Saturday, March 3, 2012

To Visit a Doctor in The Peoples Republic of China

Well, as some of you may know from my newsletter, and for those of you who are just now finding out now, I've had the opportunity to experience a doctors visit in China in the same way that everyday ordinary Chinese citizens do. For my Facebook friends who do not receive my newsletter, let me give you a little background.

Shortly after returning from Australia on January 31st, I began to experience some discomfort in my upper abdomen, and on two occasions, some really severe pain.  Because this occurred while the students and staff were still at home for Spring Festival, I decided that if this did not clear up by the time they returned I would find someone to take me to the doctor. Upon their return, I had not really experienced any more sever pains, and had only some minor discomfort, so I told Tuo, a friend and an administrative worker about it and said if it did not go away in two weeks I would like him to go with me to help interpret. As you probably have surmised by now, it did not go away, and we made arrangements to have the visit on Friday March 2nd.

Early in the morning of March 2nd, around 4 a.m., I was awoken with pain in my upper abdomen, severe pain! After about an hour and taking some aspirin, which did not help. I decided maybe I should try to get Tuo to call 120 and go to the emergency room. So, I got dressed and went into the living room and sent him a text message telling him my pain was severe. I then sat down and opened my bible and came to 2nd Chronicles 19;20 and began reading about Jehu's rebuke of Jehoshaphat, and Jehoshaphat's reformation, and calling on the Lord when Judah was about to be invaded.  Oddly enough, as I read, the pain subsided, and I fell asleep. Since I had sent a text message, Tuo did not hear the message tone, but when he awoke around 6:30 and called to ask if I wanted to go to the doctor right away. I told him no, as the pain had subsided and that we would just follow our plan and go after lunch. On with the visit!

In China, you just don't go to the doctor, because there is no private practice so to speak (that may change in the next few years), you go to the hospital to see the doctor. Our plan was to arrive at 2 p.m. because like most government institutions, offices shut down around noon and then reopen around 2 p.m. That is not to say that in an emergency you would not be able to see a doctor, just if you are seeking a regular visit you have to wait for the normal time.

Back of My Chinese Medical Record Card
Front of My Chinese Medical Record Card
So, we get there and pick a line to stand in to wait for the registration- payment office window to open. When the window opened Tuo went to the check in desk to give them my personal information so that I could get my medical card. Every Chinese person has a card similar to this, but it also has their picture on  it as well. On the back of the card as you can see is a magnetic strip similar to the one on the back of our credit, and bank cards. Right now, it just has basic information such as name, age, place of residence, and is used to record your visit and payment information. The plan for the future is to have all information recorded to the card so that the required medical booklet can be eliminated. Right now, all of your medical records are recorded in this book:
My Chinese Medical Record Book
With the exception of your basic information, all the medical records are kept in this book, and all citizens are responsible for keeping the book safe and to bring the book with them for each medical visit.

Well by the time Tuo returned with these I was almost next in line. When it was my turn, I gave the lady my card, book, and passport (for I.D.) and she slipped the card into a reader, typed in some information to the computer, and then popped the cover of the book into a printing device, and it put my name, my patient record number, and age on the front.  I paid 5 yuan (.80 cents U.S.) for the card and after we told her the nature of my problem, she gave us a slip of paper that assigned me to see an internal medicine specialist on the second floor. So, we arrive on the second floor, give the receptionist our paper and are assigned a number and the office number we would go to when the number was called. Even though there were about 20-30 other people in the waiting room, my number was called after about 15 minutes. We made our way back to our assigned office. The doctor was still with another patient but Tuo walked right in and asked the doctor something as I stood in the doorway. You should know, there is no expectation of privacy in the Chinese hospital. That is just the way it is, and the Chinese people are use to it and don't seem the least bit phased by it.

Well, it became my turn and I sat down across from the doctor as Tuo told her my symptoms. She asked a couple of questions and through Tuo I gave my answers. She then had me lay down on the examination table and began to examine my abdomen and lower stomach, apply pressure at various points and asking if it caused any pain. (just like a U.S. doctor would do). Meanwhile, other patients who were waiting to see her were milling in and out asking questions and inspecting the fat laowai (by the way, I have lost 4 more kgs=8.8 pounds) being examined.  This is very similar to my experience when I first arrived in China and had to take a physical. People would come in and out of the exam rooms where I was being seen and asked the docs questions and take a peek at the foreigner being examined. So, I was not totally surprised that this would be happening during this visit.

