Hu Dayi: With coronary angiography for physical examination, a room fibrillation cost 170,000 yuan for one hospitalization

The patient is 63 years old, has a history of smoking for many years in the past, has been drinking, has quit smoking, and has limited alcohol. No hypertension, no diabetes mellitus, no significant elevation of LDL cholesterol (normal high limit). Love sports, usually ride 20 kilometers, play badminton without discomfort. Normal weight.

In 2017, I went to the hospital to do a "deep physical examination", worried about heart disease, and heard doctors say that coronary angiography is the gold standard, and coronary CT is not accurate. The doctor also gladly agreed to do it for him, saying that it was safe to spend money to buy it, and if the photocopied was fine, it would be solid. As a result of the contrast, the three blood vessels have different degrees of stenosis, the heaviest is the middle stenosis of the anterior descending branch 60%, the other stenosis 20%-30%, fortunately not enough for 70%, not stented. The discharge diagnosis of the discharge record reads "Coronary heart disease, unstable angina" in black and white.

The patient rides 20 kilometers, plays a badminton game, has no symptoms, angina is the discomfort of the patient himself, where does the angina come from? Or "unstable"?! This is a diagnosis made up by the doctor! Why fake a fake diagnosis? No, no, no! How does Medicare pay?

If you tell the truth: physical examination-style in-depth physical examination, hasn't it become a joke? Medicare definitely refuses to pay. "Fraudulent Insurance"!

In 2020, the patient went to Hainan for the winter. Went to the local hospital for physical examination, talked about the situation of coronary angiography in 2017, and the local cardiologist also admitted him to the hospital to review the coronary angiography, and the results were no worse than the 2017 examination. Discharge diagnosis: coronary heart disease, unstable angina. Symptoms are fabricated for reasons as above, to obtain medical insurance.

In June 2021, the first sudden onset of palpitations, ecG shown as atrial fibrillation (atrial fibrillation), paroxysmal, infrequent onset, symptomatic at the time of the attack, but tolerated. He was treated in a branch of a local Beijing university hospital and was immediately admitted to the hospital, one to do electric shock defibrillation, two to do radiofrequency ablation, and three "one-stop" to do left atrial appendage occlusion. Fortunately, there are no long breaks in the Holter at night, and there is no one-stop pacemaker.

Doctors say the ablation procedure was successful, but it is necessary to insist on taking amiodarone for at least three months after the operation. The anticoagulant rivaroxaban 20 mg was also prescribed. Discharge settlement, cost 170,000, left atrial appendage blocked at own expense.

"Radiofrequency ablation + left atrial appendage blockade" has become a "conventional" model for hospitals to generate income. Left atrial appendage was blocked and the anticoagulant rivaroxaban was prescribed. Left atrial appendage occlusion is only indicated in patients who are intolerant to anticoagulants or who do not respond to anticoagulation. This patient can tolerate anticoagulants very well, and is not a high-risk person for stroke, why give the patient such a ridiculous "one-stop operation"?

Does this patient have indications for repeated coronary angiography? Apparently not! Exercise load ECG and this consultation plus risk factor assessment, a CT scan at most in 2017 is sufficient.

This patient's 4-year medical experience once again revealed: income-generating-oriented, with a pure biomedical model as the standard of excessive examination, excessive treatment is difficult to return!