Dr. Rich is an Emergency Medicine physician from Los Angeles who is currently practicing in China. He was given the name Wang Shi Kai by the Chinese Medical Board. This is the continuation of his first email, which can be found at this link. In this series of posts we feature his emails sharing his unique experiences practicing medicine in China.

I work at 2 drastically different hospitals, just like I did in L.A. One is an expensive private hospital, the other a public hospital. The private hospital is state-of-the-art but people who come there are wealthy and expect over-the-top 1st class service. They do not tolerate waiting to be seen. About 70% of the patients are local Chinese, the other 30% are an international clientele from over 200 different countries. Many foreign embassies are nearby and we also have a contract with the Beijing Airport to see travelers who get sick. We have a good specialty call panel, including Neurosurgery and Cardiothoracic Surgery, and I can get lab tests and imaging results, even MRI's, very quickly. It’s interesting to see radiologists actually come to the ER to examine some patients before they give a read on the imaging!

I’m happy that we have a Pediatrician to see all the children who do not have trauma-related complaints. Every time I turn around there is another parent rushing their child through the ambulance bay doors with a fever. They carry them like they are near death but most of them just have viral illnesses. There seems to be a real fear of fever and parents often demand a CBC and CRP. We did have one case last month where a young patient with a fever was sent home and later died. They family came back to the hospital seeking revenge on the Pediatrician and barricaded her in a room for several hours while security tried to intervene. It’s also common for parents to request Plastic Surgeons for simple lacerations. They are obsessed with scars. It can be very uncomfortable trying to suture a child with 6-8 family members standing right next to and behind you, critiquing every move. I saw a father tell a Plastic Surgeon, who was doing a great job on a complex facial lac, that he saw the surgeon’s hand shaking.

The patients must pay up front in both the private and public hospitals before being seen. I have seen people with severe chest or abdominal pain just get up and leave once they are told of the cost. Every lab test and study has a price listed next to it when you order it, such as a CT scan of the head which costs about $1200 US. Things are much, much cheaper in the public hospitals. There are no EMTALA laws here. You can just call an ambulance and have the patient taken to another hospital if you can’t provide the services they need. You don’t have to look around for an accepting hospital or talk to a receiving physician. The patient just disappears.



I see about 1.5 patients an hour in the private hospital, in addition to supervising Fellows and residents, but that’s because people demand thorough explanations of their problems and are paying a high price for service. Customer service is the rule. The public hospital, on the other hand, is complete chaos. A doctor might see 60-70 patients in a 12-hour shift. Many doctors get angry if the patient even asks a question. There is a serious strain on the relationship between doctor and patient in the public hospital. And the doctors get kickbacks by prescribing drugs, so they are very keen to give IV antibiotics and many other medications when they are not really indicated. The patients are quickly discharged with a prescription, admitted to the hospital for Observation or further treatment, or sent to see a specialist. There are various specialists such as Nephrologists, Neurologists, Pulmonologists, etc. who have a few chairs or beds in the ER and continually see patients that are triaged to them. Most patients in China do not have a PMD or Family doctor. They are used to seeing specialists for whatever the origin of their problem is thought to be. I recently saw a young, healthy female with a simple earache and her family was disappointed that I was not an ENT physician.



On one of my first shifts I took care of a patient with an eye injury after getting punched. He had severe swelling, loss of vision and ultimately needed a lateral canthotomy. I called the Ophthalmologist on-call who didn’t seem to know what I was talking about, even when I had a nurse explain it to him in Chinese. Something about he was only an expert on certain parts of the eye, not the part I was referring to. I explained to the patient what I thought he needed, then told him I had never done one before but had read about it. I tried to refresh myself by looking it up on YouTube but, of course, YouTube is blocked in China, so I did the best I could. And it worked! The patient got his vision back and later I was able to find an Ophthalmologist who could take over the care.



I’m learning a lot about Traditional Chinese Medicine. Some patient’s prefer these treatments and even though I’m not exactly sure what I’m prescribing, I’ve used some remedies for sore throats and even a topical powder to promote hemostasis from a bleeding cervical biopsy site with success.



I think in the end this is going to be an amazing experience, just what I was looking for after working in ER’s in California and New Mexico for almost 20 years. I won’t be seeing any gun shot victims but I don’t mind a break from that. I hope to return someday with lots of stories and wisdom. I really wish I could have seen your class through to the end but keep in touch and we’ll meet again. The world is a small place.



Best,

Wang Shi Kai