An American Doctor In China: What’s Different?

People often ask me, “is your medical practice different in China compared to the U.S.?” Finally, after working in China for three years, I can now answer you with a definitive yes — and no. And sometimes Y…

OK, What’s Different?

#1 Difference: Chinese patient expectations Last week I had another of many similar encounters: a young Chinese woman came in with typical common cold symptoms of runny nose and cough, and otherwise was fine. She made it very clear, very quickly, that she expected me to give her not just antibiotics, but IV antibiotics. Even after I explained to her that she only had a virus, she was quite flustered and still asked for the IV, telling me “you are very different than a local hospital”. Ahhhhh, yes indeed…

It is indeed true that we expat clinics are different than local hospitals. It’s common knowledge that Chinese hospitals have a startlingly high rate of antibiotic use, especially IV therapies, for viral illnesses that do not need antibiotics — like the common cold. It’s called “perverse incentives”: since deregulation in the 1980’s most Chinese hospitals rely on the revenue from prescriptions and procedures to pay their bills. So, Chinese patients are used to IV antibiotics for their colds; now, many newly-wealthy Chinese walk into a super-expensive expat clinic — and they only get over-the-counter meds and not even prescription antibiotics? You see the dilemma here.

Fortunately, with a lot of explanation and education — which they usually do not get from their 3-minute interaction with their local doctor — most patients will understand. And many also realize that their luxurious 15-20 minutes with the expat doctor, plus the organized appointment times and mellow waiting rooms, often make the extra expense worth it.

#2 Difference: Everyone’s super-healthy — or falling apart. In general, most Beijing expats are really healthy. They’re trim, they dress well, they’re at the gym 3 times a week, they eat organics off the farm — and they love it here. But there’s that other side of the expat world, the darker side that also loves it here but for less healthy reasons. That’s the type that smokes and drinks and sleeps around far more than they would ever consider doing back at home. I’m mostly concerned about the businessman mentality here, where it’s culturally accepted, if not indirectly coerced, to binge drink and smoke at business dinners — not to mention the implication that success allows you to have mistresses. I see a lot of broken marriages as well as alcoholism and chronic bronchitis in these types of expats, and I wonder if their often phenomenal business success was worth the trade-off in their physical and family health.

I feel that this is a major expat issue that I’ve been trying to address in my clinic and here on this website, and I hope to continue to show people a healthier lifestyle alternative — that you don’t have to sacrifice your family and your health to be successful in China. After all, when we are all old and at death’s door, will we be looking back upon our lives and thinking about our economic success, or fame, or business partners? Of course not; we’ll be thinking about our legacies of family and children and loved ones.

#3 Difference: Weird Diseases. As a family doctor, I see the full spectrum of diseases running through my community. I quickly noticed after coming to China (from a Sonoma county rural clinic) that the frequency and severity of chronic diseases was much lighter here. That’s for a good reason; few people with a major chronic disease would be physically qualified, much less interested, to work halfway around the world in the demanding, fast-paced business world of China.

So, my Beijing clinic days are filled less with out of control diabetics and alcoholic hepatitis patients, and more with acute stomach flu and the various respiratory Beijingitis syndromes. But I also get to see some unusual, more tropical-style diseases, as well as ones that are mostly wiped out in the West. For example, rabies (unfortunately) is a real issue here, while back in the States we’d never be running to the doctor every time a neighbor’s hamster bit your finger. And with all the travelling that expats do, I deal a lot more with tropical diseases with cool names like scombroid, schistosomiasis and ciguatera.

#4 Difference: Expats Are Cool. One definite perk is simply talking to my patients and listening to their stories as to why they are here and what adventures they are having. The range of countries and interests is fascinatingly broad, and my inner world is far wider just from living in Beijing and meeting such a diverse group.

OK, What’s The Same About Working Here vs America?

Well, that’s just not as interesting as the differences, is it? Perhaps for a later piece…


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16 thoughts on “An American Doctor In China: What’s Different?”

  1. Great blog Rich. One other difference that Rich has probably already noticed….the interest to see a specialitist among locals. This is understandable as primary care as a speciality in China is still developing and all the academic resources have thus far been given to speciality care (much like it was in the West for the past).

