The Chinese Doctor

Fascinated by the Chinese culture, I had researched what it was like to be a doctor in China. My thinking was that if my Chinese was good enough, I could go to China to practice for a few months to a year or so, and develop more of my Chinese, as well as see how healthcare works in another country. I didn’t mind if my wages would be much lower, but it was the experience that would make the decreased wages worth it.

My research led me to see how fractured and weak the healthcare system in China was.

Doctors are overworked, and underpaid. A lot of doctors provided substandard health care as a result of an overwhelming number of patient demand that could not be met by the health care system. With a country that has over a billion people, it’s no wonder. Coupled with the fact that there has been a net migration of rural residents flooding into the cities, and this will burden the health care system a lot.

Last year, my grandma needed to pay a visit to the hospital as a result of what was likely an asthma attack. In the hospital, everything is based around the almighty dollar. A deposit of around 5000 yuan was required upon being admitted as a patient, just so that you will be able to pay for your medical fees. And what should happen if you end up spending all that 5000 yuan? You get refused medical service. My aunty managed to bargain with the doctor’s in hospital and was able to bargain the deposit down to 2000 yuan. But a couple of days as a patient, my grandma was not given her morning medications. When asked why, the nurse advised that her 2000 yuan deposit was all spent, and no medications would be provided until this amount was topped up.

Other things that seem to be wrong with the health system there, is the encouragement of the “hong bao” or red envelope. In China, a red envelope contains money, and is often given as a token of goodwill. For the rich in China, giving a red envelope gives them a sense that things can be accomplished more quickly, that the doctor will spend more quality time with the patient. My mum who had been to one of the hospitals had clearly seen a Chinese sign that states “No red envelopes allowed”, yet I’ve heard that this gets curtailed by the use of credit cards given instead that are loaded with money.

The way that the doctor gets paid is also shocking. Doctors seem to get paid for prescribing things. In that way, this ends up to a lot of unnecessary prescribing for the sake of earning extra money. My father who had gone to one of the hospitals because of an upset tummy and 1 or 2 episodes of diarrhoea was offered IV fluids. He wasn’t dehydrated or anything, and didn’t need the IV fluids. Why give someone something when the risks of infection from the cannula etc outweighed the benefits? Perhaps by giving IV fluids, it is relatively “safe” and makes good money as well, and in the minds of other patients, they think something is being done.

Finally, perhaps the most disheartening thing I’ve read, have been doctor killings from patients. A times article sums up this perfectly here.

It’s quite sad actually, but I’ve been told that being a doctor in China is not what people aspire to, given the great responsibility and little financial reward given. I don’t blame them given the way doctors are being treated there.

 

 

Back to the Surgical Wards

I’m back on that horrible horrible surgical ward, the ward of bad memories from last year. The constant buzzing in the ward of bells and alarms is all too obvious. I see some familiar haunting faces. Faces that give me a nauseating feeling of disgust.

It’s a good thing that those haunting faces are on the other side of the surgical ward. I’m looking directly back at those past surgical consultants that gave me such a hard time last year, from the desk of the orthopaedics team.

For the mean time, I’ll be looking after bones, joints and wounds, as opposed to botched up colon resections, dehisced surgical wounds, and bladder to abdomen fistula-from-bad-surgery (all of which I really did encounter during my surgical time last year) thank you very much.

Our orthopaedics patients are few in number (sometimes only 5-6 on the ward), generally quite well post op (joint replacements – what can go wrong?), and have far fewer comorbidities. Our team is fairly large too (3 residents vs 4 for surgery, but much fewer patients, and way less clinics).

Some of my registrars still suck, with one even being a registrar from last year. He assigns some of the most time wasting tasks for me, at one time, phoning me up and slowly dictating all the patient details to me so that I could write up a theatre booking form. It was painstakingly slow, dictating the patient’s name, and at times, missing a few letters so that I’d ask him to repeat again. Makes me question the registrar’s judgement in that firstly, it would be much quicker for him to fill the damn form out himself, and secondly, he’s not only wasting his time, but also the resident’s time, therefore wasting two people’s time.

Some things in orthopaedics remain the same as surgery however. The mad frantic rush in the morning ward rounds as we jump from patient to patient, and the unclear plans for VTE prophylaxis, as each consultant likes different VTE prophylaxis use. On the other hand, a lot has changed too. There are way fewer MET calls on our side, or constant requests to review unwell patients, and way less phone calls from other staff hurrying us to get certain jobs done.

Yeap, I enjoy orthopaedics way more than surgery. I’m just thinking how much it sucks for the surgical residents now, but I can empathise with them at least. Been there, done that.