艰难医改之路 北京协和医院为何能越走越顺

2017-09-14 沈娟 品途商业评论

医改的核心问题是解决医患关系、患者的就医体验与医生的体面待遇,一个都不能少。

中国的医疗改革进程,前后算下来已有30多年。这30年来,有过历史性的突破,也有一些反思和总结。在医疗服务体系中,北京协和医院,就是一个典型。

成立于1921年的北京协和医院,是一家近“百岁”的集医疗、科研、教学于一体的大型公立三甲综合医院。北京协和医院在当前医学界的地位,除了依靠其自身的专家、技术、资源等优势,始终走在医疗改革的前沿,也是其历久弥新的“法宝”之一。

那么,北京协和医院是如何通过搭上医改这趟“顺风车”,进而实现服务与品牌的双重升级的呢?

解决“看病贵”:药品零加成 耗材零差率

近年来,看病难、看病贵已经成为焦点民生话题。看病贵的根本原因,是长期以来“以药养医”、“以检查养医”的风气屡禁不止,医院靠过度用药、过度检查和过度治疗来保障营收,既造成了医疗资源的滥用与浪费,也贻误了患者诊治,并加重了其经济负担。这样一来,医患矛盾不断激化。

从2016年起,北京市就开始全面推广公立医院医药分开,并且实施范围不限于市属医院。这次北京市的医改选择了一条与其他城市不同的改革路径:取消药品加成、设立医事服务费和调整医疗服务价格,三项政策同时实施。

今年4月8日零时起,北京协和医院第一时间执行了“医药分开”等医改政策,并且在医院门诊大厅各窗口均张贴了医改相关提示。医改后药品价格平均降幅在20%左右。

值得注意的是,早在改革之前,北京协和医院就在自身的管理上避免“以药养医”的问题。北京市卫计委曾在2015年发布了《2015年度北京地区医疗机构及重点专科的住院医疗服务评价报告》,报告中分析,在北京市58家综合医院中,北医三院、北京协和医院等19家医院治疗同类疾病的费用较低,住院日也较短,服务效率高。北京医院、北京协和医院和友谊医院分列“医疗服务综合评价”前三名。

药品加成取消了,但是过度检查的现象依旧存在。据媒体曝光,甚至还有一些医院和医生以所谓“行规”的名义,在打医疗耗材回扣的主意。

医用耗材品种繁杂,最常见的有纱布、一次性注射器、棉球,还有各类钢板、止血钳等,在手术室内使用比较多,一般占手术病人平均费用一半以上。而目前国内耗材目录还没有统一,一种耗材使用同一个名字,但是不同材料价格相差好几倍,让人眼花缭乱。

对此,北京协和医院器材处处长周力在“第二届医疗器材安全管理国际高峰论坛”上表示,耗材“零差率”有望在2020年全面展开。

与药品“零加成”雷同,耗材“零差率”就是对城市公立医院的耗材按实际进价销售,即进价多少,医院卖给患者的价格就是多少,医院不再通过耗材差价增加业务收入。

如此一来,在药品加成取消的基础上,耗材加成将接着被取消,北京协和医院等公立医院的亏损必然将进一步加大。

根据目前的相关规定,按照总量控制、结构调整、有升有降、逐步到位的基本原则,在降低医院大型医用设备检查治疗费和部分常用检验费的基础上,通过适当提高诊查、手术、治疗等医疗服务价格,增加财政投入以及加强医院自身管理等措施予以调节。

这意味着,和解决药品零加成带来的医院亏损一样,耗材“零差率”之后,医生和医院的收入将通过提高医事服务费来收取。

从北京协和医院的率先发声可以想见,在接下来的这次改革中,它又将走在前列。

改善患者就医体验这事比天大

改善患者的就诊体验,真正解决看病难的问题,是北京协和医院这几年一直在做的事。

近日,北京多家医院取消窗口挂号和医保异地就医互联网结算的消息一前一后刷爆了朋友圈。
据北京协和医院官方微博消息,自今年9月1日起,患者前来就医只能用协和App、电话114、银行、院内自助机挂号。自此,继北京儿童医院、阜外医院之后,协和医院成为又一家取消窗口挂号服务的三级医院。

此外,协和医院还为不会使用手机APP、微信或者网络进行挂号的老人保留了专门的挂号窗口,无二代身份证患者也可到专门窗口进行挂号。

按照北京市此前发布的“挂号新政”,今年年底之前,22家市属三级医院将全部取消现场挂号,推行“非急诊全面预约”挂号就诊模式。预约挂号的渠道,目前主要包括电话114、微信、支付宝、银联等7种方式。

“医保跨省结算”一直以来是老百姓心中不可企及的梦想。中国医疗资源分布极不均衡,具备高水平诊疗条件的医院多分布在一线城市。

据了解,北京协和医院有近一半的患者来自于外省市,而协和医院的年门诊量达360万人次,接诊疑难危重病人比例超过70%、诊疗疾病的难度位居北京乃至全国首位。

如今,在北京协和医院住院治疗,出院时便可通过医院跨省新农合结算系统直接报销,直接省去了之前报销过程中的重重环节。

北京协和医院医务处副处长李春厚表示,跨省就医结算是为了更好的方便患者,一来规范了就医秩序,二来减轻了患者垫付资金的压力,就医体验得到提升。

为什么北京协和医院要在改善患者就医体验上下这么大的功夫?

