Western Physicians in China see things differently

Dr. Richard Cyr of the excellent “My Health Beijing” blog has had a practice, in Beijing, for the past three years.  Sometime ago I communicated to him that it would be fascinating to read how his Beijing experience differs from his experience as a physician, in the United States. Over on his blog, he recently put up an entry called “An American Doctor in China: What’s Different?”

I’ll let you read the blog entry yourself, but let me just point out my favorite paragraph:

#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…

Over prescribing has been a reiterated theme on this blog (most recently here) and we’ve often pointed out that’s it’s not just doctors who are to blame for the over prescription of drugs.  Patients all over the world are more than willing to ask doctors to prescribe certain treatments.  The rise of direct to patient advertising and web based resources like WedMD,  in the United States, has exacerbated this problem beyond antibiotics.  Dr. Richard Cyr points out that patient ignorance is hard to battle when doctors are over burdened with patients and only have three minutes to see each patient; indeed, the short amount of time that doctors in China (and other overburdened systems) have to see patients, reinforces the over prescribing of drugs.

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.

I will only add that good news is around the proverbial corner.  Wit the new Essential Drug List and accompanying changes in the ways that hospitals in China prescribe drugs, as well as new investments into medical education and hospital systems via China’s health reform, over prescribing should become much less of a problem…though under the table payments are another problem.