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Jan Cao

[Bilingual Brew] Why China's Health Care Reform Has A Long Way To Go

[Please enjoy this Tea Leaf Nation bilingual brew. The article is first shown in English, and then in the original Chinese. 亲爱的读者,欢迎享受我们的 “双语茗茶”。英文翻译在上,中文原文在下。]

After a spate of violence, these nurses in Shenzhen wore hard hats to work

“Doctor-patient relationship” is a popular term on Sina Weibo, China’s Twitter. Recently, among more than 940,000 microblogs related to this word, a new topic has emerged: Relatives of a patient in the city of Suzhou recently slapped a doctor and knocked four teeth from a security guard’s mouth after being told there were not enough hospital beds for their loved one.

This was not the first incidence of violence in Chinese hospitals. In March this year, a patient at Harbin Medical University No. 1 Hospital Affiliated stabbed four doctors with a knife. One of the doctors, an intern in his twenties, died from the wounds. After the incident, hospitals started tightening up security, while doctors and nurses panicked. 

Surprisingly, facing the death of a young doctor, not all Chinese netizens felt pity or condemned the stabber. According to a report in China Youth Daily, 65% of readers voting in a poll described themselves as “Happy” when asked about their feelings after reading the news. 

What exactly is the “doctor-patient relationship?” Netizens on Weibo offered definitions. @最爱香草奶昔 tweeted, “It is a bit after 12 p.m., the children’s hospital is still crowded. Parents who bring their children over are all very anxious, but no one from the hospital is working. They are back home for lunch and a nap. ‘Come after 2:30 for check-ups and diagnoses!’—This is the ‘doctor-patient relationship’ in China.” @走猫步的天使 said, “A nurse called Yan Ni was beaten to hematuria… this is the current ‘Doctor-Patient Relationship’!”

These tweets evince opposite understandings of the current relationship between doctors and patients. One distrusts the doctors and thinks they are not being responsible. Besides extremely long wait times and the doctors’ cold or indifferent attitudes, many patients complain about under-the-table deals where doctors receive “red envelopes,” essentially bribes for doing their job. The other tries to understand doctors and finds it unreasonable to blame only doctors for the deterioration of relations with patients. It’s not easy on anyone, and not all doctors are villains. 

Online, many doctors and medical students worry about the future of their chosen profession, and even their personal safety. @天使Li468 tweeted, “As the relationship between doctors and patients becomes tenser, and as violence in hospitals becomes more severe, it is hard to [fully] understand the pressure that public opinion places on health workers. We need to reflect and ask what really caused the current situation. Only those who’ve studied medicine themselves can understand, and they don’t want their children to take the same path.” 

Much like in the U.S., it costs a fortune to be a Chinese medical school student. The pressure is intense, and the amount of work a student does is clearly disproportionate to how much a student gains in future income. As relationships with patients worsen, doctors now must also seriously consider their personal safety as well. 

Step 1: Stuff with money. Step 2: Give to doctor

As the daughter of a doctor, I’ve heard many similar complaints. My mother and her colleagues complain that all problems come from management. Many doctors’ explanation for the high price of medicine is similar to that of netizen @古三思‘s:

“Medicine factories need to raise the prices for profit. [Competing with others, ] they have to fight their way into the hospitals. And since the hospitals have no better way to generate income, make the prices even higher. Doctors are only the last part of the chain of benefit. The solution to the problem is medical reforms. Make competition between medicine factories fair. Standardize treatment processes. The government should pay the doctors, so that hospitals don’t have to earn money from high medicine prices to pay their employees.”

In fact, medicine factories have their own representatives who are responsible for the promotion of their medicine in hospitals. For those doctors who have the right to prescribe, each prescription brings them a commission from the company representative. However, these doctors are not the majority in any hospital. 

As for the “red envelope” money, one of my mother’s colleagues says that she often has to drive to a city two or three hours away for a diagnosis. If the inviting hospital doesn’t provide “red envelope” money, the money my mother’s own hospital gives her isn’t even enough to purchase gas for the trip. 

Even if patients and their families understand that their pain comes more from the system than from health workers, medical reform is difficult. In the U.S., discussion about health insurance reforms started at the beginning of the twentieth century, and it is still a focal point in elections. In Berlin, my friend once had to wait for over three hours to get a doctor to see her sprained foot. In China, there are perhaps more problems as conflicts between doctors and patients mount. But when comparing China with developed countries, remember that her medical reforms only started in 1985. There is still a long way to go.

 

“医患关系”是一个微博热点词汇。最近,在新浪超过九十四万条与此相关的微博中,又有了一个新话题:苏州某病患家属因为被通知医院床位不够,甩手打了医生一个耳光,而保安人员更是被打掉了四颗牙。[视频在这里

如此发生在医院的暴力事件已经不是第一次了。今年三月,一位在哈尔滨医科大学附属第一医院就诊的病人持刀捅伤四位医生,其中一位二十多岁的实习医生不治身亡。这起事件之后,各大医院纷纷加强保安措施,医护人员也人心惶惶。

但是,面对年轻医生被病人持刀捅死的事实,网友们却出乎意料地没有表现出一致的谴责和痛惜;相反,根据《中国青年报》的报道,腾讯网转载的”哈医大杀人事件”新闻报道后,有4018人次在网站设置的“读完这篇文章后,您心情如何”的投票中选择了“高兴”,占投票的共6161人次的65%。(《中国青年报》3月26日)

