Thursday, 11 February 2016

Hospital gangster siege reveals the murky side of China's healthcare management

The bizarre 22-day occupation by mobsters of a hospital in Zhengzhou, Henan, is a revealing example of the murky finances and power arrangements behind China's hospitals. 

In late December almost 100 unidentified men invaded the Zhengzhou Meixin Chinese Medicine Hospital and disrupted its operations for more than three weeks. According to Chinese media, the men  - many wearing masks - obstructed the lobby, harrassed medical staff, put up banners and drove patients away. The hospital was thus put under siege by local thugs who stayed in the building playing cards and intimidating anyone who entered.

However, this was not the result of a medical dispute by aggrieved family members of a sick patient, but an extortion attempt to try recoup huge unpaid debts owed by the hospital manager, Wang Guangyu. According to Chinese media reports, the mob had been sent in to force Wang to make good on 17 million RMB funds that he owed to a distant relative, Li Jing. Her husband had previously invested more than 40 million in the hospital via Wang Guanyu, but after the husband died last year, the funds were not repaid in full. After several rebuffs, Li Jing called in the rest of her family to put some muscle on Wang.

In any other country a dispute like this would be settled by the police and the civil courts. However in Henan, amazingly, the ringleader of the occupation gang, Guo Zhiyang, was himself the leader of the local justice department and a former senior policeman.

For someone who is supposed to be upholding the rule of law, Gui Zhiyong appears to be a pretty lawless and criminal character. During his occupation of the hospital staff were threatened by men bearing knives and poles. One pregnant member of staff was so terrorised that she went into premature labour.

The incident ended on 9 Feb after provincial media became interested. When outside journalists first visited the hospital they were rebuffed, but were able to make some reports and take pictures. When this made the news beyond Zhengzhou, the occupiers slipped away, leaving the hospital deserted.

Guo Zhiyong could not be found but he issued statements saying he had been trying in a reasonable and lawful manner to handle personal matters with family. He accused the media of slander through their portrayal of him as a gangster and said he would take appropriate action to defend his reputation.

The whole saga may be an instructive lesson for any foreign companies contemplating running a hospital in China!

[Note: this incident is also reported by a "Gloria Chan" of the SCMP . However, the article so sanitised and anodyne as to be incomprehensible. Presumably this is the SCMP's way of trying to please the Chinese government by not washing China's dirty linen in public.]

Sunday, 7 February 2016

Why are China's doctors dropping dead?

 In a single week in 2013, four doctors died suddenly of cardiac arrest. Meanwhile in the last two years it has been reported that fifteen anesthetists in their thirties and forties had sudden cardiac deaths. There have even been premature deaths among distinguished surgeons. What's going on?

According to Dr Huang Weimin, an orthopaedic surgeon at the General Hospital of Jinan Military Region in Shandong, doctors are simply being worked to death. It's the Chinese medical equivalent of karoshi (death from overwork). The Chinese and Japanese characters are the same: "过劳死" (Guolaosi).

Writing in the International Journal of Cardiology this month, Dr Huang says there are four main factors that are driving Chinese doctors to an early grave:

1. Excessive hours and work intensity. Doctors work up to 12 hours a day and in general at least 50 hours a week.

2. Extra non-clinical duties. Doctors are required to publish a quota of scientific articles every year to remain qualified and to be eligible for promotion. This requires research, finding funds, and doing the necessary paperwork for publication. All this work must be carried out in addition to their general clinical work, often in their own time.

3. Doctors must attend many meeting and medical conferences and also have a heavy teaching and supervision burden.

4. The excessive workload and lack of time contributes to a deteriorating doctor-patient relationship, which results in more pressure on doctors and also doctor-patient disputes, litigation against doctors and violence against doctors.

Dr Huang says that all these factors have been highlighted by the doctors' trade union, the Chinese Medical Doctor Association (CMDA). In May 2015 the CMDA issued a “White Paper on the Practice of Chinese Doctors” which called for an easing of pressure on doctors.

