What’s up Doc?

A favourite thread for the ‘China ranter’, surely, is the enormous gulf between rich and poor in this society supposedly forged through class struggle; and the inequality this imposes. It wouldn’t be a huge leap of faith to guess that another area that draws criticism among expat ranters and others is the health care system (I use the term loosely).

It may be an unoriginal topic for a rant, and readers may not want to give me points for originality, but it doesn’t seem to have a great deal of coverage on LL, so allow me to indulge.

During the National Holiday just past (October 2009), while billions of Yuans’ worth of military hardware was forming part of a dazzling display in Beijing, along with thousands of intensively trained military men and women, this lost laowai, living in Shanghai, had the misfortune to develop a minor physical ailment. After trying some traditional home remedies, and finding them ineffective, my Chinese girlfriend, bless her, searched the Net and found a hospital located in Yangpu District, an hour or so away by subway. It was advertised as specializing in treating dermatological conditions, which was a good match for my ailment, and was also open over the holiday, unlike most of the larger public hospitals. A handy internet chat service which enables you to get advice/make an appointment told us that their star physician, Professor Gu, was available the next day, and so the next morning we set off, with my limping rather pitifully due to my affected foot.

We arrived, and were told to wait for a consultation with Prof. Gu, and sat on the chairs in a corridor outside the doctors offices. A man came out of Prof Gu’s office, stood next to me, and smoked a cigarette, before going back into the office. We waited for almost an hour. Then the man and Prof. Gu came out together, both smoking – and walked off somewhere. A nurse told us that Prof Gu was unavailable now, as he had surgery, and we were told another doctor would see us. We were ushered into a room where a consultation took place. At this point in the rant, I would like to highlight that I am not going to rant about the shoddiness of the hospital, and the smelly toilet, as that is not central to what I want to say.

The youngish new doctor, who declined to introduce himself, or identify his level of expertise, examined my offending appendage, and seemed a little baffled. He hummed and hawed, and asked me a question for which the answer was self-evident, and which he should have been able to answer himself. He then inspected my tongue, and felt my pulse for a minute or so, this being a hospital that combines TCM (Traditional Chinese Medicine, and Western Medicine). He then made a diagnosis that neither I nor my Chinese girlfriend could really understand fully, wrote out a prescription for some Chinese medicine, some Western medicine, and told us to try this and come back in a week if the problem was still ongoing. Neither my girlfriend nor I were filled with confidence by this consultation, but we dutifully went to the payment area, where we were told that the medicine, both Chinese and Western, would cost 550 Yuan. We decided to leave without buying the medicine.

Two days later, my condition had become painful, as well as affecting my ability to walk, and we decided to go back to the hospital, and this time make sure we spoke to a ‘Professor’, to get a second opinion, and whose greater experience may help us to feel confident in the diagnosis. At this point the large hospitals nearer to home, like the recommended Huashan Hospital, were still closed for the holiday. So, we went back, and made sure we spoke to a Professor. When we went into the Professors office, there was a family of three sitting there, who appeared to be in the middle of a paused consultation, and the Prof had also called the youngish doctor from last time to be present. He didn’t greet us, and looked on unsmilingly as the the Professor asked what the problem was – I felt that our seeking a second opinion had turned into us ‘dissing’ the first doctor. He looked at my foot for a moment, touched it briefly, looked at my tongue and took my pulse, and then told us that the previous diagnosis was correct (the alternative was to tell us his colleague was wrong in front of his colleagues face). We dumbly nodded, took the new prescription he wrote out, and went to the payment area. I found this time round it was about 100 Yuan cheaper than last time, so I went back to ask why, as I felt that both doctors had failed to explain clearly what their diagnosis was, and what they were prescribing and why. The doctor told me that some of the Chinese medicine previously prescribed, something to do with a snake, was unnecessary, so he had scrubbed it. All I could say was “oh, right”.

We paid just shy of 400 Yuan, and then waited 3 hours for the Chinese medicine to be prepared and put in little plastic pouched to take away. After using this medicine for 2 days, my problem had become significantly worse. I couldn’t walk, and was in pretty severe pain. The enormous and painful blister that the Professor and his colleague had told me not to lance was so large it looked like some alien was growing out of my foot. The pressure within it was causing me a lot of bother, and there was no way I could go to work, except maybe on crutches (OK, call me a baby if you want, but you weren’t there man). On the third day of using the medications given by the Prof. I couldn’t take the pain anymore, and luckily Huashan hospital, of great renown, was open after the holiday break.

At first we considered just using the ordinary service offered on the first floor. There is also a VIP and Laowai service on the 8th floor, where they speak English, and it doesn’t resemble a busy bus station. The first floor was just mobbed with people; people filling out forms, people waiting in chairs, people standing around, and a person shouting abuse in Shanghainese at one of ladies behind the desk, who gave as good as she got. It is an important life skill to know when to say ‘bugger this for a game of soldiers’, and one I don’t have. My girlfriend does though, and she told me in no uncertain terms that we were going to the 8th floor. Yes a consultation is 500 Yuan instead of 50 Yuan (what!?), but that’s what we did.

Ah. Relief. A polite nurse asked me for some personal details, and gave me a form on which to fill in my name. Easy. We waited 5 minutes in a quiet (empty) waiting room, with soft chairs, and then were led to the doctors office. No one was smoking. The doctor waited patiently while I explained the history of my brave little foot, and examined it briefly. She seemed certain of how to treat it. She told us what it was and what it wasn’t. She told us what she was going to prescribe, why, and how to use it. We thanked her, used the excellent and spotless toilet, and went on our way. We did as she said, and all the pain went away.

I had spent 573 Yuan. I hadn’t waited, I felt hadn’t been fobbed off without alternatives. If I had stuck with the original hospitals treatment I would have needed to take several days off work due to immobility, and then would have gone all the way out to Yangpu, probably to be prescribed more foul tasting Chinese medicine, and ineffective creams (which the Huashan doctor told us to discontinue as it would be completely ineffective), and paid another 400 Yuan.

So. Ranting is fine, but if one can rant constructively, it is finer. My advice to you people out there, of whichever colour and creed. If you are not sure what your ailment is, but you are thinking of saving a few kuai by going to the dodgy private hospital, which advertises on TV, but has much cheaper consultation fees, DON”T! You will very probably end up paying more in the long run due to irresponsible diagnosis, and exorbitant (possibly repetitive) charges for medications.

The superiority of the VIP/Laowai service (not marketed exactly like that by the hospital, but almost) seemed manifest to me. My poor long-suffering girlfriend actually became very upset and angry during this process at the sheer disparity between the VIP/Laowai service, and the services used by the vast majority of Chinese. The latter seemed designed and delivered in order to keep the patient, or rather customer, in ignorance and in thrall of the illusory superior knowledge of the doctor, so as to extract as much money as possible. Everyone knows about the ‘have’s’ and ‘have nots’ in China. Fine. I don’t want to moralize about that. I would be very impressed and grateful however, if the Party would put as much energy into creating a healthcare system with a culture of standards and accountability, as they have in creating a spectacle of military strength and organization this year. I was very impressed at how so many soldiers can march with such precision – please bring that culture of detail and excellence to where it matter most.

Healthcare fact file

Country Total expenditure on health per capita (USD) and % GDP spent on healthcare:
China USD342 4.5%
Czech Republic USD1,490 6.8%
Brazil USD765 7.5%
Egypt USD316 6.3%
Russia USD638 5.3%
India USD109 4.9%
Albania USD358 6.2%