事实上,早在2015年,国家卫计委先发布了《关于印发进一步改善医疗服务行动计划的通知》,随后又发布了《进一步改善医疗服务行动计划实施方案(2015-2017年)》,提出了全行业“进一步改善医疗服务行动”的总体要求、工作目标与进度安排。

作为国家卫计委直属单位,北京协和医院将此项工作列入重中之重,并付诸实施。如“多渠道预约诊疗”、“精细化引导分时段就诊、分时段检查”、“多层次落实患者分级诊疗”等屡次见诸媒体的新闻,都是北京协和医院为改善医疗服务,部署并实践的一些具体工作。

考核导向:不以经济效益论英雄

中国的公立医院一直都是“特别”的存在。对于很多公立医院来说,由于政府产权等原因,卫生行政部门既办医院又管医院,医院缺乏经营管理自主权和灵活性。对于自身的功能定位和发展方向,医院自己并不清楚。

日前,国务院办公厅发布《关于建立新的医院管理制度的指导意见》,其中“管办分权”制度赋予了医院更多的自主经营权。

但是对于像卫计委直属的北京协和医院一类的传统大型公立医院来说,想要进行现代医院管理制度改革难度很大,因为存在很多学术以及学科上的错综联系,改革就是“牵一发而动全身”。

这次,北京协和医院再一次向行业证明了其改革的敏锐度。北京协和医院集中了全院的智慧,出台了《北京协和医院章程(试行版)》(以下简称章程),以章程为统领,完善内部管理机构、管理制度、议事规则和办事程序等。

据了解,目前在北京协和医院,小到病例的书写、操作的规范,大到疑难重症的多学科会诊,全部都有着系统的规范与要求,严格的医疗管理质量“高压线”确保医务人员能够高标准完成工作,保证医疗的质量。

北京协和医院副院长杨敦干认为,章程是医院发展的根本大法,维护医院的公益性、坚持公立医院的正确办院方向,需要用章程把医院的性质、宗旨、方向、定位固定下来。以章程为核心的现代医院管理制度建设,将推进医院管理的科学化、规范化、精细化。

长期以来,公立医院的职能划分存在不清晰的地方。例如公立医院的公益性和经营性在人事与财物方面没有加以区分,直接导致公立医院逐利趋向严重,于是出现了诱导消费、追求药品加成收入和回扣的不良现象,“以药补医”演变成了“以药养医”。

有鉴于此,北京协和医院在此次的章程中提出了“公益导向”激励机制。据北京协和医院院长赵玉沛介绍,按照章程的规定,医院确定了不以“经济效益论英雄”的考核导向。在这样的指导精神下,医生更愿意收治疑难重症,同时也能坚持科学治疗和用药,避免了过度医疗的发生。
结语

从1985年我国提出发展卫生事业新思路算起,医疗改革已经历时30余年。但伴随着持续推进的医疗改革,医患关系长久以来并未得到明显的改善。我国看病难、看病贵的问题“举世闻名”,医生和护士的工作强度之高、待遇之低在国际上也十分罕见。

医疗改革,首先需要解决的一个主要矛盾就是医患关系。必须找到一种方式,让医生和病人都满意,医改才算取得了突破性进展。

患者就医体验是重中之重,但是作为医疗主体的医生,如何减少对其束缚,充分体现医生的经验和技术的价值,让医生在拥有宽广的舞台和资源去服务病人的同时,还能获得合理与体面的收入,同样也是问题的关键。