It noted that more pressure on doctors can be expected with China's ageing population, the increase in prosperity and consumer expectations, and the widening of medical insurance coverage.

"The growing rates of sudden death indicate that doctors in China are already exhausted and they need alleviation of the heavy burdens. It is high time to concern the health of doctors," writes Dr Huang.

"On one hand, the government should optimize the allocation of medical resources, improve medical evaluation systems, and legislate to protect the health of medical staffs. On the other hand, the society should give more understanding to doctors and create a favorable working conditions."

Tuesday, 2 February 2016

Chinese media cranks up "Heroic, Selfless Doctor" propaganda

For the last year there has been a steady drip-drip of doctor-as-hero stories appearing in the Chinese media. A typical (and recurrent) one is the story of the sick doctor who keeps on working despite being ill enough to require an infusion line stuck in his or her arm. This is presumably intended show show how dedicated the doctor is in the spirit of that selfless icon Lei Feng.

In reality these stories make the doctor and the health service look foolish and backward. No professional doctor would turn up at the hospital if they have an infectious disease. And no self respecting doctor would believe that an infusion is the right treatment for an ambulant patient. If you're sick enough to require IV antibiotics then your place is in a hospital bed, not the doctor's seat.

The fact that these stories appear on a regular basis in the Chinese media suggests that there is some ongoing propaganda edict from on high to publicise selfless healthcare staff.

Until now, these doctor-as-Lei-Feng stories have just been an occasional eyebrow-raising oddity. However in the last month or so there have been more and more such stories appearing in the media. Last week there was a story of a doctor who was so busy that his son resorted to booking an appointment as a patient so that he could get to see his father. In a family-focused society such as China this 'heart-rending' story was no doubt intended to show how overworked and noble the Chinese doctor is.

This week the selfless medic story of the moment is one concerning Zhejiang doctors who have reportedly been lending money to poor patients so that they can pay for their medical treatment.

According to the local media, a female doctor Yang Yonghong, chief physician at Zhejiang Taizhou Municipal Hospital of Infectious Diseases lent 500 yuan to a patient who said he could not afford to pay for the antibiotics he had been prescribed. Dr Yang insisted that the man take the money to pay for an IV infusion for his sepsis. According to Dr Yang, the man had a life threatening infection that needed immediate treatment. When he wavered about paying, Dr Yang handed over the money and said he could repay her later.

The man reportedly left and did not return for his infusion. But Dr Yang said it was better to offer money and lose it than to risk a patient dying. Fortunately for this doctor the story had a happy ending when the patient returned two days later to repay her. He said he had sought treatment at a local clinic because it was too late to return to the hospital. The patient then allegedly made a full recovery.

Dr Yang has since become a local hero on social media for her generous and selfless action - especially as she was very self deprecating, saying it was nothing, and that many doctors performed similar acts of generosity every day.

"I often ask patients about their economic circumstances and if they are not rich I try to prescribe cheaper drugs and treatment. Last year I lent several hundred yuan to patients who could not afford treatment - I did not hear back and I hope they are well," she is quoted as saying.

The whole sounds very fishy and too good to be true. Is this Xi Jinping's way of sugar coating the medical reforms that will require patients to pay higher fees for medical care?

Monday, 18 January 2016

Freelance "Doctor Groups" - the first sign of workforce reforms in China


The creation of some 30 independent "physician groups" (Yisheng Shoutuan, 医生集团) is the first sign of the Chinese government's 2015 relaxation of working regulations for the hospital system. The rules have been relaxed to allow "workforce fluidity" - in other words to allow doctors to work where they wish rather than being bound to a single hospital ( a legacy of the old danwei work unit system).
 he Chinese Nationa Health and Family Planning Commission (NHFPC) wishes to create a more flexible workforce and to allow doctors to work in a more more market-oriented system, supposedly to free up medical talent and overcome the current mismatch in supply and demand for medical services.

It is still early days for these doctor groups, which face problems such as how to engage with hospitals, how ensure high quality medical standards and how to take on medicolegal risk (and insurance). These are things that are usually the responsibility of hospitals and something that doctors have not had to worry about in the past.

