Under the Knife: Why Chinese Patients are turning against their doctors | Hacker News Reader

Under the Knife: Why Chinese Patients are turning against their doctors

newyorker.com

54 pointsGabrielF0043 comments

I once accompanied a friend with a bad cold to a hospital in Shanghai. They ran a blood test, and the doctor announced that she had a viral infection. He then handed her a (fairly expensive) prescription for antibiotics. Now, as anyone who's studied biology (or even Googled 'antibiotics') knows, antibiotics have absolutely no effect whatsoever on viruses. I called the doctor out on it, and he scowled at me and said something like "foreigners do things differently".

Apparently antibiotics account for around 24% of total hospital revenue in China[1], which may explain it somewhat.

1.http://content.time.com/time/world/article/0,8599,2103733,00...

Did you post a very similar comment about that anecdote on a story about antibiotic use in China a few months ago? I feel like I've read that quote before.

Anyway, crazy stuff.

Haha, indeed I did. Although I'm sure many others who've lived in China have had similar experiences. About 75% of patients with seasonal influenza are prescribed antibiotics[1], so I think being prescribed antibiotics for viruses is pretty common.

1. http://www.bmj.com/content/348/bmj.g1083

It's the same in Vietnam. Everyone I've talked to here that's been to the doctor has been prescribed antibiotics, no matter what the problem is. What's worse, they often only give patients a few pills and not a complete regimen. I can only imagine how much this sort of thing contributes to antibiotic resistance.

"Bacterial superinfection in viral respiratory disease is a clinically well documented phenomenon."

http://www.hksid.org/pdf/bult200305.pdf

"Respiratory viral infections may facilitate secondary bacterial infections"

http://www.ncbi.nlm.nih.gov/pubmed/15166819

The doctor might have had some information about his patient, which you don't?

If he did, surely he would have told them about it, rather than just say, "foreigners do it differently".

That's not always the case. If an amateur with no knowledge of my field questions 20 years of my professional experience, I am highly likely to say FU.

My doctor friends get really annoyed when I read something on WebMD and argue with them. 8 years of schooling makes them an expert and I'm just being a jackass for thinking googling grants me an MD.

If it were somewhere else I'd have considered that, but considering how widely recognised the problem of antibiotics overuse in China is I considered that more likely.

"At medical institutions about 70 percent of hospitalized patients have antibiotics prescribed by doctors but nearly 80 percent of those prescriptions are unnecessary, Yang (director of the behavioral medicine branch of the Chinese Medical Association) noted."[1]

"Each year on the mainland about 200,000 people die from adverse drug events and 40 percent of the deaths are related to the abuse of antibiotics, Yang told the Beijing-based Health News."

1. http://usa.chinadaily.com.cn/epaper/2011-01/05/content_11798...

Foreigners do do things differently; for example, it's widely believed in China that getting IVs of saline solution is a healthful practice. I assume they're not particularly expensive, because people go to the hospital for IV drips whether they're sick or not.

It's also very commonly believed that giving children cold beverages will damage their health. Doctors can be just as superstitious as their background population.

So much grief but still focused: I asked Wang Dongqing whom he blamed for his son’s (the doctor) death. “I blame the health-care system,” he said. “Li Mengnan (the killer) was just a representative of this conflict. Incidents like this have happened many times. How could we just blame Li?”

Wow:

> When People’s Daily, a newspaper that acts as a Chinese government mouthpiece, posted an online questionnaire asking readers to rate their reaction to the murder, as a smiley face, a sad face, or an angry face, sixty-five per cent of readers chose the smiley face.

After having read the accounts of what their health care system is like, it's not hard to understand this level of outrage. It sounds like many of these doctors are exploiting the hell out of their information asymmetry in order to defraud and extort patients who have already been driven to desperation by their ailments. Arguably this behavior is due to the fact that the doctors are underpaid in the first place, but I doubt anyone expects that to be much comfort to the patients.

If Wang Dongqing was privy to his son's misgivings about the moral compromises he and/or his peers were making then the possibility of patient retaliation must have haunted him for some time. The fact that his son died as collateral damage rather than as a result of a slight he personally committed really drives home the fact that the only solution is to address the issue at the system level :/

What? This kid murdered an innocent person in anger. It starts, and it ends there. Whether it was collateral damage, or how angry the kid was, is irrelevant.

