Today was day one of the two-day “8th Annual China-US Chengdu Ophthalmic Academic Exchange Conference”, a meeting of representatives from the Sichuan Provincial People’s Hospital, West China University Medical College, and various county-level hospital directors and doctors. In the midst of overwhelmingly technical talks about “selective laser trabeculoplasty” and “retinopathy of prematurity”, Dr. Farris, one of the two ophthomologists from DMEI, gave a speech on medical ethics and the patient-doctor relationship.
The essential message was: be nice to your patients. And the more I listened, the more I got the feeling that it was coming off as a little…patronizing. This is how you should act. This is how we act in the US. I think it was a point not missed by many in the crowd, and it made me cringe a little.
“Dr. Farris raises a good point,” one of the Chinese professors announces to the crowd in Chinese after the talk concludes. “But we know there are differences between the US and China context,” he follows in a slight undertone.
It’s an attitude shared by many, if not most, of the Chinese doctors here. I ask the resident next to me to clarify, and what she tells me goes something like this:
The most basic problem lies with a general population that already has an ingrained suspicion of doctors. The media commonly sides with the patient in highlighting medical malpractice cases, so patients are quick to judge. The high cost of healthcare doesn’t help the doctor avoid the image of a heartless profiteer (although the reasons for that high cost are much more complicated). Sometimes the patient recognizes that the mistake was not the doctor’s fault. But when that patient had to take out loans just to afford the surgery up front, he/she’s still going to sue the doctor if only to get the money back. For those living in poverty, I guess forgiveness becomes a luxury that’s difficult to afford. And in the end, in a society where reputation (especially for doctors) is everything, there’s often a lot more at stake than just the money.
It’s a prickly question. But one of the long-term goals of DMEI’s project here is to improve medical education in China, and that question is one we’re going to have to address before patients will trust residents to do surgeries on them. (Ophthalmic residents in China are averaging around 10 independent surgeries by graduation—most of them done at rural hospitals where patients don’t have the luxury of picking and choosing a doctor. Residents at DMEI have completed 250-300.) So that brought me back to my initial reaction, made me reconsider that reflex of dismay. Dr. Wei, a very accomplished cataract surgeon sitting next to me, had told me with pride that she doesn’t think US doctors are any better skill-wise than Chinese doctors. And with the vast surgical volumes that Chinese doctors go through, I’m willing to believe that. So what do American doctors have to offer, when they have the chance to come halfway across the world and give a lecture like today?
Dr. Jiang had told me a story last summer which I think I wrote about, but I’ll recount in brief here. She’s seen countless Western doctors come to work with Chinese doctors, and from what she’s seen there is essentially little difference in technical skill. But the difference she saw could be represented by two cases. The first was a doctor who was treating a young child with vision impairment. Chinese doctors typically will tell the parent to lift the child up to his/her eye level. This Western doctor got down on his knees to bring himself level with the child. The second was a doctor who’s patient didn’t return for follow-up. Instead of letting the patient slip by, he persistently tried to find out what had happened, going as far as repeatedly calling the patient’s home.
There’s no doubt there’s a difference in the context of patient-doctor relationships in China and the US. And as with any kind of societal-level change, it’s an uphill battle and it’s going to take more than a few years. But the cycle has to break somewhere, and physicians are in the best position to take that stance of courage, to change their way of responding to medical mistakes (which are guaranteed to happen to ANYONE) and in turn change patients’ way of responding to them as well. I think the US docs are here to give them a little push.
China may be unique, but I think the following quote has a truth that resonates universally:
People do not care how much you know, until they know how much you care.