To try tackle these issue the Beijing Henghe Hospital has set up a "doctor group collaboration model platform" to try work with doctors towards new ways of working. The group has already started to look towards the US for business and working models for doctors. Initial discussions have revealed that 55% of hospitals have doctors doing some form of 'moonlighting' - and therefore the doctor groups may formalise this working model.

Another survey found that many talented young doctors were leaving the hospital system because of the long hours, high pressure and low pay. A new freelance model may help retain the skills of these doctors, the collaboration discussion group said.

However, other doctors have pointed to the fact that the vast majority of doctors continue to work  in the public hospital system, and they say this system (and its workforce) is already stretched to breaking point. They ask how the public system will cope if many of its 'backbone' doctors reduce their commitment to practising in the hospitals - and also the reduced input in areas such as teaching and mentoring.

The group heard from some leading doctors saying there now had to be a pragmatic approach to developing Doctor-Hospital Partnerships to ensure optimum allocation of medical resources and also recognise the true value of doctors.

In one Doctor Group forum, vascular surgeon Dr Zhang Qiang said there were 10 issues facing doctor groups:
1. Doctor groups are a very vaguely defined concept.
2. Policies have to be open, pragmatic and work with the health ministry and hospitals.
3. What size should doctor groups be? How much will they be worth? And what disciplines will the consist of?
4. How will doctor groups be organised? As private companies? Co-operatives/ Joint ventures?
5. Where will doctor groups be located? In private hospitals? In large institutions or be in stand-alone clinics? Or as flexible visiting doctors?
6. If doctors join freelance groups [how] will they maintain their participation in academia, teaching and research?
7. How will doctor hierarchy and work assignments/responsibilities be arranged in private groups? In the public system there is a clear structure and system of rosters, promotion and responsibility - how will this translate in private groups?
8. How will private doctors interact and communicate online and digitally, if they do not have the support of the government and hospital system? Will there be referrals and shared care?
9. How will freelance doctor groups be financed and where will they find their start up capital from? If there is a share ownership, who will own the shares and control the doctors?
10. Will private doctor groups have clout? For example, in medical insurance will doctor groups have enough buying power and negotiating strength to be able to arrange medicolegal cover, settle medical disputes and influence policy?

Sunday, 10 January 2016

The top three medical stories from China this week

Medical exam fraud: A medical examination cheating ring has been uncovered in Hebei after a 29 year old woman was found to be taking a postgraduate exam in place of someone else. The woman was arrested after it was found the ID card did not match the details of the doctor who was supposed to be taking the test, who was from Chengdu. The woman said she was paid 60,000 yuan (about US$9000) to take the test on behalf of another person. The woman, who was originally a doctor, said she had given up her job in 2013 after she discovered she could make more money through exam fraud.

Influenza deaths: There have been three severe cases including one death from severe H5N6 influenza in Guangdong and a further death of an overseas visitor from H1N1 influenza, according to media reports. Chinese media said that a a 25-year-old man from Shenzhen, was in a serious condition in hospital. A 26 year old woman died of the same infection in Shenzhen last week, while a third person in Zhaoqing, Guangdong was in a serious condition. Meanwhile a Guyanese man has died of H1N1 influenza in a Miami hospital after returning from China. The infections are presumed to have come from exposure to live poultry and it is not thought there is a high risk of human-to-human transmission.

Air pollution harms fetus:
Pregnant women who are exposed to the high level of air pollution in China are likely to have low birth weight babies, a study shows. Exposure to high levels of PM2.5 particles, as found in China's smogs, was linked to a decrease in birth weight and an increased risk of low birth weight, according to a study by specialists at the Guangdong Women and Children Hospital, Guangzhou. The doctors said the effect of air pollution on fetal growth was similar to that seen with cigarette smoke, and was due to immature fetuses being more susceptible to air pollution because they are in critical periods of organogenesis.

