In 2015, Zhang’s son bought a house with a mortgage in Guangzhou, and the down payment emptied the couple’s life savings. In order to help her son pay off his mortgage, Zhang, who is already retired, decided to find another job.
Previously, Sister Zhang was a county obstetrician and gynecologist in Ganzi Prefecture, with decades of medical experience and the title of deputy chief physician, she was successfully recruited to a private hospital in the provincial capital as an outpatient gynecologist, the base salary alone is the envy of a group of our old sisters.
When she left, Sister Zhang was enthusiastic, but the result was less than a month wilted head back: “Alas, tired, than the previous decades of work are tired.”
1
When she first stepped into the hospital as a job seeker, Zhang was quite apprehensive.
The director is a middle-aged man, looks very good, after looking over Zhang’s associate director’s certificate, looks extremely enthusiastic, a mouthful of “Zhang director”, on the spot to invite Zhang to take up employment as soon as possible.
The 10,000 base salary, plus the attractive commission points, Zhang tried her best to conceal her inner excitement, and deliberately raised her concerns: “Dean, to be honest, our place is remote, the hospital is small, and the equipment and technology certainly can’t compare with your big city. So, if you do the surgery ……”
Before she finished, the dean interrupted her with a wave of his hand: “Director Zhang, don’t worry, we have a clear division of labor here, you don’t have to do surgery or work the night shift, you are only responsible for sitting in the outpatient clinic. I will first assign you a medical assistant, she will assist you to get familiar with the hospital as soon as possible. After a while, when there are more patients in your department, I will give you another one.”
That day, a director surnamed Yang took Zhang on a tour of the hospital and gave a detailed introduction of the hospital’s business philosophy, special technologies, workflow, and so on. The warm and courteous staff, the shiny mirror-like floor, the warm and comfortable layout, and even the toilets are sandalwood scented …… into the purpose of everything, so that Sister Zhang is both rushed and excited.
Without Zhang’s questioning, she took the initiative to pour out the daily work content, the articulation process between various departments, including the temperament of several other gynecologists. In particular, she meticulously explained the hospital’s wide range of preferential policies, the names of various technologies, and the main modes of treatment and other internal information.
When the guide brought the patients into the department, Xiao Yuan’s resourcefulness and competence was shown to the fullest – greeting the patients, registering them, issuing checklists, taking them to pay, assisting with the examinations, answering questions and solving problems between Zhang and the patients with good eyes and skills, cleanly and methodically, and most rarely with a lovely smile throughout.
Xiao Yuan’s good professionalism and vigorous energy greatly infected Zhang, and she was ready to do her best.
However, she soon encountered a series of “unconventional” situations.
2
On her second day of work, Zhang found her picture and a profile that was very different from her own on the large LED screen at the entrance of the hospital, on the display board of “famous doctors” in the lobby, and on the glass of the wall of the department.
Startled, she immediately put down her bag, changed her work clothes and went to the dean while there were no patients.
“I’m only the deputy chief physician, not the chief physician, and I’ve been to Beijing, Shanghai and Guangzhou twice for further training, not to mention working in those big hospitals. The main thing we do there are simple gynecological surgeries like abortion and IUD removal, we have never done minimally invasive hysteroscopic surgery, and we are not good at treating infertility.
The director got up straight away and poured Zhang a cup of tea, with a smile in his words.
“Director Zhang, you should not be too serious about this. Nowadays, even the wine is afraid of the alley, and even the technology is good, you have to package it. If you honestly say you are a small remote county out, who will look for you? Look at you, look kind-eyed, a look at the work of many years of old expert temperament, and then write the profile of some atmosphere, easier to obtain the trust of patients, but also help you to work well.
“Ultimately, our purpose is the same, is to cure the patient. But as you know, there are still many people in society who are prejudiced against private hospitals, so what the marketing team has to do is to find ways to bring in patients, and you are responsible for keeping them with the real skills you have accumulated over the decades.
“Most of the patients coming in are still mainly common diseases such as abortion, inflammation, irregular menstruation, which are so difficult and critical? Of course, we welcome those kinds of patients, also have the equipment, technology, and doctors, you just need to communicate them down and receive the inpatient department. The rest is what you’re good at, and it’s not cheating. Don’t you still have confidence in your own skills?”
The last sentence blocked Sister Zhang’s speechless.
Before she could properly smooth out her thoughts, the dean turned the tables and asked about her feelings about the previous day’s work, and once again talked about the hospital’s service concept, its strong team of experts and its future development blueprint.