After the examination, she wrote something in the medical book. I presume it was her findings based on the answers to my questions and her physical examination ( I have not asked Tuo for a direct interpretation yet). She then sent us to go have a sonogram of my abdominal area from the top, and both sides. But, first we had to go pay. The cost was 136 yuan (about $22 U.S). We made our payment, and then went to the wing of the hospital where the sonogram would be performed. We go to the reception window and show the lady our instructions and payment record and she sends us directly back to where the sonogram would be performed. Up until this point, I did not feel I was getting any preferential treatment because I was a foreigner, but kind of did so when she sent us back first while there were quite a few people in the waiting area. However, they could have been waiting for some other type of testing. Maybe I was just fortunate and the Lord opened the path because he knew Tuo had to be back at the school before 4:30 in order to catch the bus back to his hometown in Zhenjiang.

Anyway, we go in and I am instructed to lie on the table and the specialist begins her work. As she takes her pictures, she tells the person next to her what she is seeing and he types the notes into the computer. I commented to Tuo that this is the type of procedure that is often performed on pregnant women to see the fetus. I was under the impression that Chinese women were not allowed to have this procedure, but as I was getting up, a very pregnant Chinese woman was in the room waiting. So, obviously, they can have the procedure. However, my understanding is that it is against the one child policy  regulations to inform them of sex of the child. ( If any of my Chinese readers would like to clarify this, right or wrong, send me a comment and I will publish it in the comment section.)

With the sonogram complete, and picture in hand, we head back to see the doctor. As we arrive, I see an older couple waiting outside and see the doctor consulting with another patient. Tuo walks right in as I protested that we should "wait our turn". He informs me that there is no need to wait, that you don't get a new number and you have the right to see the doctor once the test is done. Reluctantly, I just followed his lead. After the doc finished with the patient in front of her I sat down across from her while she looked at the sonogram and read the notes. She then wrote her opinions in the medical record book, and then informed me that I had gall stones. She said that she would like to have another test done to determine whether there is any blockage in the main duct leading to the gall bladder. However, that test would have to be scheduled in advance. I am assuming it is going to be some sort of x-ray, or possibly a ct scan. So, next week, I will go back and schedule an appointment that is convenient for Tuo to go with me.

My First Recorded Chinese Medical Record
In the meantime, she prescribed some medication and gave me two options for taking the medication. I could come back next week for several nights and take the med by IV (for my Chinese readers, the drip, or drop), or I could take the med in pill form. The popular option is the IV because it works faster, but, I really don't have time to come back each night, so I chose the pill form route. So, with this portion of the visit concluded, she gives me back my book with her notes, and an order slip for the pharmacy and off we go. At the pharmacy window we pay 26.5 yuan ($4.20 U.S.). As some added information, your really don't need a prescription for most medicines like in the U.S. You can just usually go to a pharmacy store and by what you need over the counter. I have purchased penicillin and amoxcylin many times for my annual bronchial infections.

Overall, a pretty good experience. Total time invested from start to finish, an hour and a half. Total cost of the visit: 167.5 yuan ($26.59 U.S.). I should mention here that there are no fees for the doctor or the specialist performing the test. They are paid government employees. While I did have as good as experience as possible for a medical visit, I feel the need to add a few caveats.

First, as you can see that health care in a socialist country is not entirely free (neither is a college education as some of those OWS people think they have a right too). In fact,  Each year, the Chinese people are paying more and more for their health care. I am fortunate to have a good paying job, so my expenses were minimal to me. But for those without health insurance, and that are making minimum wages the expense can be somewhat of a burden. I have been told to save my receipts and turn them into the school and they will submit them to the insurer for reimbursement.  So, when I find out how much the insurance covers, I will update this and let you know. By the way, I am told that the second test will be a bit more expensive, a little over a 1000 yuan (around $158 U.S.). Again, for someone like me with a good paying job, this is not a great expense. However, with some one with no insurance, and at minimum wages, (depending on the city, this can be anywhere from 900-1200 yuan a month, and I would suppose just like everything else, in larger cities like Beijing and Shanghai these fees would be substantially higher) these fees could be quite burdensome.

