I’m now in my ninth year practicing family medicine here in Beijing, and people often ask me, “is practicing medicine different in China compared to the U.S.?” I usually tell them, “yes – and no – and sometimes maybe.” And as I’d piqued their curiosity, I’d then share with them a few examples of my adventures and misadventures here — which I’d like to share with you now.
In terms of differences, the most jarring for me when I first arrived continues to be common: the wide range of patient expectations regarding treatments. I don’t just mean the more obvious ones between expats and local Chinese: I see enormously different approaches to health among the many world cultures we experience here at BJU. A classic example is the common cold. A very typical encounter will go like this: a young Chinese woman comes in with typical symptoms of runny nose and cough, but otherwise is fine. She makes it very clear, very quickly, that she expects me to give antibiotics, preferably through an intravenous (IV) line. Even after I explain to her that neither are needed or effective as she only has a virus, she may be quite flustered and still ask for the IV, telling me “you are very different than a local hospital”. Yes, yes indeed we are.
But isn’t that one major reason why expats like myself come to China in the first place? To challenge ourselves and step out of our comfort zone? That was definitely an appeal to me when I first arrived with my newlywed wife, who spent most of her childhood in Beijing but moved to the US after high school. So she was coming back home to Beijing, but I was completely nervous coming here, ten years ago. Sure, we could have continued to live in wonderful Sonoma County for decades: me practicing at the same family medicine clinic in the redwoods and driving home to our hillside home in the vineyards, sipping our own wine and munching on home-grown organic arugula salad in the pollution-free air, but if I had stayed, then I never would’ve experienced all of these other cultures and ways of approaching health and medicine. Nor would I probably have become a New York Times health columnist, an oft-quoted pollution expert, or have a health book published in Chinese (my mom couldn’t read it, and neither can I, but she was so proud). Nor would we have had our fantastic Chinese nannies helping my wife and I thrive, and not just survive, as new parents during the first few years of our sons’ lives.
So as my years in China slipped by (far more than I had ever expected) I slowly realized that my patients were teaching me as much as I was teaching them. Let’s use the common cold again as an example; we all know that western allopathic medicine offers nothing effective for the common cold. It’s quite humbling as a doctor that the world’s most common disease has no cure. But many Chinese use quite a bit of herbal medicines for their colds and flu, as do many other cultures such as India or even Germany. My favorite cough syrup for children and adults now is the famous herbal mixture pipagao 枇杷膏, which I find more effective — with far fewer side effects — than any western OTC cough syrups. And while I still can’t find any high quality studies showing the effectiveness of 板蓝根 for the common cold, I’ll still follow my wife’s orders and take this famous medicine when I’m sick. I honestly don’t know if it’s any more than the placebo effect, but I feel better and it makes my wife happy (which is always a good side effect).
Enough about the clinic differences; what’s the same about my practice here and back in California? The short answer is that my daily routine is about the same as before: I take care of kids and adults, managing the usual health checks, colds, back pains and stomach troubles as much as I would back at home. I actually thought I would be seeing a lot more tropical or exotic diseases, but in reality I see only a few unusual cases, usually right after the holidays after returning from the tropics or high altitudes.
Of course, even from a visual comparison of sunny California with my usual grey days here, the environmental differences are quite stark, most obviously air pollution but also food safety. And I certainly urge everyone living here to at least have a decent air purifier in your bedroom as an absolute must, and that includes people in all major cities in China, not just Beijing. It’s unquestionable that air pollution harms our immune system, and was recently listed by the WHO as a cancer-causing chemical. But even with this local issue, smoking and also heart disease from poor nutrition are still far more serious issues for public health in China.
So my general wellness advice for all my patients here in Beijing, no matter what age or where they are from, remains about the same as I would tell them back in California: you have control over your health, much more than you may realize. Lifestyle choices and a healthy state of mind are crucial in preventing or causing the world’s most common illnesses of heart and lung disease, diabetes, obesity and cancers. Yes, of course, other factors also play a part, including the environment, genetics and socioeconomics. But the basics of healthy living are the same here as anywhere: moderate exercise, a nutritious diet, healthy sleep, not smoking, keeping a healthy weight, and a positive mindset focusing on gratitude for our adventures here.
But we didn’t need to see a doctor to know all that, did we? Your mother was always right: an apple a day keeps the doctor away…
This article was written in December 2015 for Health Matters magazine here at United Family Hospital and published in their current edition. I must note that my situation in China is now quite different, and my next blog article will provide a very interesting contrast to this one…stay tuned…
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