“Why do some hospitals earn a few thousand dollars for a child, while others can do tens of thousands or hundreds of thousands? –Service! This is the value of service!
“The group of people in our customer service department are not studying medicine, but often you can’t keep the patients, they can stay, why? Because they talk not only about the disease, but more about the heart! What do you mean by effective communication? It is that you have to speak to the heart of the patient, so that the patient feels that you are indeed for her good.
“The method of treating gynecological inflammation by drugs alone has long been obsolete, the effect is too poor and too slow, it must be combined with physical therapy. Those instruments in our gynecological treatment room are very advanced and very effective, you must use them up.”
After some conversations, not only did she not correct her profile, but Zhang also made a promise to the director that she would work hard on her service attitude, communication skills, and promotion of physical therapy.
Private hospital, “service first”
When she returned to the office, she found several banners on the wall, each with the words “to Director Zhang” printed on it, but with different thank-you messages, recipients and dates, the earliest of which was on a certain date in a certain month in 2011.
“This was just put up by someone from the planning department.” Little Yuan cautiously glanced at the door to make sure there were no patients wandering around, then smilingly turned back to explain, “Every department has one, in fact, most of them are made by the hospital itself, and when a new doctor comes, just change the name.”
“I’ve only been here a few days, how can someone send a banner a few years ago, this patient check will not be worn out?”
“Alas, director, you think too much. The patient is concerned about whether you can cure the disease, who will check how long you have been here ah? The first thing that you need to do is to get a new patient number. Even if someone really asks, you can say that you were in the inpatient department.”
Zhang rubbed her temples and told herself to just take the doctor seriously and not get hung up on the hospital’s marketing tactics, “to be flexible and adaptable.” But at night when talking to her partner, she still subconsciously concealed the matter.
3
Zhang’s understanding of what constitutes “serious medical care” is to develop a treatment plan based on the patient’s condition and wishes. However, it was clear that such a perception was at variance with the hospital’s requirements.
The person responsible for daily communication with Zhang is Director Yang, who goes around Zhang’s department several times a day. If she met Zhang in the middle of a consultation, she would stand on the side with a smile on her face, listening to Zhang’s communication with the patient and occasionally interjecting a few words at “critical moments. If there are no patients, she chats with Zhang, sometimes about family matters, more often by opening the clinic logbook, analyzing the specific circumstances of the day’s patients and “kindly” sharing some of the tips of several other gynecologists.
For example, Dr. Wang is good at communicating with patients. She rarely uses obscure terminology and likes to explain the condition and treatment plan to patients by drawing pictures and giving examples. Therefore, all patients who are registered to her department basically stay, and most of them willingly choose the most costly option.
For example, Dr. Duan will personally accompany the patient for a series of procedures such as payment, examination and admission, and she constantly goes to hush the patient during the process of treatment, and even insists on calling back regularly when the patient is discharged home. Therefore, she has accumulated a lot of loyal customers, and those old patients will often take the initiative to introduce new patients to her.
For example, Dr. Zhao’s brain is very fast and she has a good grasp of the costs of all aspects of the hospital. When she encounters patients who refuse to seek medical treatment because they do not have medical insurance, she can immediately launch several sets of bite size plans; when she encounters patients who do not want to do physical therapy because it is too expensive, she will be flexible to break down an hour of physical therapy into half an hour or even a few minutes, or promise to do enough to send a few times – physical therapy is almost pure income, the machine is idle The machine is also idle, do a minute can charge a minute of money.
Director Yang spoke with care, and Sister Zhang listened with excitement, feeling as if she had made sense of the mess and would soon be on the right track.
However, things were far from simple. The tricks that other people use with ease were stumbling and stumbling when they came to Zhang. Especially the two tricks of accompanying the whole process and returning phone calls, she barely tried them a few times before she didn’t have the courage to continue – feeling less like a doctor and more like a supervisor with ulterior motives and a stalking salesman, which was very awkward.
The physiotherapy, which the president named and pushed, has many effects, such as “anti-inflammatory, help cell regeneration, promote blood circulation”, and Zhang has concerns – she personally went to the gynecological treatment room to observe many times, but still feel that the drugs are more reliable than the equipment that can easily be hundreds of dollars an hour, so that when recommending to patients, always hesitate to speak, seemingly lack of confidence.
All this has led to the retention rate, follow-up rate and per capita consumption of Zhang’s department being much lower than those of other departments.