Secondly, even though there are no doctor fees, I've been told that if you want to get excellent service, you need to slip the doctor a "hong bao",  a red envelope with cash in it. The more cash, the better the service. Altough, during my visit, I did not see this happening, nor did I give my doc a hong bao. I have some friends who related to me that at the birth of their child, they slipped the doctor two envelopes with grocery  cards. They would not tell me how much money they had put on the cards, but they did so as payment for the doctors special attention. Right or wrong, this is just the way it is, and I am told that it is common practice and the Chinese people are use to this method. As I said earlier, Chinese medical workers are paid government employees and are not generally paid as well as their western counter parts, and also have the expense of their schooling to pay for, as well as probably putting in more ours than their western counter parts. Again, if any of my Chinese readers would like to clarify this, or add their commentary, please do so and I will publish your comments.

Thirdly, even if some of the medical expenses are subsidized by the government, the sheer number of the population 1.3 billion and growing, along with the aging of the population, places a greater burden on the government resources, and this is getting harder and harder to balance. Not to mention the burden on the people who pay the taxes, from which the government derives its resources . I know that everyone talks about how great the Chinese economy is and all that, but there are many problems underlying the economy that are not readily visible or often reported by the press. State subsidized health care is one of them.

Finally, I don't want to be political in these blogs, and this is as political as I will ever get, (well, besides the OWS reference mentioned earlier) but a socialist health care system is not the panacea that it is made out to be, and with the current legislation recently passed in the U.S, this is where we are heading. Now, I know that our health care system is in need of reform, and that millions of uninsured workers need a safety net (by the way, in the U.S, I am one of those uninsured) but I believe that the bill rammed through congress will eventually only make our health care system worse, and not better. The bill has not even gone into effect and there are already problems associated with the implementation, and major questions are now arising about the supposed savings this bill would bring.

 There is an old saying, "you get what you pay for". So, to that end, if we are not paying for anything (except insurance premiums) what kind of treatment are we going to get? Will we be slipping "hong baos" to our doctors? I believe we should have attempted to bring reforms to the practices associated with insurance and the actual medical practice itself. Insurance companies do have a right to make profits, and doctors should have the right to practice without the worry of some frivolous lawsuit that forces them to order every test imaginable to protect them from malpractice claims (an insurance issue). Yes, there are bad doctors out there and everyone knows it. Part of that solution would be for the AMA to rigorously pursue and enforce medical standards and ethics. The trouble is, there is too much protection afforded and too little punishment meted out to the bad doctors, all because they are "one of their own". Doctors protect doctors, and lawyers protect lawyers. It is time they are reminded that they are to serve the people that pay them, and not protect the profession at all costs. Punishment would only enhance the reputation and increase the peoples confidence in them...Ok, end of the rant, and that will be all the politics that you will see from me on this blog.

So, there you have it, my experience with the Chinese medical system. Thus far,  speaking as someone who has the resources to pay without feeling of being burdened by the expense, and as someone who has now experienced both eastern and western healthcare, I must say twas an excellent experience. If any of my Chinese readers want to share their experience, I would love to hear from you.  As always, feel free to ask questions or comment, and I will do my best to respond to your questions. All comments will be published and of course you can comment anonymously if you desire. And, if you are so inclined, please say a few prayers for me. Thanks for reading.

1 comment:

  1. I have some corrections. First, the medical card I received is only good at that hospital. If I go to another hospital, I would have to get a new card for that hospital.

    Second, when I said the difference between my card and the others was that they had a photo. The card with the photo is actually their citizen card that shows their residency. They still need to have the additional medical card.

    Third, I did not get special treatment for the sonogram. I am told that the doctor wrote up the order as an emergency.

    Fourth, I have been told that there are drugs that have to be prescribed by the doctor. Even so, there are many drugs available over the counter that we would need a prescription for in the U.S.

    Lastly, pregnant Chinese women are allowed to have sonograms, but they are not allowed to know the sex of the child.

    Corrections provided by my friend Tuo. Thanks buddy!


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