Demystifying Medicine One Month at a Time

Be Careful What You Wish For

Why our medical malpractice system is superior to not having one.

One of the topics I went to China to discuss was our medical school’s approach to teaching medical ethics.

At Wuhan University they have a first-year course, but I was told by both the school administrators and some of the students that the material is dry and not seen of immediate importance, so students often skip the class.

Here’s how it’s structured: 27 hours of straight lectures.

No case studies, no discussions, simply a professor of policy and administration who talks to them about morality, ethics, and offers only some specifics about clinical medical issues–like end of life or reproductive health.

Try not to be on the receiving end

The faculty deans at Wuhan have accepted the idea that to improve their course, they need to make it more case-based and interactive. To that end, the students want to hear from “real” doctors discussing cases that occur in their clinical practices.

I met several practicing doctors who are interested in helping improve the course. One of them is a cardiologist who became interested in medical ethics because of her own moral distress in dealing with angry families when a patient dies. She had spent two years in the US doing research, so had some frame of reference for how things are done here. “If something bad happens to the patient, the family can always sue. In China, it is not so.”

Instead, the family might openly grieve and become angry and aggressive. She reported that doctors have been attacked by angry family members, and in one instance she knew of, killed.

In her experience, even when a patient (and their family, as surrogate decision makers) had been duly informed about the risks and benefits of the proposed procedure (e.g. cardiac cath), and then consented to it, the family still became irate when the patient died–although this was not an unexpected outcome given the gravity of the clinical situation (an acute heart attack).

A member of one family kicked her, and demanded their money back. This doctor further told me that Chinese families typically demand a refund when a patient dies in a medical setting, and that it is often given as a matter of culture.

She estimated that this occurs about one or two times out of every one hundred patient deaths.

Thus, seeking more education about ethics (and implicitly the topic of patient-doctor-family communication) has become an imperative for her.

Makes you think.

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An additional note: In this superb NY Times article about the paucity of mental health care in China, the writer makes mention of hongbao, the Chinese custom for giving cash-stuffed envelopes to doctors in fields like surgery or cardiology. The article states that doctors can earn one-third of their income from hongbao.

Psychiatrists don’t get hongbao; this is only one of many reasons that Chinese medical students choose not to enter the field.

In America, we have a name for hongbao: it’s called concierge medicine.

1 Comment

  1. Susan Blumberg-Kason

    Very interesting. I think this issue in China has come about partly because the government used to provide medical care and other services at no cost. People mostly all got the same care and they looked toward the government as a caregiver. Now that the state doesn’t run all these services in China (hospitals, schools, even food), people are getting used to having things done according to their wishes, not the state’s. So even when they are receiving a service from the state, their expectations are now higher than they were even 10, 15, or 20 years ago.

    Maybe now I won’t feel so dirty when I’m called in for jury duty (which have always been for medical mal suits)! Or maybe not!

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