It's like saying: you know, there's all these fat people that are constantly abused and get run-around by pretty girls. They are suffering so bad, it's not hard to understand their level of outrage when one of them raped a woman.

Seriously, violence against innocents can never be justified. No matter the rational behind it. And by defending them and their actions, we're just giving them credence and making them think their anger and actions are "not their fault".

Causes or context for violent acts can be understood and taken into account when considering the act. Thankfully, most judicial systems do this.

Taken into account? Please elaborate...

What sorts of things/causes/context can justify or play-down the severity of violent actions, in your view?

Duress. Lies/false information.

Or even premeditated vs. crime of passion, which is well established in our legal system.

Or, how about that ?Italian? guy who hired thugs to kidnap his daughter's killer and extradite him to face trial

HN users are down-modding legitimate questions to spark debate? Interesting.

I up-voted your parent comment, because it was a semi-legitimate question (semi, because the GP comment you made was a bit wild/out of context).

However, asking the forum 'why' or playing a role of down-vote brigading is frowned on. Just make your points :)

Easiest to understand would be crimes of passion. Someone who kills without pre-meditation is usually considered to have committed a lesser crime than someone who planned it.

Then you have more complex situations. Killing an intruder in your home for example. The details are crucial to understanding if it's justified or not.

Even more complex are the rules of engagement in war. Was the bombing of Dresden justified, etc.

Every society grades and judges violent acts in context.

You mean "mitigating factors"?

http://en.wikipedia.org/wiki/Mitigating_factor

Where are you from, if I may ask? They're a very well established part of the legal system in lots of places.

You'd like the world to be black and white, heroes and villains. It's not that simple. Sometimes there aren't any good guys.

What does it say to you that the father of the innocent victim blames the system first and the killer second?

It's not about heroes and villains. It's about right and wrong. You're more than welcome to fill in the blanks between right and wrong with mushy grey area, however, some of us have higher moral standards and don't deem actions less wrong if the aggressor was "angered", or "ill".

"What does it say to you that the father of the innocent victim blames the system first and the killer second?"

It gives credence to my points. It shows the level to which people have been brainwashed/tricked into thinking that violence is "ok as long as there is some reason". This individual was able to justify and excuse a person violently murdering their loved one due to whatever circumstance. Rather than just calling it senseless violence and coincidence, and holding the violent individual at fault.

At the end of the day. Someone chose to take another person's life. And all these people are pretending that's okay, or "less wrong". Circumstance, or not, this person made a willing choice and decision to take another person's life, to end it, forever. I hope everyone here let's that sink in, before they try talk about "mitigating factors".

Conflating facing a severe and painful disease [1] while being repeatedly dicked around by the medical system through a combination of incompetence and greed with an entitled asshole who rapes a woman because he feels like he's, well, entitled to have sex with people he finds attractive is pretty stupid.

As was explained in the article, the murderer had endured a painful illness, a misdiagnosis, used his grandparents' life savings and borrowed money for treatment, traveled some distance, had treatment interrupted, was blown off again by the medical system, and snapped. Of course it doesn't justify murder, but it is quit different than, for example, a premeditated murder over money.

[1] http://en.wikipedia.org/wiki/Ankylosing_spondylitis

He felt entitled to retribution. The fact that he was "dicked" around by medical individuals over a more serious matter does not nullify the comparison, here are the details of the two scenarios:

In both scenarios the victim's were not directly to blame. In both scenarios a larger group of people "dicked" around the aggressor. And in both scenarios (one hypothetical) the violent actions are being downplayed, or justified because of some sort of indirect harm towards the aggressor.

This backlash just shows how easy it is for people to conflate the issues involved. It is in essence justifying violence against innocent individuals, and frankly, it's sickening.

"Of course it doesn't justify murder, but it is quit different than, for example, a premeditated murder over money." Murder is murder, I don't see the distinction here. You can't go ahead and say murder isn't so bad if the aggressor was "having a bad hair day", or any other trivial issue. If you want to say that this individual was justified in his act of killing because he was in danger and was forced to do so, or was defending himself, then fine that's a different issue.

>It's like saying: you know, there's all these fat people that are constantly abused and get run-around by pretty girls. They are suffering so bad, it's not hard to understand their level of outrage when one of them raped a woman.

That you think this is a sensible comparison says much more about you than anything to do with the case at hand.

