This post is part of a series we are calling "Best, Wang Shi Kai." Dr. Rich is an Emergency Medicine Physician from Los Angeles who picked up and moved to China where he is currently practicing. He was given the name Wang Shi Kai by the Chinese Medical Board. In this series of posts we feature his emails sharing his unique experiences practicing medicine in China. Here are the links to his first email which gives some background Email 1 Part 1, Email 1 Part 2

Continued from last email where Dr. Rich described his patient interactions and interesting cases. In this post Dr. Rich discusses his frustration with the antibiotic prescribing patterns of his colleagues.

-Now that it's Winter, the hospital supplies warm jackets to the clerks and nursing staff. The jackets stay in the ER and they are shared amongst everyone. I'm pretty sure they never get washed.

-Parents do not trust doctors. They usually insist on blood tests or imaging to validate a diagnosis. At a recent conference trying to limit antibiotic overuse, one of our Pediatricians stood up and said that all children with a fever should receive antibiotics. Many of our pediatricians (and ER doctors and Internists) will prescribe antibiotics for anyone with an elevated WBC or CRP, usually without drawing blood cultures. I recently saw a 19 yo female who had a fever for 5 days. On ROS, she may have had some dysuria. She had been to 3 different hospitals over the past 5 days. The first one did a CBC and CXR. The CXR was negative. Her WBC was 12 so she received one dose of Ceftazidime IV. No prescriptions. The second hospital didn't do any tests but gave her a dose of Clindmycin IV. No prescriptions. The third hospital also didn't do any tests but gave her a dose of Ribavirin IV. I did a UA and she had 50-100 WBC/HPF and discharged her on Cipro.

-A patient with fever, cough, SOB and hypoxia went to a local hospital where they only did a CBC. His WBC was normal so he was given 1 dose of IV antibiotics and didn't receive any prescriptions. When I saw him, he had a pulse ox of 84%, LLL crackles, and a large area of consolidation on CXR. Good thing his WBC was normal!

-I read the note from one of our Pediatricians who saw an 18 month old girl who presented with one episode of vomiting. Her brother had similar symptoms and was treated with antibiotics. The Pediatrician's note read as follows: Vomiting. No diarrhea, urine OK. WBC 36,000. There was no temperature documented. No abdominal or Neuro exam. No urinalysis. She was discharged with Zofran and Amoxicillin. Good luck.

-Doctors at the local hospitals get kickbacks from drug companies for giving IV antibiotics and many of these doctors rely on that money for their income. There is an incredible antibiotic overuse problem. And many patients are so used to getting them that they insist on it.

-Over the last few days here, the air quality index has been terrible. I've never seen anything like it. You can actually taste the air. I can't even see some of the buildings across the street. And yet people are still smoking everywhere! Including in the elevators in my apartment building. I've "borrowed" a few N-95 masks from the hospital for my commute.

I have some more stories but I'll save them for another time. Despite all the above, I'm enjoying my new life and I love my colleagues, even if we do have different opinions. The nurses are all eager to learn and they continue to surprise me with their kindness. On the morning after Thanksgiving, following a busy night shift (I think I've worked 25 Thanksgivings in a row now) they brought me a breakfast of homemade porridge, dumplings, soy milk and bread. It was as good as any turkey dinner I've ever had. I hope you are all doing well. Please pass this along to anyone who might be interested.

Best,

Wang Shi Kai