In October 2011, we—David H. Garfield, MD, medical oncologist, United States; Harold Jacob Brenner, MD, FRCR,radiation oncologist, Israel; and Lucy Lu, oncology nurse,Shanghai, China—were part of a group that opened the first of planned multiple outpatient cancer centers in China, offering radiation therapy, chemotherapy, and imaging, including magnetic resonance imaging (MRI), computed tomography (CT),ultrasound, and mammography. Although we had previously researched oncology in China, we were still in for a great many surprises.
The Chinese and Their Doctors
Mainland Chinese attitudes are different from what we are accustomed to in the West. There is a lack of trust between patients/families and physicians, related in part to there being few urban general practitioners, resulting in no long-standing,physician-patient relationships. There is a feeling that care is being provided for personal gain, much more so than in the West. When individuals are ill, or think they may be, they go directly to hospitals, including traditional Chinese medicine hospitals, rather seeing a non–hospital-based practitioner. Care is received almost entirely in hospital; this is the main way physician-patient relationships develop.If patients receive chemotherapy once per week, or radiation therapy 5 days per week, patients happily remain in hospital full time, which is especially appealing when they are bedded on VIP floors or during monsoon seasons. This may last longer than 1 month, during which time they are housed and fed.
Chinese Oncology
As an example of unintended consequences, the government has made it inexpensive to see physicians. This has led to a general complaint about medical care in Shanghai: the limited time physicians spend per patient. We know an excellent surgical specialist who sees up 40 patients within 2 hours, meaning
approximately 3 minutes are spent with each, at a cost of approximately $40 per patient. For $3.50 each, 80 to 100 patients are seen during 4 hours by that same physician on another day.
During those few minutes, rarely is a physical examination performed. Several questions are asked and answered, with a brief look at images and laboratory tests, tumor markers, and so on; that is it.
Patients, Physicians, and the Party
Chinese patients, thinking they have or are diagnosed with cancer, will demand that certain tests be performed. Physicians,rather than argue necessity, will acquiesce instead of having these patients complain to hospital administrators, when they must then defend their case. In this regard, it must be pointed out that hospitals have two administrators: first, a conventional one, as in the West, and second, a Communist party member. A physician must take care. A bad outcome is felt to put physi-cians, particularly surgeons, at risk for administrative admon-ishment, lawsuits, or, worse, bodily harm.
。many more 。。。。。。。。。。。。。。。。。。。。。。JOURNAL OF ONCOLOGY PRACTICE 2013-3-26
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