were investigated for their mental health status. The survey results showed that the positive rate of depression was 53.5%, mild depression was 29.3%, severe depression was 14.%, and severe depression was 1.1%. No matter during the epidemic or at ordinary times, many depressed patients began to accept online hospital consultation, and the number of depressed patients was increasing. In this regard, I was in a good mood to interview Dr. Zhou Ping from Xijing Hospital of Air Force Military Medical University and Dr. Li Youdong from the First Hospital of Hebei Medical University.
Chinese medicine pays attention to seeing, hearing and inquiring, while western medicine pays attention to seeing, touching and listening. Online consultation has many limitations, and even if there is a video, a lot of information will be missed. Therefore, we should try to find some information in a limited time, so that we can see the patient's condition comprehensively and make a correct diagnosis.
Depression is a complex problem. Psychiatrists who are biased towards psychology have different ways of understanding the problem from those who are from the pure biological school. Doctors from the pure biological school pay more attention to several symptoms, and what are some symptoms related to depression. Psychiatrists with psychological background will try their best to understand the patient's information.
whether the patient has any accompanying symptoms. Besides depression, do you have any sleep problems, depressed mood, eating problems and obvious weight changes? Some patients will also complain of pain, which is chronic pain with no cause, and it will be projected on a certain part, such as stomach, heart or other parts. Therefore, in addition to collecting patients' emotional symptoms, we should also understand other physical problems in order to understand patients' situation more comprehensively.
the cause of depression. Psychologically, we call it a traumatic event. First of all, we should know whether the patient has a traumatic event. If it is postpartum depression, it is probably because of the occurrence of childbirth or termination of pregnancy. Secondly, whether the patient overdraws his body too much, some people with circular personality will have high and low mood changes, and may be highly overdrawn, feeling particularly capable and secondary to depression; Some patients will do something intensively because of special fatigue, which will lead to overdraft, which will also lead to depression. Of course, whether the living environment of patients has changed, such as promotion, loss of relatives, loss of property or loss of power, will also become the cause of patients.
the patient's previous personality. Some patients' depression is atypical, which may have been a mild personality before, or they may become irritable, easily provoked and have deviations in thinking.
whether the patient has a basic disease. If the patient has diabetes or cancer and has used a lot of drugs, many drugs themselves are prone to depression, such as immunomodulators.
whether the patient has a family history. The patient's family history is very important, and depression has genetic factors. Whether the elderly people in the patient's family have stroke or central nervous system diseases needs to be fully understood.
single medication with little side effects. Before using drugs, we can get less information about patients through online treatment, and the examination may not be comprehensive enough. Sometimes patients can't provide ECG and biochemical examination information. When using drugs, try to use drugs alone, then choose drugs with small side effects, and when combined with other drugs, try to choose drugs with simple substitution routes.
drug therapy combined with psychotherapy. If we understand the patient's symptoms and prominent life events,
we should also combine psychotherapy. If the doctor has no psychological background and can't do psychotherapy at the same time, we can also recommend the patient to a competent doctor who can do psychotherapy.
patients need timely follow-up and feedback. If you suspect that the patient has a basic disease or related diseases, you should also tell him the time of the patient's return visit during the diagnosis and treatment, so that the patient can return to the clinic in time to understand the patient's recovery or changes.
Only when we do these things, there will be fewer omissions in the diagnosis and treatment of patients with depression in Internet hospitals, which will give patients more comprehensive protection.
Zhou Ping-Xijing Hospital of Air Force Military Medical University-Attending physician
Is the online consultation diagnosis accurate?
At present, with the coverage of 5G network for follow-up visits and the popularization of medical consumption behavior on the Internet, the voice+video function launched online can basically achieve the effect of face-to-face diagnosis, and accurate diagnosis and treatment schemes can be given through comprehensive evaluation.
Is there any medical dispute in online consultation?
medical disputes may occur both offline and online. for online diagnosis and treatment, it is necessary to make full informed consent and strictly follow the standardized procedures to avoid medical disputes as much as possible.
can the patient consult online all the time?
Most people haven't developed the behavior habit of Internet medical consumption. In addition, it is a question of trust in Internet medical treatment. Generally speaking, they feel that it is more practical to see a doctor in an offline entity hospital. After seeing a doctor online, some patients will also go to the offline hospital to further improve the examination and get a definite diagnosis. Of course, the service system of internet hospitals should also be improved, which can provide full-course services such as consultation, evaluation, diagnosis, treatment plan and follow-up.
Can the epidemic change people's views on Internet medical care and how to suggest trust?
This epidemic situation is conducive to promoting people to try and get used to Internet medical consumption behavior. Internet medical care is indeed more convenient. You can enjoy the expert's diagnosis and treatment without leaving home, and the medicine can be mailed home.
for the first time, patients need to provide high-quality medical care and services with good curative effect and high safety, so that patients can achieve the purpose of medical treatment and gain trust. For patients who see a doctor offline, it will greatly reduce their worries, increase their trust, and save time, transportation and other costs if they can find the first doctor online for a follow-up visit later.