Sunday, 3 January 2016

Actress Li Bingbing disparages Australian medical system, flies back to China for tonsillitis treatment


Chinese star Li Bingbing has lit up social media with scathing criticism of Australia's healthcare system, claiming in a Weibo post that Australian doctors had been inept and unable to treat her severe tonsillitis. The actress eventually flew back to China where she received intravenous antibiotic treatment at the Peking Union Medical College Hospital and was said to be recovering. The actress claimed she was relieved  to be back in the "good care of the motherland", but her Weibo post triggered an online debate about the merits of China's healthcare system, overuse of antibiotics and how the privileged can jump the queue.

The star of such critically-acclaimed films such as Resident Evil: Retribution had been in Australia filming the scifi movie 'Nest' (about a labyrinth of man-eating funnel web spiders, apparently) when she became feverish with a temperature of 39 degrees. On her blog she said she went to the hospital but was forced to wait two hours to see a doctor, who finally agreed to do blood tests as she suspected she had SARS. However the tests were negative and she was discharged. Li Bingbing said her temperature fluctuated and she 'burned for two weeks', although the photos she posted showed only a temperature of 37.5 degrees.

On December 6 she posted photos on Weibo showing her in the bed of an unnamed hospital, which she claimed was in Australia, with blood stains on the bedsheets which she said was from a botched attempt to insert an IV line. She wrote that the nurse had been unable to insert a needle into a vein despite three attempts and compared her poor technique to the superior skills  of Chinese medical staff. The superstar complained that she had been to three different hospitals without getting any satisfactory treatment for her fever and had therefore returned to China for medical care.

[UPDATE: I have been told that some of Li Bingbing's photos do not match those of an Australian hospital - the equipment is not that used by Australian hospitals. Also, Australian hospital policies require linen to be changed immediately if soiled by blood.]

The Weibo post elicited  a response from an ethnic Chinese  doctor working in Australia, who said that Li Bingbing's claims suggested that she did not understand Australia's medical system and how to seek help. The doctor explained how Australia had a gatekeeper system of GPs, and that unlike China, hospitals in Australia were not the place to seek initial treatment for fevers. He said GPs would usually advise rest and fluids for fevers rather than antibiotics, but he also questioned why the star had a fever for 14 days before seeking treatment. He was unable to explain why Australian doctors might have missed severe tonsillitis and said he did not have the full medical details due to hospital confidentiality regulations.

However, Li Bingbing's management then issued a legal letter demanding that media retract and delete this doctor's article because it was based on inaccuracies. The star claimed to have followed the Australian system rules for seeking medical care  and said she had consulted a "famous" Australian doctor and two other doctors - including GPs. The star's management also strongly denied that Li Bingbing had sought preferential treatment or had been unable to understand English properly.

The saga triggered a wide ranging debate in China's social media, with some netizens saying that the episode was a lesson for Chinese not to "blindly worship" foreign countries and their healthcare systems. Some said it showed that China's doctors and nurses were more skilled, and also that Australian doctors had little experience in treating common illnesses for Chinese patients.

However, other online commenters said that the incident revealed the differences between Chinese and foreign hospital attitudes to use of antibiotics and infusions. They said it showed that foreign hospitals were more strict about antibiotic overuse, and also that they had more careful treatment pathways and did not give in to public pressure for inappropriate treatment. Some critics said Li Bingbing's praise for the "care of the motherland" sounded like government propaganda. However, others used a play on a Chinese saying: "the moon isn't rounder in foreign skies" to assert that  medical care should not be assumed to be better in foreign countries.

Li Bingbing's social media criticism may be a setback for the many countries hoping to cash in on Chinese medical tourists. However, Li Bingbing is not exactly a trusted expert in evidence-based healthcare. According to Wikipedia, she has a qigong practitioner for a 'godfather' who claims to be able to conjure up snakes from thin air and cured her mother of a mysterious disease.

Sunday, 20 December 2015

Are China's doctors happy? A national survey of job satisfaction provides some unexpected results


China's doctors have a lot to be unhappy about. Low pay, long hours, medical disputes that trigger abuse and violence from the public - and daft regulations that force them to publish a quota of 'scientific articles'  every year even when they have no interest in research. 

