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Chinese doctors leaving public hospitals to promote hierarchical medical system

By Jiang Jie (People's Daily Online)    14:38, December 12, 2016

It has never been easy to be a doctor, and it’s even harder in China, however, where the huge population massively expands the patient pool and poses unique challenges to medical staff.

Pressure is extremely high in public hospitals, where long lines of patients often await consultation. Working amid large crowds sometimes even poses a physical threat, when agitated patients go rogue. Some doctors struggle but continue to pursue their careers at public hospitals, while others quit and turn to private hospitals as a path forward in the Chinese medical system.

(Photo/National Business Daily)

Mounting pressure

When a nation has the world’s largest population, what naturally follows is a huge crowd of patients – coughing, bleeding, whining – waiting impatiently outside consultation rooms. Such scenes can be witnessed in almost all hospitals across China. Such was life for Zhou Yidan, a former physician specializing in gynecological oncology at the Cancer Hospital under the Chinese Academy of Medical Sciences.

“There were only two physicians in our consulting room for outpatient services. Since there was no limit on the number of outpatients at the registration center, we were dealing with more than 100 patients every day in the morning. We could never take our lunch break on time at 11:30 a.m.,” Zhou said in an interview with People’s Daily Online. She frowned with her eyes closed, as she recalled her life back then.

“It was way too tough,” she said.

Zhou pointed out that, as much as she wanted to spend more time consulting with each patient, the huge number of waiting patients pushed her to speed up. It was like working on an assembly line, she said.

“I didn’t want to communicate with my patients in this way. I knew they would feel ill-treated when they only received a few minutes with me before another patient squeezed in. They were all cancer patients. They deserved better treatment, but I just couldn’t give it to them,” she said.

Pressure also haunts Chinese doctors in a more violent way. According to the Xinhua News Agency, the number of medical staff injured on the job has been on the rise in 2016. As of Nov. 30, more than 60 doctors and nurses had died in 42 assault cases.

A different path

“There must be a different way to be a doctor,” thought Zhou, who eventually applied to become a visiting scholar at Houston Methodist Hospital and MD Anderson Cancer Center in the U.S. She made an even bolder decision after returning from the U.S. She quit her job at China’s top cancer hospital and began working at private hospitals. She is now a gynecologist at Health in Here medical center in Beijing.

Similarly, Guo Xiao, a former cardiologist at Fuwai Hospital, one of China’s best hospitals specializing in cardiovascular diseases, also gave up her position to work at Distinct Health Care, another private hospital in Beijing.

Zhou and Guo no longer face crowds of patients surrounding a small consulting room. Instead, their private hospitals offer spacious rooms decorated in warm colors.

(File photo)

“The nurse will say hi and offer you a cup of water when you arrive. Most importantly, I can have enough time, and the patient enough privacy, to actually talk about disease treatment and prevention. At least up till now, I haven’t seen any patients who were discontent after their appointments,” Zhou said.

Echoing Zhou, Guo also stressed the importance of communication, citing an experiment she participated in at Fuwai Hospital where she followed up closely on several patients’ cases after they took a drug test for their heart disease.

“Since I was assigned to keep records of their daily clinical manifestations, I got to know their individual habits and had more opportunities to repeatedly recommend healthier daily habits,” Guo told People’s Daily Online, adding that her patients often did then transition into healthier lifestyles.

“Long-term close observation and treatment have made me realize the influence a ‘family doctor’ can have on a patient. It is completely different from how I worked before,” she noted.

(File photo)

The dream of working more closely with patients is one shared by many, which translates to an increasing acceptance of private hospitals in China, where the hierarchal medical system remains weak. However, even amid the national call to establish community hospitals, the majority of citizens still look to top-ranking public hospitals for most kinds of diseases, for fear that smaller institutions are not as effective – especially as some private hospitals are notorious for high treatment fees.

“Thanks to the patient pool, a public hospital is indeed more professional, especially in training young doctors who can be raised from general practitioners to specialists. It is true that there remains a gap between public and a private hospitals for now, but many doctors [at private hospitals] are professional enough for general practice, and we can always transfer patients to public hospitals for specialized treatment if needed,” said Guo.

According to Feng Chen, general manager of Health in Here CBD Medical Center, most of the medical demands of the public are focused on basic medical services, which can be met by general practitioners.

“The habitual practice of going to a ‘big hospital’ for any sickness must be changed, and trust in doctors [at private hospitals], I believe, can be won if patients have open access to the backgrounds and qualifications of their doctors,” Feng said at a press conference in November.

Feng’s medical center equips each consulting room with an iPad to display pictures and introductions of doctors, while public hospitals do not even offer name tags for physicians.

“What also needs to be changed is the concept of medical treatment. It is not always cheap and it does not always involve a bundle of medications. A consultation can last for hours, during which time doctors explain in detail how to avoid getting sick. That’s what a doctor does,” Zhou said. 

(For the latest China news, Please follow People's Daily on Twitter and Facebook)(Web editor: Jiang Jie, Bianji)

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