Under the Knife: Why Chinese Patients are turning against their doctors

http://www.newyorker.com/magazine/2014/08/25/under-the-knife

by GabrielF00 • 12 years ago

54 43 12 years ago

So much grief but still focused: I asked Wang Dongqing whom he blamed for his son’s (the doctor) death. “I blame the health-care system,” he said. “Li Mengnan (the killer) was just a representative of this conflict. Incidents like this have happened many times. How could we just blame Li?”

jjoonathan• 12 years ago

Wow:

When People’s Daily, a newspaper that acts as a Chinese government mouthpiece, posted an online questionnaire asking readers to rate their reaction to the murder, as a smiley face, a sad face, or an angry face, sixty-five per cent of readers chose the smiley face.

After having read the accounts of what their health care system is like, it's not hard to understand this level of outrage. It sounds like many of these doctors are exploiting the hell out of their information asymmetry in order to defraud and extort patients who have already been driven to desperation by their ailments. Arguably this behavior is due to the fact that the doctors are underpaid in the first place, but I doubt anyone expects that to be much comfort to the patients.

If Wang Dongqing was privy to his son's misgivings about the moral compromises he and/or his peers were making then the possibility of patient retaliation must have haunted him for some time. The fact that his son died as collateral damage rather than as a result of a slight he personally committed really drives home the fact that the only solution is to address the issue at the system level :/

zo16• 12 years ago

What? This kid murdered an innocent person in anger. It starts, and it ends there. Whether it was collateral damage, or how angry the kid was, is irrelevant.

It's like saying: you know, there's all these fat people that are constantly abused and get run-around by pretty girls. They are suffering so bad, it's not hard to understand their level of outrage when one of them raped a woman.

Seriously, violence against innocents can never be justified. No matter the rational behind it. And by defending them and their actions, we're just giving them credence and making them think their anger and actions are "not their fault".

thaumasiotes4• 12 years ago

Wei had only recently returned from a reëducation camp

They'll put a diaeresis in re-education but they won't print tone diacritics in Chinese names. I'd kind of like to know how to pronounce the names.

paulrosenzweig• 12 years ago

English-language newspapers in China don't include tones either.

thaumasiotes4• 12 years ago

I'm aware, but the new yorker is ostentatiously trying to be correct, and surely doesn't expect its audience to be familiar with Chinese names.

pcrh• 12 years ago

The use of such grammatical marks is an affectation particular to the New Yorker.

evincarofautumn• 12 years ago

I hope that in the next ten or twenty years it will become normal practice to include tones in Chinese names, or at least typeset the original names parenthetically beside the transliterations.

Terr_• 12 years ago

Visiting Beijing a few years back, I recall a bunch of signs had a pinyin versions of the street-name showing... but without tonal marks.

Never did figure that one out.

unkoman• 12 years ago

“Protest becomes the mechanism for providing social security and for distinguishing people who need help.”

Now that's one way to evaluate the health of the system. I wonder if the baseline is measured in protests/day...

adaml_623• 12 years ago

"Joe Passanante, a doctor from Chicago who did a stint at Beijing United Family Hospital, told me that he was once performing CPR on a woman when the parents of a girl with a fever walked into the room. “Here I am pushing on a dead person’s chest, trying to revive her, and they’re asking me to see their daughter,” he recalled."

It seems like a totally different world in so many ways but this quote highlights it for me.

song• 12 years ago

United Family Hospital is very different though from the typical public hospital. It's a private hospital where a simple consultation with a doctor costs about 2000 RMB (around 325 USD) and is geared towards expats with good health insurance or rich locals.

It's worlds apart from the public hospitals they were talking earlier in the article and is really not representative of the situation. There, the doctors are more likely to deal with entitled customers who feel that they should be treated with the respect their money affords them.

jimworm• 12 years ago

Not my experience with Chinese hospitals, and I've seen several (with consultation fees of 2 CNY - not the entitled rich crowd). Usually there are five or six other people pushing each other to get the doctor's attention inside the office. It's nearly impossible to be seen without some less-than-violent strategic body positioning without eye contact. No such thing as privacy, even in gynaecology.

giarc2• 12 years ago

I attended a conference on pulmonary medicine once. There was a surgeon speaking about his trip he took to China. He had removed a tumor from a patients lung and had to carry it out of the OR theatre and physically show the family. They had paid for the procedure, travelled a long way to the hospital, they demanded to see that there was actually a tumor, and that the surgeon had actually removed it. Apparently this is common in China.

jonnathanson• 12 years ago

Something like that seems crazy to us, but I can sort of understand why it made sense to the family in China. China's medical system is presumably a lot less regulated, and probably full of its fair share of hucksters, snake oil salesmen, and fraudulent service providers. Demanding to see proof that a surgery was performed would be understandable in those circumstances. (An unscrupulous doctor could still fake the proof, of course.)