There has been a lot of talk about poor morale among China's medical profession in recent years, but very little actual research to back these claims up. To address this, the medical online portal DXY conducted a survey in September 2015 that asked a simple question: "do you regret becoming a doctor?"

Responses were obtained from 2,356 doctors, three quarters of whom were male and most were working in tertiary (teaching) hospitals in eastern China (not surprising given that DXY is a medical portal used predominantly by younger and more online-savvy medics).

The survey found that overall almost half of doctors (1146) said they had regrets about becoming a doctor. There was no significant difference between male and female doctors, but there were some interesting trends by speciality and location.

Emergency department doctors had by far the lowest morale, with almost three quarters regretting their choice of career. This is perhaps not surprising as emergency doctors are at the sharp end, doing exhausting shifts dealing with trauma - and being assaulted by stressed out patients and their families with complaints.  Other specialities with poor morale included paediatrics (low pay, high stress when dealing with pushy parents of ailing Little Emperors), obstetrics and gynaecology and oncology.

The specialities with the highest degree of job satisfaction (or least worst morale if you're a glass half empty person) were radiology, TCM and anaesthestics.  The survey also showed that community clinic physicians  also had less regret about medicine as a career - the study authors say this is presumably because they see less sick patients and are more likely to have an ongoing doctor-patient relationship in the community.

Interestingly, doctors in teaching hospitals tended to have better job satisfaction - possibly because the top hospitals have better career prospects and are more professionally stimulating. The doctors in the middle tier hospitals - level 2 - had the worse morale.

Trainee doctors and senior doctors also tended to have better morale whereas mid-career doctors in their 30s and 40s had the worst morale.

On a geographic basis, doctors in the more remote provinces such as Yunnan, Gansu, and Shanxi reported better morale. The survey authors said this was an unexpected results and suggested that salaries were not as important as once thought in job satisfaction.

The study authors say they now plan to publish a more in-depth analysis of the reasons given by the doctors for poor morale.

Sunday, 13 December 2015

Bigger than Ben Hur: relaxation of hukou system will provide healthcare for China's 270 million floating population

If the relaxation of hukou (residence permit) regulations announced by the State Council is actually enacted in practice, this will have a profound effect on healthcare access for a quarter of a billion Chinese.

This week the State Council announced that local governments were being instructed to adopt new regulations that will allow nonresidents to get a household registration. This registration will give the floating rural migrants access to basic public services such as education and healthcare, and family planning services. The changes could potentially affect 270 million internal migrants who have moved from rural areas or regional small towns to the larger and more prosperous cities of China. Until now this floating population has been denied access to healthcare facilities in the cities, leading to the development of many unofficial backstreet clinics. The main problem for migrant workers was that their hukou only entitled them to healthcare in their place of residence registration. This also applied to their children.

However, it pays to read the fine print - this does not mean that city hospitals will be immediately swamped by rural migrants seeking healthcare. The new regulations say that city governments should extend 'basic' services only to nonresidents who qualify for residence via a points test based on factors such as length of residence (as much as seven years) and stable employment. Many rural migrants will only qualify for temporary residence cards in the cities, which may limit their access to healthcare.

According to Xinhua, the State Council made the changes because "if these issues can not be effectively addressed in the long-term, it will trigger a series of social risks and contradictions."

However, some media commentators have been asking whether the legislation is premature because local governments are neither willing nor able to provide additional healthcare services to 'outsiders'

The other questions being asked in the Chinese media are: what are the criteria that will allow a nonresident to acquire city registration? Also, what level of services will the be eligible for? Another important question being posed by analysts is what kind of effect the widening of hukou system will have on current city residents? Will they be crowded out of hospitals and healthcare service by the onrush of outsiders?

One expert from the Renmin University, Beijing, also pointed to a potential problem with the loosening of the hukou system: the degrading of the funding base for rural health services. Professor Yang Junhua said many rural areas had already seen huge migration from the their towns and villages, depleting their tax revenue base, meaning they were unable to support services for the 'left behind' residents who tended to be either older and retired or young children. Allowing rural residents to switch their hukou to cities would further undermine the viability of rural healthcare services, he warned.