七部委发文,要求50家大三甲医院全部改革,做好此轮医改的排头兵。重点改革任务有九条,核心部分依然是围绕着改善患者就医体验和完善医院收入分配机制。

北京协和医院一类的公立三甲医院有着得天独厚的资源、人才和技术优势,但能否长久的保有这些优势,留住优秀的医护人才,不确定性很多。放眼望去,改革之路依然漫漫。

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topicList=[TopicDto(id=35970, encryptionId=6150359e0f4, topicName=协和)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e2c92500045, createdName=12498636m49(暂无昵称), createdTime=Sat Sep 16 03:17:00 CST 2017, time=2017-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1450225, encodeId=c941145022538, content=<a href='/topic/show?id=790f359e656' target=_blank style='color:#2F92EE;'>#协和医院#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35976, encryptionId=790f359e656, topicName=协和医院)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4aee5549395, createdName=guguangxiang, createdTime=Sat Sep 16 03:17:00 CST 2017, time=2017-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=244022, encodeId=a89c244022b6, content=非常好的文章.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Thu Sep 14 20:21:28 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243942, encodeId=bc3e243942a0, content=学习了新知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Thu Sep 14 13:06:40 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243925, encodeId=793a2439254c, content=全国就一个协和.院情不一样.不具代表性, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dad51998618, createdName=London fog, createdTime=Thu Sep 14 12:40:00 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243923, encodeId=d1ac243923ad, content=满意, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/qGKMica88xLNTsSfA3esPeJtviaBlojbl1a8qKSoNQgDDMgT5iap4ibGswq1ia1uG0luewaiagfIYe8U0ubXd6m8nk3g/132, createdBy=71b72097056, createdName=妇产软妹子, createdTime=Thu Sep 14 12:33:42 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243918, encodeId=3ed3243918a9, content=良性循环.越办越好., beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Thu Sep 14 12:27:16 CST 2017, time=2017-09-14, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=1995006, encodeId=14dc199500656, content=<a href='/topic/show?id=61b53363166' target=_blank style='color:#2F92EE;'>#北京协和医院#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33631, encryptionId=61b53363166, topicName=北京协和医院)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6da1120, createdName=lidong40, createdTime=Wed Dec 06 06:17:00 CST 2017, time=2017-12-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1763683, encodeId=e90e1e6368390, content=<a href='/topic/show?id=2796336294e' target=_blank style='color:#2F92EE;'>#北京协和#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33629, encryptionId=2796336294e, topicName=北京协和)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5ac337549818, createdName=1508842480_96220449, createdTime=Sun Jan 21 13:17:00 CST 2018, time=2018-01-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1286823, encodeId=bb321286823e2, content=<a href='/topic/show?id=ebac3442063' target=_blank style='color:#2F92EE;'>#医改#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=34420, encryptionId=ebac3442063, topicName=医改)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b3e9205, createdName=tidiq, createdTime=Sat Sep 16 03:17:00 CST 2017, time=2017-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1389839, encodeId=85a213898398d, content=<a href='/topic/show?id=6150359e0f4' target=_blank style='color:#2F92EE;'>#协和#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35970, encryptionId=6150359e0f4, topicName=协和)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e2c92500045, createdName=12498636m49(暂无昵称), createdTime=Sat Sep 16 03:17:00 CST 2017, time=2017-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1450225, encodeId=c941145022538, content=<a href='/topic/show?id=790f359e656' target=_blank style='color:#2F92EE;'>#协和医院#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=35976, encryptionId=790f359e656, topicName=协和医院)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4aee5549395, createdName=guguangxiang, createdTime=Sat Sep 16 03:17:00 CST 2017, time=2017-09-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=244022, encodeId=a89c244022b6, content=非常好的文章.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Thu Sep 14 20:21:28 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243942, encodeId=bc3e243942a0, content=学习了新知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Thu Sep 14 13:06:40 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243925, encodeId=793a2439254c, content=全国就一个协和.院情不一样.不具代表性, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dad51998618, createdName=London fog, createdTime=Thu Sep 14 12:40:00 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243923, encodeId=d1ac243923ad, content=满意, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/qGKMica88xLNTsSfA3esPeJtviaBlojbl1a8qKSoNQgDDMgT5iap4ibGswq1ia1uG0luewaiagfIYe8U0ubXd6m8nk3g/132, createdBy=71b72097056, createdName=妇产软妹子, createdTime=Thu Sep 14 12:33:42 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243918, encodeId=3ed3243918a9, content=良性循环.越办越好., beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Thu Sep 14 12:27:16 CST 2017, time=2017-09-14, status=1, ipAttribution=)]
    2017-09-16 tidiq
  4. [GetPortalCommentsPageByObjectIdResponse(id=1995006, encodeId=14dc199500656, content=<a href='/topic/show?id=61b53363166' target=_blank style='color:#2F92EE;'>#北京协和医院#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33631, encryptionId=61b53363166, topicName=北京协和医院)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6da1120, createdName=lidong40, createdTime=Wed Dec 06 06:17:00 CST 2017, time=2017-12-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1763683, encodeId=e90e1e6368390, content=<a href='/topic/show?id=2796336294e' target=_blank style='color:#2F92EE;'>#北京协和#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=33629, encryptionId=2796336294e, topicName=北京协和)], attachment=null, authenticateStatus=null, createdAvatar=null, 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likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Thu Sep 14 20:21:28 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243942, encodeId=bc3e243942a0, content=学习了新知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Thu Sep 14 13:06:40 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243925, encodeId=793a2439254c, content=全国就一个协和.院情不一样.不具代表性, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dad51998618, createdName=London fog, createdTime=Thu Sep 14 12:40:00 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243923, encodeId=d1ac243923ad, content=满意, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/qGKMica88xLNTsSfA3esPeJtviaBlojbl1a8qKSoNQgDDMgT5iap4ibGswq1ia1uG0luewaiagfIYe8U0ubXd6m8nk3g/132, createdBy=71b72097056, createdName=妇产软妹子, createdTime=Thu Sep 14 12:33:42 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243918, encodeId=3ed3243918a9, content=良性循环.越办越好., beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Thu Sep 14 12:27:16 CST 2017, time=2017-09-14, status=1, ipAttribution=)]
  5. 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likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Thu Sep 14 20:21:28 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243942, encodeId=bc3e243942a0, content=学习了新知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Thu Sep 14 13:06:40 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243925, encodeId=793a2439254c, content=全国就一个协和.院情不一样.不具代表性, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dad51998618, createdName=London fog, createdTime=Thu Sep 14 12:40:00 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243923, encodeId=d1ac243923ad, content=满意, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/qGKMica88xLNTsSfA3esPeJtviaBlojbl1a8qKSoNQgDDMgT5iap4ibGswq1ia1uG0luewaiagfIYe8U0ubXd6m8nk3g/132, createdBy=71b72097056, createdName=妇产软妹子, createdTime=Thu Sep 14 12:33:42 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243918, encodeId=3ed3243918a9, content=良性循环.越办越好., beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Thu Sep 14 12:27:16 CST 2017, time=2017-09-14, status=1, ipAttribution=)]
  6. 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likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Thu Sep 14 20:21:28 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243942, encodeId=bc3e243942a0, content=学习了新知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Thu Sep 14 13:06:40 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243925, encodeId=793a2439254c, content=全国就一个协和.院情不一样.不具代表性, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dad51998618, createdName=London fog, createdTime=Thu Sep 14 12:40:00 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243923, encodeId=d1ac243923ad, content=满意, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/qGKMica88xLNTsSfA3esPeJtviaBlojbl1a8qKSoNQgDDMgT5iap4ibGswq1ia1uG0luewaiagfIYe8U0ubXd6m8nk3g/132, createdBy=71b72097056, createdName=妇产软妹子, createdTime=Thu Sep 14 12:33:42 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243918, encodeId=3ed3243918a9, content=良性循环.越办越好., beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Thu Sep 14 12:27:16 CST 2017, time=2017-09-14, status=1, ipAttribution=)]
    2017-09-14 天涯183

