Table 1 Deficiencies with existing medical materials use

DP₁: Ignorance of evidence/guidelines

Doctors do not understand the latest research evidence and regulations regarding medical implants using (DP1a)

Doctors do not have enough time in studying the latest professional development and progress owing to the heavy clinical works (DP1b)

Doctor face difficulties to identify and abstract the latest useful evidence from numerous and rapidly growing literatures (DP1c)

Doctors lack adequate foreign language proficiency contrasted by that the majority of medical research are published in English (DP1d)

DP₂: Incomplete need/preference assessment

Doctors tend to conduct systematic and sophisticated auxiliary examinations for collecting evidence to protect doctors/hospitals from low probability "clinical accidents", rather than to improve the accuracy of diagnosis and treatment (DP2a)

Doctors are keen at looking for physical determinants of diseases but pay less attention to psychological factors, family economic status and cost-effectiveness (DP2b)

Doctors lack the ability of systematic analysis and multi-objective collaboration for patients’ needs and preferences (DP2c)

DP₃: Inappropriate decision/selection

Doctors tend to order clinical diagnosis and treatment procedures (especially the MMs using) without clear indications (DP3a)

Doctors often order a same and complete set of laboratory and imaging examinations to all their patients rather than selecting specific items according to the needs of specific patients (DP3b)

Doctors tend to overuse specific MMs to cater to perceived demands of patients or sales agents (DP3c)

Doctors tend to prescribe more or less certain MMs for demonstrating application of new technologies or to compliance to policy/management system requirements (DP3d)

Doctors are often biased in selecting and recording patient symptoms and medical history, so as to justify application of specific diagnostic and therapeutic pathway and procedures (DP3e)

DP₄: Difficult quality/effect monitoring

Lack of effective follow-up mechanism (DP4a)

Lack of operable follow-up indicators and procedures (DP4b)

Lack of adequate follow-up resources and technologies (DP4c)

PP₁: Problematic cost-effect assessing

Patients can hardly obtain complete, objective and understandable information regarding treatment procedures and MMs use (PP1a)

Patients do not have enough knowledge of relevant physiological/pathological mechanisms of disease development and thus lack the ability of independently comparing alternative procedures and making optimal decisions (PP1b)

Patients and relatives have many irrational thinking patterns, such as "do everything one for health at any cost" (PP1c)

Patients are often given misleading information about prognosis and diagnosis and treatment alternatives due to various reasons (PP1d)

PP₂: Incomplete history provision

Patients often fail to fully recognize the importance of telling their doctors accurate history and symptoms (PP2a)

Patients tend to conceal certain symptoms/history because of the presence of specific relatives or friends (PP2b)

Patients may intentionally over-report/exaggerate some symptoms/history in order to obtain specific priority (such as earlier surgery) or compensation (e.g., medical insurance compensation) (PP2c)

Patients may give biased report about their conditions to meet perceived expectations of doctors, relatives and friends (PP2d)

Patients often lack the opportunity to check, revise and supplement symptoms and medical history collected in medical records (PP2e)

PP₃: Inadequate clinical involvement

Patients have various suspicions and misunderstandings towards doctors and hospitals due to inaccurate self-media reports about negative cases (PP3a)

Patients tend to "say good words in front of doctors " due to the influence of traditional Chinese culture (PP3b)

Patients often avoid raising objections to doctors’ recommendations for diagnosis and treatment in order for fearing of upsetting doctors (PP3c)

PP₄: Lack of follow-up mechanisms

Patients often do not keep in contact with the responsible doctors after their hospitalization (PP4a)

Patients often have insufficient understanding of family rehabilitation and self-management after hospitalization (PP4b)

Patients often seek for health services from different hospitals rather than a same hospital, which decreased the consistency/continuity of diagnosis, treatment and evaluation (PP4c)