After a series of additions and subtractions, Xiao Yuan, who receives commission on performance, looked at Sister Zhang with a bitter face, “Director, it’s been half a month, but our department is only this much. If this continues, I won’t be able to afford to eat next month.”
4
Looking at the other departments, Sister Zhang was also very anxious, and the one who was more anxious was Director Yang. She came more often, and although her attitude was still modest and polite, her words were not.
“This patient with mycosis fungoides, why did she only have one day of physical therapy?
“Why didn’t this patient receive hospitalization when her fibroids were so large? Did you tell her about the advantages of having surgery with us? It’s not easy to come to a patient, and since she’s here, we have to find ways to give stay.
“How was the follow-up treatment plan for the infertile one communicated? Did you ask her husband to come along for the examination? The actual fact is that you can find a lot of people who are not sure if they are going to be able to get a good deal on their own. This kind of patients must be built separately, focus on management, regular phone calls, tracking return visits ……
“A good attitude does not mean that you have to cater to the patient, the time to be soft, the time to roar, can not always be led by the patient, you are the one tugging the kite string. You can spend more energy with her midway around, but eventually you have to take it back.”
In Director Yang’s increasingly obvious “finger pointing”, Sister Zhang realized after the fact: through the polite veneer woven in the name of “care and help”, all that actually came out was orders and rules.
After working all her life, she was so old that she was taught by a layman how to be a “doctor” all day long, and she felt like she had been slapped in the face.
She sat on the chair, gloomy face, clutching the cup of tea, as far as the eye can see, just a few of those big red banners with gold edges and hanging tassels: “Double-hearted medical virtues, a miraculous hand to return the spring”, “withered wood in spring, happy to have your son a thousand gold, medical skill is fortunate to have a living Hua Tuo” …… she closed her eyes, suddenly some nostalgia for that group of people crowded on a few old desks buried in writing medical records, every floor tile seems to emit the smell of sterilized water old hospital.
This is the first time that Sister Zhang had the intention to withdraw.
After Xiao Yuan found out, he stared round-eyed: “Director, you’re used to it, why do you want to leave? If the performance of the department is good, you can get several tens of thousands of dollars a month. The company’s main business is to provide a wide range of products and services to the market. Xiao Yuan’s eyes are shining and he reached out and gestured.
These words were like a stone that slammed into the depths of Zhang’s heart.
So much money, others can earn it, why can’t I earn it? There is no workplace where there are not some bad things? Even in the old unit, there are still various annoying places? Now their own performance is really bad, the hospital to keep an eye on more is normal …… one reason after another should stay came up.
However, a few days later, Sister Zhang and Director Yang still broke out in a violent conflict over a patient.
5
That patient needed to be hospitalized for surgery, but close to her period, Sister Zhang let the patient go home and wait for her period to clear for 3 to 7 days before coming back.
As a result, not long after, Director Yang came to the door: “Director Zhang, that patient just made an appointment online, and the consultant has already communicated with her that she can be hospitalized today, how can you let her come back next time? Do you know that once she leaves, she will probably turn around and go to another hospital, losing a patient for nothing?”
Sister Zhang blackened her face on the spot, and the dissatisfaction she had been suppressing exploded instantly: “Are you a doctor or am I a doctor? Do not do cervical surgery near the menstrual period, this is the most basic medical principles, do not command if you do not understand. By the time the patient gets infected, are you responsible?”
Probably not expecting Zhang to speak so bluntly, Director Yang’s face suddenly became ugly.
Not long after, the dean himself stepped in, and a phone call called the two who were arguing fiercely to his office. After briefly asking the reason, he reprimanded Director Yang head to head, but to Sister Zhang is a gentle breeze, no reproach.
Looked at the director Yang ash face to exit, Sister Zhang heart a burst of pleasure, and in line with the days of accumulated grievances all out: “Dean, I have worked for decades, is not unable to listen to other people’s views, if you really think I can not, directly let me go, do not spend all day and night to me as a primary school-like lessons, as if doing anything is wrong ……”
The dean is a master of speech, just a few rounds will be full of Zhang’s anger extinguished a seventy-eight. After calming down, in the face of the always pleasant Dean, Sister Zhang instead breeds some small guilt.
But after a long turn, the dean’s words still made the smile on Sister Zhang’s face gradually stiffen: “Director Zhang, your old experts, your old experts, your old experts, your old experts.
