Four items of disease screening

The four items of disease screening we often refer to by default refer to the four items of infectious disease screening before clinical invasive procedures - including the detection of four infectious diseases transmitted by menstrual blood/body fluids: hepatitis B virus (HBV), hepatitis C virus (HCV), AIDS (HIV), and syphilis (TP); however, the contents of the "four items" in different scenarios vary greatly and cannot be generalized.

A while ago, I accompanied a friend to the gastroenterology department for a gastrointestinal endoscopy, which required a small 0.3cm polyp to be cut out. When he got the bill and saw the four screening tests, he was confused on the spot. He dragged me to complain, "I just cut out a lump, but how come I was tested for AIDS? Does the hospital want to overcharge?" It’s not that the hospital wants to earn an extra 180 yuan. These four items are required inspection items clearly required by the national surgical safety regulations. From tooth extraction, tattooing, hysteroscopy, to laparotomy and dialysis, as long as there is damage to the skin and mucous membranes and possible contact with blood, this screening must be done first. On the one hand, it is to protect the patient himself: if a relevant infection is found, the medication regimen should be adjusted before the operation and protection should be taken during the operation to prevent the virus from spreading and aggravating the condition; on the other hand, it is also to support the medical care and subsequent patients: I encountered a patient with emergency trauma during the general surgery rotation before, and there was no time to do a screening before the operation. There are also some private clinics that do not perform screenings as required and do not disinfect instruments properly. The local disease control and prevention department previously reported a case of syphilis infection after wisdom teeth were removed at a small clinic. In the end, no clear evidence was found to trace the source, so they had to suffer the consequences.

When it comes to this, some people will definitely choke: I keep myself clean and do not mess around and have never had blood transfusions. Is it a pure waste of money to check this? This is also a very controversial point in clinical practice at present: those who support mandatory screening believe that many infected people now have no symptoms during the window period and do not know they are infected. Unified screening can cover all risk points; some public health scholars also propose that screening requirements should be divided according to risk levels. Low-risk groups who do not have high-risk behaviors and have been negative in previous screenings can be exempted from screening as appropriate to reduce unnecessary medical expenses. However, the national operating regulations have not yet been adjusted, and most hospitals will still issue unified bills. If you really feel that it is not necessary, you can fully communicate the risks with the doctor, and you can refuse the inspection after signing, but you will have to bear the responsibility if something goes wrong.

Don't think that these four items are fixed configurations. The "four screening items" mentioned by different departments are completely different. The "four items of eugenics" prescribed by the doctor when setting up a profile in the first trimester refers to TORCH screening for rubella virus, Toxoplasma gondii, cytomegalovirus, and herpes simplex virus, in order to detect the risk of intrauterine infection; the "four items of early cancer screening" prescribed to the elderly usually refers to lung cancer. The basic screening package for gastric cancer, colorectal cancer, and liver cancer includes low-dose CT, gastroscopy, colonoscopy, alpha-fetoprotein testing, etc.; there are also "four basic screening items" for employment physical examinations in some units, which are blood sugar, blood lipids, liver function, and chest X-rays, which have nothing to do with infectious diseases. I once met a newly pregnant girl who came to the Department of Infectious Diseases with a list of four items of eugenics to ask if she had syphilis. She made a big mistake. If she saw "four items of screening" on the list and couldn't figure it out, just ask the doctor who issued the order which direction. Don't make blind guesses and scare yourself.

Nowadays, these four testing technologies are very mature. Rapid testing can produce results in 2 hours, and ordinary testing can also provide reports on the same day. The cost is mostly in the range of 200-300 yuan, and is basically reimbursed by employee medical insurance and resident medical insurance. Don’t panic if a certain item is found to be positive. Many times it is a false positive or a past infection. For example, a positive syphilis antibody may be due to an infection that has been cured many years ago. A positive hepatitis B surface antigen can also be divided into carriers and current patients. The hospital will arrange a re-examination and will not directly give you a confirmed diagnosis. To put it bluntly, this thing is a two-way safety lock. It is really not a waste to spend a few hundred dollars to buy it for yourself and the medical staff.