“医患关系”到底代表了什么?新浪微博网友们从各自的角度给出了不同的定义。@最爱香草奶昔_说:”中午12点多,儿童医院内就医的人们依旧是人声鼎沸,陪护着小儿患者的家长们个个心急如焚,但无论是收费、坐诊还是检查的医务工作者们早已纷纷回家吃饭、午休。 ‘检查、治疗,两点半以后再来!’——这就是中国的医患关系……” @走猫步的天使则称:”沈阳医学院奉天医院急诊室护士燕妮被患者家属殴打至血尿,打人者高喊我老丈人是七路派出所所长,打你也白打,太气愤了。这和我爸是李钢有什么区别?这就是现在的医患关系!”

这两则微博分别展示了对现今医患关系两种截然相反的理解。”最爱香草奶昔_”对医院和医生不信任,不认可。他们认为,医院和医生的所作所为对病人不够负责。除了等待时间过长和对病人态度冷淡以外, 许多患者抱怨医生开后门,收红包,无”医德”。而”走猫步的天使”代表的另外一部分人则表示理解医生这一人群,并表示,病人及家属把不同原因导致的矛盾全部指向医生并不合理。这一群人主要抱有”谁都不容易”的态度,认为医生并不都是”坏人”,光由于某些人的举动而抹杀对这个职业的信任有些矫枉过正。

网络上的在职医生和医学生则对这一职业的前景,甚至自身安危表示了担忧。@天使Li468说: “随着医患关系的紧张医闹的壮大…让医务人员承受的压力与舆论谁能明白…导致这种局面到底是什么造成的值得反思…所以只有学医才能深深体会到所以才不让自己的孩子走自己的路啊…” 而另外几位自称是从事医疗行业的网友也说,尽量不让自己的孩子学医,不仅因为学费高,压力大,工作收入与产出不成比例,也更是因为医患关系让医生们开始严肃考虑自身的性命安危了。

作为医生的子女,我自己也听了许多这样的抱怨。我妈妈和她的同事们听说了最近几起医疗纠纷酿成的血案,都抱怨说其实这是管理机制的问题。我认识的医生们和负责药品推广的药品代表们对药价过高的解释与微博网友@古三思的理解十分类似:”…药厂为了生存需要提高药价,为了进入医院需要打通关系,而医院以药养医拉高医药价格,最后由患者承担,医生只是利益链边缘的最后一环。出路就是体制改革,引入医药公平招标,规范治疗,由国家给医生发工资,而不是以药养医。” 事实上,药厂有医药代表们专门负责药品在医院的推广。对于那些有处方权的医生来说,开一剂药他们能够从医药代表那里拿到一定的回扣。然而能够如此创收的医生,并不是医院的大多数。

而对于会诊收红包这件事,我妈妈的一位同事则说,她常常需要自己开车去两三个小时外的城市会诊,如果对方医院不提供”红包”这种灰色收入,自己医院给的会诊费根本不够补贴来回开车的汽油钱。

就算患者及其家属意识到他们的痛苦更多来源于体制,而不是医护人员,医疗体制改革本身依旧是艰难的。在美国,关于医疗保险改革的讨论开始于二十世纪初期,一直到最近还是各届总统选举的焦点。在德国柏林,我曾经陪扭伤脚的朋友在医院急诊室排队等了三个多小时才见到医生。而中国患者所面对的。除了排队太久、医疗保险不完善这些体制造成的问题,还有医疗纠纷难以解决,违法订立药价等等在实施中产生的困难。相比与发达国家长达一个世纪的努力,中国的的医疗体制改革却仅仅开始于1985年,这样看来,面前也许还有一条漫长的路。

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Jan Cao

Jan Cao is a senior and a comparative literature concentrator at Brown. She loves watching Japanese TV dramas and cooking.
  • Ghettopolarbebe

    “In Berlin, my friend once had to wait for over three hours to get a doctor to see her sprained foot.”  I am assuming your friend went to an emergency room (and not an urgent care center) where patients are triaged then treated on the acuity of the injury (there are no appointments in the emergency room).  A multi-car accident would obligate the doctors (or other medical professionals) to treat those patients first before treating less urgent patients. In very rare instances would a sprained foot ever be life-threatening.  

  • Ghettopolarbebe

    “In Berlin, my friend once had to wait for over three hours to get a doctor to see her sprained foot.”  I am assuming your friend went to an emergency room (and not an urgent care center) where patients are triaged then treated on the acuity of the injury (there are no appointments in the emergency room).  A multi-car accident would obligate the doctors (or other medical professionals) to treat those patients first before treating less urgent patients. In very rare instances would a sprained foot ever be life-threatening.  

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  • http://www.myhealthbeijing.com Richard Saint Cyr MD DABFM

    It is always sad to read about the mistrust between doctors and patients in China. In my Beijing private hospital I help to teach and train local doctors and students, and they love the science of medicine but are very worried about their career path. I really admire the current group of medical students, who work as hard as Western medical students for a far less rewarding career path — both economically and culturally. Clearly a Chinese doctor needs to get paid more, and the “perverse incentives” for hospitals to make money from prescriptions needs to be fixed.