Doctors in Harbin

[Manuel]

So how much money and guanxi is required? How long is a piece of string? The answer, of course, is that it varies from place to place and from doctor to doctor. The system is corrupted. It's not about "service", it's about being given optimal healthcare.

[roddy]

Please don't bump old threads on a specific topic (doctors in Harbin) to make a general point (healthcare in China isn't very good). Better either look for a more general topic to post in, or start one. 

 

But now we're here - Lost in China, did you find anywhere?

[Manuel]

Just read this article, thought I'd post the link here. The situation in China is a bit of a vicious circle.

 

http://www.theatlantic.com/china/archive/2013/12/chinas-doctors-are-under-attack/282002/

[kdavid]

Just re-read my contributions to this thread from 2011. I was writing from a dark place, and am quite appalled by the unfair generalizations that I made.

 

The birth of my second son (in 2014) went very smoothly. I also had one doctor save me quite a bit of money and inconvenience by correcting a misdiagnosis (he was the third doctor I had seen on the issue though, with the first two recommending major surgery). This latter issue was late 2013.

 

Per the article linked to above:

 

The failure to fundamentally solve the problem of affordability and access, coupled with over-prescription and over-treatment issues in the hospitals, fuels tensions between patients and healthcare providers. 

 

 As a result, doctors spend even less time with patients, and the quality of services they provide is negatively affected. 

 

 

First, I'd like to see what the numbers are in other countries. Sheer numbers in China regarding many social issues will often be higher given the country's population. Per capita is a much better statistic to measure, IMHO.

 

Second, in my experience with the Chinese system, while costs of procedures can be quite staggering, it's not so much the costs that people gripe about, but the bedside manner. Health care reform is seeking not only to improve care, but also culture, and this latter point must wait for a new generation of doctors to come on board.

 

Finally, regarding the over-prescription issue, there have been studies done on this culture of unnecessarily medicating with IVs and antibiotics. The findings have shown that patients are unhappy if they aren't given some type of medicine. Who would be satisfied after being told to "suck it up for a few more days" after having taken a long train ride into the city and waiting in line all morning? Many people want something to show for their inconvenience, even if that something won't actually alleviate their condition.

 

Four years isn't long enough to reform any system this big. Just like the environment, it will take time.

[abcdefg]

Finally, regarding the over-prescription issue, there have been studies done on this culture of unnecessarily medicating with IVs and antibiotics. The findings have shown that patients are unhappy if they aren't given some type of medicine...Many people want something to show for their inconvenience, even if that something won't actually alleviate their condition.

 

This is true in the U.S. as well.

 

It's particularly true in any health-care delivery setting where the doctor and the patient don't know each other, don't have an ongoing relationship based on some degree of mutual trust.

 

If it's "good old Dr. Jones" who my whole family has used for ten years, and he tells me, "This is almost surely a self-limited condition. Just ride it out with rest and fluids for now, and phone me if you aren't better in 48 hours," I'm more likely to go along than if we had just met as strangers in a stressful E.R.

[Manuel]

 

If it's "good old Dr. Jones" who my whole family has used for ten years, and he tells me, "This is almost surely a self-limited condition. Just ride it out with rest and fluids for now, and phone me if you aren't better in 48 hours," I'm more likely to go along than if we had just met as strangers in a stressful E.R.

 

That sums it up.

 

But just like having a degree in Mathematics doesn't necessarily mean you are qualified to be a Maths teacher, having a degree in Medicine doesn't automatically mean you are qualified to interact with patients. It's part of the doctor's job to create mutual trust, and acting like not giving a crap doesn't help. I've met many public hospital doctors that were successful at creating trust, so I don't see why other doctors have to act like assholes; they are basically giving the whole medical community a bad name. Not that I approve of violence, but I bet most of those doctors that got assaulted probably had it coming, and the ones who didn't simply paid for the incompetence of the quacks before them.

 

Here's some things bad doctors can do to become good doctors:

