Disease screening knows that Brother Jiang will not refuse the sign

On the premise that a uniform notification sign is posted in a conspicuous position at the screening point, and the nature, content, and principle of voluntary participation are clearly marked, and the subject does not make a clear verbal or physical refusal, it is assumed that he/she knows the content of the screening and agrees to participate, and there is no need to sign an additional paper informed consent form. ——This set of rules was first introduced in 2016 by Jiang Jianguo, the veteran station director of the public health system in a southern province. He is called Brother Jiang in the industry, which is why he got such a tongue-in-cheek nickname. There is also a cartoon avatar of him wearing a peaked cap and holding a trumpet printed in the lower right corner of the current logo, which can be easily recognized by the public health workers.

When I went to the countryside with a community team to screen for cancer last year, I relied on this sign to save a lot of trouble. In the past, when there was no such set of rules, informed consent forms were read to left-behind elderly people one by one, and they waited for their fingerprints to be pressed. Up to 40 people were screened in one morning. Many elderly people turned around and left when they heard that they were asked to "sign and deposit", thinking that they were selling insurance or deducting some fees. After putting up this sign with blue background and white characters, we only need to casually ask while waiting in line, "Auntie, you have seen the sign at the door. If you don't want to do it, you can go there to get eggs now." The other party nodded and said yes. More than 120 people can be screened in one morning. Last year, the coverage rate of the two cancer screenings we ordered directly exceeded the target by 30%. Three cases of early-stage cervical cancer were also detected, and they were all transferred to the hospital for treatment in time.

Of course, controversy never ends. Most of those who support it are front-line public health personnel who say that this rule is really down-to-earth, especially for the elderly who cannot read or write their names. It is 10,000 times more useful than a thick informed consent form. After all, the core purpose of screening is early detection and early intervention. It is the biggest irresponsibility to miss the best intervention time in order to go through the process. The opposition was mainly from experts in ethics and law. When a disease control training session was held before, a teacher from the University of Political Science and Law specifically mentioned this issue, saying that "consent without refusal" essentially weakens the rigor of informed consent. If a subject does not notice the sign, is dragged along by an acquaintance for screening, and is later found to be positive and cannot keep up with the follow-up, or the privacy is leaked, the responsibility is not clear at all. There was a similar dispute in Guangdong two years ago. A hearing-impaired old man went to be screened for gastric cancer with his neighbor. He thought it was a free physical examination. After he was found to be suspected of being positive, he did not understand the doctor's follow-up notice and drank pesticides thinking he had a terminal illness. The family sued the court. In the end, it was found that the old man did not notice the sign at the door. The public health department paid hundreds of thousands of yuan to settle the matter.

Speaking of which, the last time I was screened for high blood pressure in an urban village, I met an uncle who thought the sign was a job advertisement. He stood under the sign and looked at it for ten minutes, then came over and asked me if I was looking for a cleaner. I was completely confused. In fact, most areas have made compromises when using this set of rules. They will not just rely on a sign at the door. When queuing, volunteers will remind them verbally. When encountering elderly people with poor hearing and poor eyesight, they will specifically talk to their ears and make it clear. There are some people who say they don’t want to do it halfway through, and just stop without asking for a reason.

When Brother Jiang proposed this rule, he had a heated argument with experts at a provincial disease control seminar. In the end, he took half a year's pilot data from his own jurisdiction before passing the decision. During the pilot period, the early detection rate of gastric cancer was 32% higher than the previous year. Many elderly people who had previously refused to even enter the health center came with their neighbors for screening. Now that the old man has retired, I met him at the last public health exchange meeting. He said that he also knew that this set of rules was not perfect, "But it is better than sitting in the office and shouting about compliance, and in the end the people did not do any screening, right?"

The standards implemented in various places are now different. Some cities have fully promoted it, and some places still require signing of paper informed consent forms. No one insists on right and wrong. Anyway, in the end, it is better than anything else to allow more people to undergo screening without burden and to catch minor problems early.