Professor Yang also predicted that there would be resistance on the ground from city governments to implementing the new regulations, and thus the central government would have to be strict in monitoring and enforcing the rollout of any hukou reforms.

Nevertheless, if fully implemented the new residency regulations are a 'game changing' step for China and have major implications for healthcare. The 'floating population' have long been neglected in terms of healthcare and many of the rural migrants in cities have poor healthcare as a result: unable to access health services they have missed out on basic services such as vaccination, leading to outbreaks of infections such as measles. The new residency rules could have more of an impact on China's healthcare system than the recent more widely publicised two child policy.

Sunday, 6 December 2015

Shanghai hospitals to ban antibiotic infusions for coughs and colds

Not before time, some of the more advanced and enlightened provinces of China are to ban the widespread practice of giving patients antibiotic infusions for common colds.

Visit any emergency department or outpatient department in a major Chinese hospital and you will see row after row of patients hooked up to IV infusion lines. These are people who have coughs, cold and fevers and are given intravenous antibiotics as routine therapy. In most other countries this would be seen as an absurd, unscientific and harmful overtreatment, but in China it is the norm. There is an almost superstitious belief among Chinese people that an infusion is a panacea.

Many doctors have spoken out against the practice but until now hospitals and health authorities have done nothing to curb the practice. That may be all about to change. The Jiangsu health department has put hospitals on notice by saying that from 1 July 2016 infusions will no longer be permitted as routine therapy in outpatient departments of major hospitals (2nd and 3rd level). This will include city hospitals in cities such as Shanghai.

In a recent interview with People's Daily, Xuzhou Medical College Professor Wu Yunming said the most appropriate treatment for a cold was to take a simple antipyretic such as aspirin, rest and drink plenty of fluid.

"Sick people going to hospital for an infusion has become a long established bad habit, which is one of the important factors for antibiotic drug misuse," he said.

Professor Wu said it was a practice that must be stopped but it would require a change of thinking among the public as well as among the medical profession.

He said strict rules were needed to ban infusions because although doctors were aware that they were inappropriate, self regulation and guidelines had failed to curb their use. Professor Wu said it was typical for an outpatient department to have 200 patients in a morning having infusions - and not unknown for up to 700 patients a day receive such treatment. This was highly profitable for hospitals, which charged 100-200 per infusion, he said.

"Hospitals are businesses and infusions represent a significant source of revenue for them," he noted.

A reporter who visited a major hospital found that healthcare staff were sceptical about the planned ban. They say their was widespread patient expectation and demand for infusions, and if tertiary hospitals did not offer them then patients would simply go to smaller hospitals or local community health clinics that would still provide them.

Professor Wu said rational use of antibiotics was an important issue because antibiotic infusions could cause anaphylactic reactions, increase resistance and also cause other major side effects on the kidney and liver. Infusions also wasted a lot of workforce capacity and resources as nurses had to set up and monitor infusions. He said there needed to be a system-wide plan and implementation of the infusion ban, with an emphasis on social responsibility for hospitals and professional responsibility for doctors.

A spokesman for the Jiangsu department of health said it would be issuing a 'blacklist' of more than 50 medical conditions for which infusion was not permitted.

Thursday, 3 December 2015

China's pharma companies take a stake in public hospitals. What could possibly go wrong?

China's not-very communist health minister Li Bin wants to see hospitals turn to "social capital"(ie private investors). And it is slowly starting to happen. China's 'public' hospitals are currently in a strange place - they are essentially state-owned for-profit enterprises, but bound by an odd mix of rules and regulations that keep some prices in check and yet which allow rampant price gouging and overservicing in areas such as pharmaceuticals. Not for nothing are pharmacies know as the 'gold mine' of hospitals.

To try get rid of the obvious incentives for hospital doctors to overprescribe the government is currently phasing in a ban on drug commissions. They are trying to de-link income from drug sales and hospital revenue.