• Good doctors proactively take initiative to explain and justify their prescriptions before the patient even asks, using layman's terms to ensure effective communication. This also minimizes the chances of over-prescribing. With drugs having so many possible side-effects and some medication costing several hundred RMB, you cannot expect patients to "just buy it" (pun intended). Practitioners of other professions (engineers, consultants, web developers, software developers, constructors, etc) all do that as part of their service.
• Good doctors make patients aware of their prescription's most likely side effects, based on his experience and judgement. Many doctors just don't even do this. Yes, it's probably written on the leaflet inside the box, but the leaflet often is just a dispassionate list all the possible side effects, whereas a good doctor can tell you, based on his experience and the patient's medical history, what the most likely side effects are, if any, and what to do in the event thereof.
• Good doctors don't act like they can't wait for you to leave.
• Good doctors end the session with a follow-up remark, e.g. "Come back next week if ..." or "Come back to see me again in two weeks".
• Good health systems have a centralized medical records system that can be accessed by all hospitals. If this is not possible, patients could have a "medical records book" that they must bring with them to the hospital, and which can be used at all hospitals in the country, rather than the usual worthless 5-kuai mickey-mouse disposable booklet that is easily lost and replaced.
• Doctor jobs are very volatile in China, for a number of reasons. In Spain I've had the same GP since I was a kid. in China you are unlikely to see the same doctor twice, reducing the chances of a "good old Dr Jones". Lack of an effective medical records system means the next doctor is unaware of any previous conditions, how they were treated and the effectiveness of former prescriptions.
• Good doctors have legible handwriting. Illegible handwriting gives patients the impression that the doctor is trying to hide something or keep the patient in the dark. In China many doctors won't even tell you what the prescription is until you've paid for it, because they don't want you to buy it elsewhere where it might be cheaper.
• Doctors who, despite many attempts, cannot manage to write legibly, should use a computer to type their prescriptions and records. It's 2015.
• Good doctors should keep themselves updated on the latest medical developments, just like practitioners of other professions do, especially the more senior doctors.
• Good doctors have a basic notion of hygiene.
• Good doctors observe the modesty of their patients and prevent other patients, including a whole family, from creeping into the room by locking the door while I am semi-naked, or asks everyone to leave the room before the consultation begins.
• Good doctors don't smoke inside the hospital (I've only seen this in small remote hospitals though).
• Good doctors don't act like cocks. Many doctors believe they have god-like status because our health is in their hands. I've come across several plumbers in the UK who acted just that way when water was running down the walls. Same problem: in many cases it's just an over-hyped job that happens to be very necessary at the particular time, therefore you are their bitch.
• Good doctors look at the patient when they talking to him.
• Good doctors are not afraid to admit they are not sure about something, and are happy to refer you to someone else for a second opinion, plus a follow-up. There should be a way for the first and the second doctor to interact and discuss their findings.
• Most doctors jobs (not talking about brain surgery here) are not as technically involved as, say, engineering or software development jobs. Most doctors simply follow a script; in fact, deviating from the script might get them in trouble. They just memorized a bunch of fancy big words that only they can understand and learn how to identify conditions and prescribe medication accordingly. Sounds like a simple database look-up job that could be carried out by a computer program. I would trust the computer program as much as a doctor who doesn't look at me when he is talking to me.
• I've successfully treated myself for several conditions that doctors either said "was nothing" or prescribed drugs that didn't work. A little bit of research online and over-the-counter medication has often done the trick. I know many people who've successfully done the doctor's job by  themselves.

Bottom line: Be humble and treat patients as if they were your own offspring.

 

EDIT: Sorry about the rant... I can become agitated over incompetence and negligence.

[Flickserve]

This is an interesting topic.

China's problem of over prescription occurs with the problem of remuneration. The doctors get reimbursed for setting up iv's and prescribing. They don't earn very much so unfortunately, this becomes a part of the culture. This is a problem of the healthcare system, not the doctor.

Over investigation will be common. This is the trend across all countries.

Patient's, especially Asian ones, expect something to be done. So, doing something becomes part of the culture. Giving a Mickey Mouse iv fluid, which is low risk, helps a lot in the feeling of doing things. Even if you say it's unnecessary, because every patient and family member expects it, and every colleague of yours will do it, and the nurse asks you are you sure, it becomes just easier to start the iv. Time management is important for most people, let alone doctors.

In Asia, people think a doctor can cure a common cold with prescriptions. My wife is a good example of this. Every time, our children have a cold, I have to take them to the Doctor (i think it's rather unnecessary) . Once the Doctor and I decided not to give antibiotics - when I got home, my wife exclaimed "what sort of ***** doctor is that? ". So, the Doctor and husband get a lot of flak. Don't say just explain the situation to the wife... That definitely doesn't work despite her BSc from a top ranked University and her MBA both obtained from UK. My wife grew up in Asia...

There are good and bad Doctors in any country - not just China. There are also good and bad relatives. My UK doctor friend told me of an old lady under Her care in the hospital for a few months. The daughters would continually claim of not being informed of anything by the doctors or nurses. This was despite written documentation. Anyway, the lady died in hospital, the daughters were told and came in. The next day, the daughters came into hospital to the ward looking for their mother not realising she was dead.....

For sure, I have heard stories about China medical practice. There is still a long way to go. On the other hand, no country has a perfect healthcare system.