Blog | Monday, January 20, 2014

Know yuan to say yuan: a report from Beijing on quality, patients and doctors


Recently I was a guest in Beijing of the General Internal Medicine department at Peking Union Medical College Hospital, or PUMCH. On this third full day, I had an enlightening chat with the medical student I have mentioned in previous posts.

We were walking towards an outpatient general internal medicine clinic down a corridor choked with people; these clinics are overbooked because of PUMCH’s reputation (I’m not sure if there is a doctor shortage in China generally). I asked how much it cost to see a doctor in this clinic. “7 yuan,” he said. I kept going. How much does a CT cost? An MRI? A knee replacement? He gave specific costs without hesitation. “How much does a CT cost in the U.S.?” he asked.

I laughed. We both knew the question is ridiculous. Transparency in cost and quality is a dream for the U.S. system given the extent of variation in health care use and that hospitals can charge whatever they damn well please.

It was appropriate, then, that I gave a talk today at PUMCH on public reporting: that is, information provided by various entities on cost and quality in the U.S., and whether this information actually changes decision making, patient satisfaction, or outcomes. An article we published on the topic is here.

The audience included not just doctors, residents, and medical students, but members of the medical affairs staff and those concerned with hospital quality at PUMCH. It appears there is not much research literature addressing how patients pick their doctors in China. Given the completely out-of-pocket nature of much of Chinese health care, however, it could be that greater price and quality transparency is possible in the Chinese system than in the American. To take one example, on-line doctor ratings in China appear to be widely used and, as I was told at any rate, influential.

The high point of today, however, was observing in the outpatient clinic of Dr. Jun Zeng, the head of general internal medicine at PUMCH and, in addition to being an internist, a rheumatologist. From a diagnostic and treatment perspective, I saw that she used corticosteroids in many cases where her American counterparts in rheumatology would use the increasingly popular, and expensive, TNF inhibitors. I asked her about this and she said proudly, “I’ve been practicing for 20 years and know how to use these medications in a stepwise fashion. Steroids work in many cases, and TNF inhibitors are not always needed.”

I loved to see how she sat a table face to face with a patient, writing in a notebook while her junior colleagues provided prescriptions to the patient she had just seen. “What’s the matter?” she started off a visit, and another, “What can I do for you?” Great openings. I couldn’t understand all the Chinese, but I could see someone who was doing her utmost to provide patient-centered care given the limitations of her system, which, come to think of it, I need to ask them explicitly about: what frustrates them about Chinese medicine in the same way that my frustrations typify American medicine?

Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews. He is also a poet, journalist and translator in Yiddish and English. This post originally appeared at his blog.