However it's not clear to me how this squares with the trend for China's pharmaceutical companies to go into partnership with hospitals, and essentially to become their operators. Take the recent deal by the Guangzhou Baiyunshan Pharmaceutical Group to invest in six hospitals in the obscure Shandong city of Jining. The joint venture covers six main hospitals with around 6000 beds and a total annual revenue of 2 billion yuan.

The local health department has 49% stake in the new Jining health provider company, while the pharma company has a 33% stake in return for 5 billion yuan investment. Other stakeholders include investment companies, with between 15% and 2% interests.

Analysts say the new joint venture will allow industrial groups to make profits from controlling supplies of pharmaceuticals as well as medical devices, supplies and equipment. I'm no health economist but I can't see how allowing a pharma company to own and operate all of a city's hospitals is good for the patient. Who decides which drugs are made available at the hospital - and what happens to the competitor products? Also what is to stop overservicing, as we have seen so evidently a problem in the current system?

As a commentator in Caixin magazine concludes:

"With deals like this we need to first be clear what is the purpose of the restructuring of public hospitals, and through the restructuring of what kind of results you want to achieve? These issues need further study and discussion. "

Monday, 30 November 2015

China is crazy for medical apps

The latest medical app craze in China is iBaby, developed by an entrepreneur from Harbin to provide antenatal, childbirth and childcare advice to Chinese women. The creator Lu Guotao featured on a recent Apprentice-style TV show on which he demonstrated how his app can link women up to advice via video and online help from obstetricians. Lu turned down offers from investors and went it alone to market the app, which he says now has tens of thousands of users in 31 provinces. Lu says he has had 10,000 obstetricians sign up to provide medical advice online via the app. The one stop platform for pregnancy advice also links women up with local clinics and offers links with merchandisers for pregnancy wares.

Lu says he was already a successful businessman when his wife became pregnant, but they were so busy attending to their work that she lost the baby through a miscarriage. Lu turned his grief into an energetic mission to help avoid such incidents again, by providing accessible information, advice and contacts for prospective parents.

He says the huge success of the app is not surprising given China's move towards relaxing the one child policy and also the opening up of the healthcare system to private investment and more flexibility in doctor roles.

The app has received backing from national obstetric experts including Professor Liu Xinghui, director of the West China Second Hospital, Sichuan University, Chengdu. Professor Liu offers weekly online lectures via the app. She says women can access a wide range of obstetric experience via the app.

Sunday, 22 November 2015

Medical news from China: 7 stories that made the headlines this week

1. Nurses in Wuxi are being taught lessons in etiquette by air hostesses. The aim of the program is to make the nurses more customer focused and dispel their image as unfriendly.

2. Acute kidney injury is common in China with 700,000 deaths a year. Researchers from the Medical College of Nantong University found that acute renal impairment went undiagnosed in more than 70% of cases, and was often caused by patients taking nephrotoxic drugs or TCM.

3. A female neurologist in Wuhan is suing a woman for slander and damage to her reputation after the women mounted a four year campaign to blame her for her mother's death. Dr Mei Bin is suing the woman for 5000 yuan in compensation and apology after the woman spread false stories about her and claimed she was unqualified for her post. Dr Mei Bin said she had nothing to do with the care of the women's mother and the allegations against her were false, probably related to a doctor with a similar name in another province.

4. Researchers from Zhejiiang report a case of human to human transmission of H7N9 influenza in hospital from Feb 2015. Both men died, according to a report in the BMJ.

5. Health inequalities: hospital mortality rates are 40% higher in rural areas compared to the cities, a new study shows.

6. About 44% of Chinese women take Traditional Chinese Medicines during pregnancy, the most common being Angelica sinsensis (29%), Ziziphus jujuba (21%) and Dioscorea opposita (13%). Most women used TCM on the advice of their mother or mother-in-la, according to the survey of 700 women in Sichuan. The researchers warned that TCM may cause fatal hepatic and renal effects and some are adulterated with lead or pesticides.

