Medicine in China

**This is very much my opinion interlaced with as many "facts" as I was able to obtain by talking to friends, Chinese patients, and other doctors. I have done my best to explain everything as it was explained to me (but the language barrier persists...)

I have really avoided writing a lot about the medical system, ophthalmology clinics, etc in my blog because I find it overwhelming.  It is so nice to be here and learn from the Chinese (my boss Dr. Wu is an incredible cataract surgeon), but also to teach them about our way of doing things.

First off, the medical system is very different in America. As I have mentioned before, there is a LOT of violence against doctors in China. And Chinese doctors aren't considered "rich". Therefore, it is a demanding job, with the possibility of ungrateful patients, for moderate pay. And, the schooling is very lengthy, just as in the U.S. There is "no room for error" in Chinese medicine. I don't proclaim to be a perfect doctor. I care deeply about my patients and work hard to arrive at the correct diagnosis. I seriously try to treat all patients as if they were my own family member. But I have to remember, I am not infallible. And at some point in my career, I risk the possibility of a missed or delayed diagnosis or a surgical complication. These are things that doctors fear...it is a big responsibility to take care of other people's eyes (and in some cases, lives). We do not take this lightly. It even keeps us awake some nights and causes us to "take work home" when we are to be spending time with our families. But it is a wonderful profession too with many inner rewards.

Recently, there was a large positing on one of the doors to the hospital. It was only present for a few days, then taken down. I was walking home with a friend one day, when she stopped to read the sign. I inquired as to what it said. She reported that it was a notice that a pediatric surgeon had jumped to his death from a building several days earlier (age 34). The root cause was apparently because the parents of a child under his care were not happy with the care the child received. Not only does violence against doctors occur, but some choose to end their own lives as a result of complications. Again, doctors are not  perfect. And complications will occur, even in the hands of the "best" surgeons. And sometimes, despite our best efforts and a "technically perfect" operation or a timely diagnosis, the patient will still not fare well.

At any rate, the statistics I recently read in the Chinese newspaper (English version online) indicated the following:
      The average number of assaults on doctors in China surged to 27.3 per hospital in 2012, up from 20.6 in 2008, according to a survey by the Chinese Hospital Association. And more than 17,000 violent incidents against hospital and medical staff were recorded by China's Ministry of Health in 2010, comparing to 10,000 in 2005. (South China Morning Post: scmp.com)

When discussing all this with Mr. Z (one of my "burning questions" was to learn more about the medical system in China), he indicated that the doctors' salaries are in part, determined as a percentage of the treatment prescribed. Thus, the more expensive them medication or treatment, the higher the doctor's wages. This has made patients become VERY distrustful of the "Western" medical system. Often times, patients will seek treatment via Traditional Chinese Medicine as first line treatment.

In the United States, I really try to be judicious about my healthcare spending, both in my personal life and in my professional life. I think about how much things cost. I give samples to patients when available (although 'samples' are rare these days in the University setting because it is considered a large conflict of interest). I try not to order imaging (CT/MRI) without a really convincing reason. I try to avoid the "costly treatments" and will start with conservative therapy whenever possible. But I have had 13 years of education beyond high school to be the best doctor I can be. And sometimes, that means  prescribing costly treatments (medications, glasses, surgery, etc) and ordering expensive tests.

Yet, the patients here have become very skeptical that a certain treatment is in their best interest, but rather feel it may be in the "best interest" of the doctor's pocketbook or paycheck. (I am sure this sentiment occurs in the U.S. as well.) Additionally, medical care is very expensive (sound familiar?), and many people cannot afford the exorbitant costs. Many feel the government needs to intervene and start providing more funding for medical care (sound familiar?).

So, as Mr. Z described it, "Every problem in China has a reason behind it."

       The traffic problem? Too many cars because people have migrated from the countryside in recent years. (Remember, 40 some years ago, Chengdu's population was 1/14th what it is now...)

      The population problem? People are having too many children in an already overpopulated country. (Solution = one family, one child policy).

      And the problem behind medicine in China is the culture of doctors prescribing expensive treatments when very in expensive treatments may suffice, in a country where many patients do not have the means to afford the care. Thus, leading to patients' mistrust of the doctors and the system. (Solution?? Possible more government assistance for health care, but this debate/solution is ongoing...)

Of course, this does not describe the entire problem. It is much more complex and intricate than that. An additional problem is...there are so many people to treat! How do you provide medical care to 1.3 billion people?!  Another issue is lack of education. Mr. Z is very educated. He sates that often the educated people understand the system. But some people (laborers in the rural areas) with little to no education may not understand.

I will say, I have met some incredible doctors here. The absolute majority of whom do not use money as motivation, but rather treat the patient in the most honest manner. But you know the relationship between patients and doctors is not good when one of your attending physicians chooses not to wear a white coat because they don't want to divulge that they are a doctor...

I think China is a phenomenal country! I have been treated like a queen here. I am NOT trying to be critical of the system (goodness knows we have a lot of "issues" in the U.S.A.), but rather describe and open people's eyes to some of the healthcare problems in China. (I'll save the "Healthcare System Problems in the U.S." for another day!)