    非常好的文章.学习了

    0

  7. 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likeNumber=68, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7LIiaRZTzJ3SEfiauCzTMPW7YvPPYLNJBXG9oh6Al1icq2VQQkIHWxqXehcicTS62YKJVBhxeth3wggw/0, createdBy=7ce01621306, createdName=天涯183, createdTime=Thu Sep 14 20:21:28 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243942, encodeId=bc3e243942a0, content=学习了新知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=67, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20201006/4db877c2887649beb09cb5effd0b38c7/916f66edd48a4e77b20ebc3e14b6e45c.jpg, createdBy=141e1980133, createdName=Y—xianghai, createdTime=Thu Sep 14 13:06:40 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243925, encodeId=793a2439254c, content=全国就一个协和.院情不一样.不具代表性, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dad51998618, createdName=London fog, createdTime=Thu Sep 14 12:40:00 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243923, encodeId=d1ac243923ad, content=满意, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/qGKMica88xLNTsSfA3esPeJtviaBlojbl1a8qKSoNQgDDMgT5iap4ibGswq1ia1uG0luewaiagfIYe8U0ubXd6m8nk3g/132, createdBy=71b72097056, createdName=妇产软妹子, createdTime=Thu Sep 14 12:33:42 CST 2017, time=2017-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=243918, encodeId=3ed3243918a9, content=良性循环.越办越好., beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Thu Sep 14 12:27:16 CST 2017, time=2017-09-14, status=1, ipAttribution=)]
    2017-09-14 Y—xianghai

    学习了新知识

    0

  8. 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channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Thu Sep 14 12:27:16 CST 2017, time=2017-09-14, status=1, ipAttribution=)]
    2017-09-14 London fog

    全国就一个协和.院情不一样.不具代表性

    0

  9. 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channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Thu Sep 14 12:27:16 CST 2017, time=2017-09-14, status=1, ipAttribution=)]
    2017-09-14 妇产软妹子

    满意

    0

  10. 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    2017-09-14 1e0f8808m18(暂无匿称)

    良性循环.越办越好.

    0

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