    1. Yes, it’s true — Chinese love their #1 hopsitals and they want their specialists. There’s no culture at all of having a “family doctor” who they love and being their generations of family to, and develop good relationships over years. No doctor in China has time to chat! Very sad in a way, there’s a huge amount of physican healing simply via bedside manner and making the patient happy.

      1. I LOVE my primary care physician here in Haikou. (Dr. Zhou Zhonghua at the International Clinic in Haikou City People’s Hospital) She was the first doctor I have ever had that took the time (or had the time) to spend time asking questions and listen to me. I feel extremely grateful to have her – and I know it is unusual in China to find somebody like that. I’m much happier with her than I was with my health care providers in the US.

      2. Why are the doctors in China rushed? Are all the doctors in China under government control? And if so, do the doctors get their salary from the government? and if the doctors are government employees, then wouldn’t the doctors be exempt from any malpractice lawsuits under the theory of sovereign immunity (that is, if the China has laws similar to western countries)? If the doctors get their salary from the government, then does the government expect a doctor to see a set number of patients a day? and does the government expect the doctor to work a certain numbers of hours?

      3. They are rushed simply because they have too many patients to look after. Can you imagine a specialist needs to see 30-40 patients in one morning? And this workload is quite common here.

  2. Part II

    It's easier to get a neurolsurgery appointment in China than to find a primary care doctor who can diagnose an ear infection (lack of training in and availability of otoscopes).

    Because of this, locals don't have much exposure and trust in primary care doctors. Their vision of primary care are the doctors in the community health stations/centers they see to refill medications started on by the better trained doctors in the hospitals.

    After working in Beijing for four years, I formulated this rule…if a local Chinese patient asks you about a specialist, just refer. It is not good medicine. However, it's just the sane thing to do. Some locals now have western-modeled health insurance that requires referrals from primary care providers. This gate keeper model doesn't work well if the patient doesn't trust non-specialists.

    Good theurapeutic relationships is a two way street. If the patient doesn't trust your opinion, it's better they seek the advice of someone with whom they feel comfortable.

  3. just saw this on cdc china. http://www.chinacdc.net.cn/n272562/n276003/35192….
    The WHO apparently is callng the > 50% rate of C-Section in China an "epidemic". Besides the financial incentives mentioned in that article, a bigger incentive for docs I believe is safety. China has a "guilty until you are proven innocence" legal approach to medical mal-practice. The merits of such a system is arguable given all the problems patients have in getting answers, but one thing such a system does is increase defensive medicine. Same thing has happened in the US. No one wants to be sued. Doing something….albiet invasive, is often seen as better than letting nature take it's course. I feel bad for all those overworked docs in China's referral hospitals….who wants the added headache of delivering a not so perfect "only child"? Beijing also recently is toying with the idea of shutting the maternity units of hospitals who have bad outcomes. Again, good intentions that just pave the way to more C-sections.

    1. Yes, all true. I’ve written a few pieces on this “perverse incentives” issue in China. Personally, I always feel very lucky to have been born in America. Here, I’m surrounded by equally hard-working and intelligent Chinese doctors, but just because of where they’re born, their lifestyle, income and stress is so different.

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  5. Dr. Cyr

    I am working with a US Physician that specializes in Interventional Radiology for Venous Diseases who would like to open his own clinic in either Beijing or Shanghai, could you share with me how you were able to open your own clinic , the procedures required of a foreign doctor to be licensed in China and if the for mentioned is even possible?

    BR
    Ben

  6. How much do expat doctors make a year in China? I’ve read that about 67% of the Chinese populace, in a recent survey, don’t trust doctors; and that about 3 in 10 doctors are assaulted or killed by disgruntled patients. Have you heard any killings of doctors in China? Have there been patients who’ve threatened or beaten you up? Would it be advisable that before going to China, a health care provider at least know a mixed martial art like jeet kune do?

    1. The violence issue is very real, unfortunately, and we’ve all read the stories and seen the photos of doctors, even residents, who were killed. It’s an awful state of affairs, underlined by mistrust of their doctor. No one’s happy with the situation, not patients and certainly not doctors…

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