This is the essay I turned in to complete my China rotation. It's a little long, and wordy, but hey, that's me.
I really didn’t know what to expect of the Chinese medical system. Consciously, I didn’t think much about it; I was more concerned with what I needed to pack for a month overseas than what I would actually do when I got there. Subconsciously, however, I think I had more stereotyped ideas.
The first hospital we visited, T, was
In the afternoon, we visited the wards, where the difference was much more striking. Each room held eight to ten patients, plus several family members for each patient. There were no curtains or privacy walls, and the restrooms were down the hall for the use of the entire floor. They appeared to be less than sanitary. Each patient had a water jar or a baby bottle at the bedside; I assumed the baby bottles were for patients who were bedridden and couldn’t sit up. Each patient had a folder at the foot of their bed containing their films, which we could go pull out and examine at the bedside. Patient privacy laws must be less stringent than HIPAA, because we would discuss the case in the room in front of all the other patients and all the families.
The next day at T we visited the ICU. The ICU attending was very interested in American end-of-life ethics, and we talked for quite a while. We gathered that there are a limited number of ICU beds in a Chinese hospital, like ours, but they don’t seem to have LTACs or other places to send patients needing high-level care, so those patients simply remain in the ICU. Then, the family takes ultimate precedence over what happens with the patient. Thus, if a physician wants to transfer the patient out of the ICU (I assume because care is futile), the family may request that the patient stay. Every bed was full while we were there, and he seemed upset that families may request a patient to remain in the ICU even while other patients need that bed more. This is a situation that is at least similar to ones most of us have faced in the States, as there are never enough ICU beds for everyone who needs them (or so it seems). It did seem, from speaking to that attending, that few Chinese have any kind of DNR or Power of Attorney paperwork (or family discussion), which complicates the situation.
The most interesting difference is that they recognize brain death, but it is not a legal criteria of death. Therefore, if a patient is brain dead, they still have to convince the family to remove life support, whereas in the States (at least in those states that recognize brain death without qualifications) once those criteria have been met, that patient is legally deceased. Life support is withdrawn because the patient is not alive; it is a different situation for us than a patient in a vegetative state where life support is withdrawn from a patient who would continue living on it. I remember how much relief the brain death standard gave to the physicians when I was on neurology, because there were no tough decisions to make at that point; the patient was brain dead, therefore they were dead. It was much harder if the patient retained one brain stem reflex but otherwise had no cortical function, because then the family must make a terrible decision. All in all, the situations doctors face in ICUs regarding end-of-life are fairly similar in
The biggest difference between our health care systems took the majority of the trip to elicit. We asked this question at every hospital, of every resident and attending, and received varying answers. Finally, at
The Chinese system is much more capitalist than ours regarding payment for service. Much of the work American hospitals do is unpaid; in
Overall, I learned many things about the Chinese health care system, and by contrast, many about our own. I saw the differences between Chinese and American medical education, and I am very glad I don’t have to learn medicine in Chinese (but Chinese doctors have to learn medicine in English). I learned a bit about Traditional Chinese Medicine, if only enough to know the terms to look up for patients in the future. I witnessed a living example of an ethical situation that had been only abstract until then. The Chinese system would be an excellent system to study here in