7. A Beijing medical school has started a program to train more psychiatrists to help overcome China's widespread lack of mental health clinicians. The Beijing Huilongguan Hospital Clinical School of Peking University aims to help train several hundred psychiatrists over the next decade. China currently only has 20,000 psychiatrists and needs at least three times that number to match other countries.

Wednesday, 18 November 2015

Antibiotics in China: not quite there yet

Regular readers of this blog will know that antibiotic misuse is one of my real bugbears about medicine in China. Seeing rows of patients in emergency departments routinely hooked up to infusions of broad spectrum antibiotics for fevers is a symbol of everything that is wrong with healthcare in the PRC.

Well it seems that I'm in good company in deploring this unwelcome practice. As part of Antibiotic Resistance Awareness Week, the World Health Organisation has taken China to task for its misuse of antibiotics. In a new global report it singles out China for having particularly poor usage and knowledge of antibacterials. A survey reveals that more than 60% of Chinese think, incorrectly, that colds and flu can be treated by antibiotics. A similar proportion have used antibiotics in the past few months and one in four bought them over the counter rather than obtain them on prescription. And while 67% were aware of the term ‘antibiotic resistance, few realised that cutting down on antibiotic use was the way to tackle it.

The WHO states that China is one of the worst offenders for antibiotic misuse and blames the lack of awareness among the citizenry for this problem. For a country that prides itself on such a good education system, how can Chinese be so badly informed about such an important matter?

The head of the pharmacy department at the Beijing Union Medical College Hospital, Zhang Jichun, says many Chinese demand antibiotics as a "quick fix". At the hospital if doctors say that antibiotics are inappropriate for patients with a fever or a cough they are rebuked with: "my illness so bad, why don't you give me an infusion for it?" Doctors say patients accuse them of not taking their illness seriously and demand "give me an infusion quickly so I will recover quickly and can get back to work!"

The WHO says it hopes the new report will raise awareness about antibiotic overuse and the risk of resistance in China. I'm not holding my breath.

Sunday, 15 November 2015

Top 10 hospitals in China


I'm not a big fan of top 10 lists, and I would approach this one for hospitals in China with caution. The China 2014 Good Hospital Ranking is produced by the Fudan University Institute of Hospital Management.

I'm not quite sure what criteria they use to decide what makes a good hospital but they claim it is based on factors such as clinical competence, scientific research and academic rigour. How they measure that objectively is anyone's guess. The Fudan team also say they consulted many 'national experts' to rank the country's top hospitals. They say the rankings are a good guide to clinical excellence and should be a benchmark that other hospitals strive for.

I don't think anyone is going to see any surprises in the list - all the top hospitals are the 'usual suspects' in the major cities such as Shanghai and Beijing and Guangzhou. I'm also not sure what the point of league tables for hospitals is - if you asked me to name the top 10 hospitals in Australia I could tell you quite easily without having to do a ton of homework - just based on location and whether they are teaching hospitals with a good research culture.

The rankings actually extend to 100 top hospitals, but I've only listed the top 10 here for brevity. I'm also not sure what the point of doing these survey on an annual basis is - it's not as if hospitals will move up and down the list very much and whether that is significant anyway. Any doctor will tell you that some good hospitals can have very bad departments and vice versa - some hospitals have a good reputation in certain specialities and can be terrible for others. Much of it is down to personalities and medical politics. I can also think of some 'good' hospitals that are over-rated and charge exhorbitant fees based on their reputation and "closed shop" monopoly status.

But what do I know. Here's the list:

  1. Beijing Union Medical College Hospital
  2. Sichuan University, West China Hospital
  3. People's Liberation Army General Hospital (aka 301 Hospital, Beijing)
  4. Shanghai Jiaotong University Affiliated Ruijin Hospital
  5. Xijing Hospital (No 4 Military Hospital) Xian
  6. Zhongshan Hospital, Fudan University, Shanghai
  7. Huashan Hospital, Fudan University, Shanghai
  8. Zhongshan Hospital, Guangzhou (First Affiliated Hospital of Sun Yat-sen Univeristy)
  9. Tongji Medical College Hospital, Shanghai (Huazhong University of Science and Technology)
  10. Peking University First Hospital