This is thematically, if not completely, similar to the American practice of running a battery of expensive, redundant diagnostic tests on a patient as a CYA measure. It's not enough to have a reasonable guess at a diagnosis; you need five different kinds of proof to back up your decision. You are performing not just to the standards of medicine, but to the presumed standards of insurance companies, lawyers, and WebMD self-diagnoses.

logicchains3• 12 years ago

I once accompanied a friend with a bad cold to a hospital in Shanghai. They ran a blood test, and the doctor announced that she had a viral infection. He then handed her a (fairly expensive) prescription for antibiotics. Now, as anyone who's studied biology (or even Googled 'antibiotics') knows, antibiotics have absolutely no effect whatsoever on viruses. I called the doctor out on it, and he scowled at me and said something like "foreigners do things differently".

Apparently antibiotics account for around 24% of total hospital revenue in China[1], which may explain it somewhat.

1.http://content.time.com/time/world/article/0,8599,2103733,00...

ch4s3• 12 years ago

Did you post a very similar comment about that anecdote on a story about antibiotic use in China a few months ago? I feel like I've read that quote before.

Anyway, crazy stuff.

logicchains3• 12 years ago

Haha, indeed I did. Although I'm sure many others who've lived in China have had similar experiences. About 75% of patients with seasonal influenza are prescribed antibiotics[1], so I think being prescribed antibiotics for viruses is pretty common.

1. http://www.bmj.com/content/348/bmj.g1083

cageface• 12 years ago

It's the same in Vietnam. Everyone I've talked to here that's been to the doctor has been prescribed antibiotics, no matter what the problem is. What's worse, they often only give patients a few pills and not a complete regimen. I can only imagine how much this sort of thing contributes to antibiotic resistance.

shabda2• 12 years ago

"Bacterial superinfection in viral respiratory disease is a clinically well documented phenomenon."

http://www.hksid.org/pdf/bult200305.pdf

"Respiratory viral infections may facilitate secondary bacterial infections"

http://www.ncbi.nlm.nih.gov/pubmed/15166819

The doctor might have had some information about his patient, which you don't?

vinceguidry• 12 years ago

If he did, surely he would have told them about it, rather than just say, "foreigners do it differently".

logicchains3• 12 years ago

If it were somewhere else I'd have considered that, but considering how widely recognised the problem of antibiotics overuse in China is I considered that more likely.

"At medical institutions about 70 percent of hospitalized patients have antibiotics prescribed by doctors but nearly 80 percent of those prescriptions are unnecessary, Yang (director of the behavioral medicine branch of the Chinese Medical Association) noted."[1]

"Each year on the mainland about 200,000 people die from adverse drug events and 40 percent of the deaths are related to the abuse of antibiotics, Yang told the Beijing-based Health News."

1. http://usa.chinadaily.com.cn/epaper/2011-01/05/content_11798...

thaumasiotes4• 12 years ago

Foreigners do do things differently; for example, it's widely believed in China that getting IVs of saline solution is a healthful practice. I assume they're not particularly expensive, because people go to the hospital for IV drips whether they're sick or not.

It's also very commonly believed that giving children cold beverages will damage their health. Doctors can be just as superstitious as their background population.

zhte415• 12 years ago

A general rule of thumb for an acute complaint: Go to a hospital affiliated with a medical university. That's where the next generation of doctors are trained by (hopefully) some of the best of the current generation. As workhorses, they also tend to see a lot of cases in a working day (an indeed, some of the most unusual), leading to a lot of practical experience.

epaladin• 12 years ago

I think there's also a lot of recruitment of foreign experts for academically-oriented institutions. I've been seeing a lot more biomedical science papers from Chinese universities with non-Chinese names of faculty.

Under the Knife: Why Chinese Patients are turning against their doctors

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