“Director Zhang, your old experts are right to attach importance to medical principles, and I absolutely support this point. But then again, the current medical market is not like the old days, so many things are changing, and we have fallen on our faces a lot before slowly figuring out some methods.
“For example, that patient just now, I know you are doing it for the good of the patient and for the safety of the hospital, but the fact is that when she leaves, there are really a lot of uncontrollable changes that can occur. The disease on the cervix is not like an abortion that can not wait, some patients go home, feel no pain, do not want to cure, and the result is more and more serious delay. Some turn around and go to other hospitals, if we meet such a regular hospital is okay, if you meet some crooked hospital black clinic, is not the end?
“It is not easy to come to a patient, especially the network appointment over, each one is spent on the cost. I am not asking you to violate the principles of medical treatment, but you can play the ball. Like this patient, you first take her in, if not yet surgery menstruation, she can go home first, during this period bed fee nursing fee and other small money directly waived; if you do surgery before menstruation, you can send her a few times for free treatment at a later stage. In this way, the patient can get timely treatment, your performance also has, several aspects can be taken into account ……”
6
Coming out of the dean’s office, Sister Zhang went downstairs with a heavy heart and happened to run into a girl who had just received an inpatient unit for an induced abortion the previous day.
When exchanging pleasantries, she inadvertently glanced at the outpatient payment slip in the girl’s hand and felt a pang in her heart. After some probing questions, she hid her doubts and hurriedly said goodbye to the girl, turned around and went to the inpatient department, pulled the doctor in charge aside and asked quietly: “She is an inpatient, shouldn’t she be charged in the inpatient fee for the forceps curettage? Why did she have to go to the outpatient clinic separately to pay more than $1,000?”
“If it was charged in the inpatient system, it would have to be in accordance with the price bureau’s fee schedule, and the clamping procedure can only charge more than 100 yuan, which is not cost-effective. The outpatient separate payment is a lot more flexible, depending on the patient’s ability to afford, charge a few hundred to a thousand can be.”
“Does the dean know about this?”
“This is the dean’s rules! These bosses are different ah, the head turns fast, all aspects can be thought of ……” the doctor in charge is a straightforward, crackling a bunch of the dean’s “great achievements”.
When she came downstairs, she met the girl who had paid her bill again, and she was greeted politely. When she met the girl’s eyes, Sister Zhang opened the wrong door in some panic and left in a hurry.
Returning to the department in a daze, she fell into anxiety – at one end of the scale was money and her son’s house, and at the other end was a lifetime of practice ethics.
When she got off work, she called her partner and told him everything honestly. Probably guessing what her partner’s reaction would be, Zhang couldn’t help but emphasize once again: “But the treatment here is really good, the equipment and technology is also good, and the director didn’t force me to do what I must do. If I do a better job of service and return visits without violating medical principles, it should still be possible.”
“You are there to be a doctor, not to be a waiter, much less a liar. Since you have taken his salary, sooner or later you have to do what he wants. Some things, you go one step forward, there will be two steps three steps, a taste of sweetness is less likely to stop. It doesn’t matter if the money is less, the key is to earn peace of mind, don’t get old and old, but also be poked in the back.”
The old partner’s words made Sister Zhang enlightened.
The next day at work, Sister Zhang resigned from the dean – at this time, only a month after she joined.
The dean tried to retain: “Is still angry with Director Yang ah? We’ll have dinner together tonight and let her formally apologize to you. You are generous, don’t see eye to eye with her.
“You just came, the performance is almost normal, I am not anxious, what are you anxious about? After a period of time, the friction is good, the performance will naturally go up, I still have confidence in you.
“How about I put you in the inpatient department first? When you feel ready, then transfer back to the outpatient department. Or you don’t transfer the card away, hang in our hospital, you come over a few days a month to guide the work on it, the salary will definitely make you satisfied ……”
After seeing that all kinds of persuasion are ineffective, the dean sighed and looked regretful: “Director Zhang, I am to do reputation and brand, really need old experts like you, come together to make the hospital bigger and stronger. Anyway, my door here is always open for you.”
Sister Zhang smiled a little embarrassed: “Okay, okay, I will definitely come over when I have the chance in the future.”
After returning, still concerned about her son’s mortgage, Sister Zhang still can not be idle, some inquiries, and finally applied to a public second B hospital obstetrics and gynecology, mainly responsible for checking the inpatient medical records written by young doctors. Although the salary is a large part of the lower, but also happy to leisurely and comfortable.
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