Oh and what would that be? Other than I don't condone violence of any sort against an innocent, no matter how "mitigating" or "angered" the person is.

"Joe Passanante, a doctor from Chicago who did a stint at Beijing United Family Hospital, told me that he was once performing CPR on a woman when the parents of a girl with a fever walked into the room. “Here I am pushing on a dead person’s chest, trying to revive her, and they’re asking me to see their daughter,” he recalled."

It seems like a totally different world in so many ways but this quote highlights it for me.

United Family Hospital is very different though from the typical public hospital. It's a private hospital where a simple consultation with a doctor costs about 2000 RMB (around 325 USD) and is geared towards expats with good health insurance or rich locals.

It's worlds apart from the public hospitals they were talking earlier in the article and is really not representative of the situation. There, the doctors are more likely to deal with entitled customers who feel that they should be treated with the respect their money affords them.

Not my experience with Chinese hospitals, and I've seen several (with consultation fees of 2 CNY - not the entitled rich crowd). Usually there are five or six other people pushing each other to get the doctor's attention inside the office. It's nearly impossible to be seen without some less-than-violent strategic body positioning without eye contact. No such thing as privacy, even in gynaecology.

I attended a conference on pulmonary medicine once. There was a surgeon speaking about his trip he took to China. He had removed a tumor from a patients lung and had to carry it out of the OR theatre and physically show the family. They had paid for the procedure, travelled a long way to the hospital, they demanded to see that there was actually a tumor, and that the surgeon had actually removed it. Apparently this is common in China.

Something like that seems crazy to us, but I can sort of understand why it made sense to the family in China. China's medical system is presumably a lot less regulated, and probably full of its fair share of hucksters, snake oil salesmen, and fraudulent service providers. Demanding to see proof that a surgery was performed would be understandable in those circumstances. (An unscrupulous doctor could still fake the proof, of course.)

This is thematically, if not completely, similar to the American practice of running a battery of expensive, redundant diagnostic tests on a patient as a CYA measure. It's not enough to have a reasonable guess at a diagnosis; you need five different kinds of proof to back up your decision. You are performing not just to the standards of medicine, but to the presumed standards of insurance companies, lawyers, and WebMD self-diagnoses.

>An unscrupulous doctor could still fake the proof, of course.

Exactly, how is a family to know what is a tumor and what is just regular tissue. Heck, it could be a pig liver and not many would know the difference. Combine this with the fact that the surgeons at this talk mentioned that Chinese doctors and nurses are not well paid, you can start to see the incentive for doc's to commit fraud.

A general rule of thumb for an acute complaint: Go to a hospital affiliated with a medical university. That's where the next generation of doctors are trained by (hopefully) some of the best of the current generation. As workhorses, they also tend to see a lot of cases in a working day (an indeed, some of the most unusual), leading to a lot of practical experience.

I think there's also a lot of recruitment of foreign experts for academically-oriented institutions. I've been seeing a lot more biomedical science papers from Chinese universities with non-Chinese names of faculty.

> “Protest becomes the mechanism for providing social security and for distinguishing people who need help.”

Now that's one way to evaluate the health of the system. I wonder if the baseline is measured in protests/day...

> Wei had only recently returned from a reëducation camp

They'll put a diaeresis in re-education but they won't print tone diacritics in Chinese names. I'd kind of like to know how to pronounce the names.

English-language newspapers in China don't include tones either.

I'm aware, but the new yorker is ostentatiously trying to be correct, and surely doesn't expect its audience to be familiar with Chinese names.

The use of such grammatical marks is an affectation particular to the New Yorker.

I hope that in the next ten or twenty years it will become normal practice to include tones in Chinese names, or at least typeset the original names parenthetically beside the transliterations.

Visiting Beijing a few years back, I recall a bunch of signs had a pinyin versions of the street-name showing... but without tonal marks.

Never did figure that one out.

AFAIK it's kind of uncommon to print pinyin with tones. Especially since, when Pinyin is used as an input method, you would write hua4 for huà.

Children's books get printed with tones. I think the lack of tones in other contexts is down to no better reason than that keyboards don't have any obvious way to enter them.

Using zhuyin would solve the problem neatly, but comes with its own ("made in Taiwan") political drawbacks. It also wouldn't be an improvement in the context of English speakers reading the new yorker.

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