Saturday, 18 January 2014

The "Corridor Doctor" - whistleblower or crank?

translated by Michael Woodhead
An interesting follow up to last week's story about the female doctor from Mianyang, Sichuan, who ended up working in a corridor of her hospital for two years after being removed from office for raising concerns about overtreatment and profiteering at the hospital.
In a new article, reporter Chen Xi for the Sichuan office of the Peoples Daily describes how he went to the hospital to follow up her claims and find out the background to her sacking and allegations of 'overservicing'. What he heard was a mixture of  good and bad about the would-be whistleblower.
First he spoke to Dr Lan, who said that she had always aimed to be a 'pure' doctor and wanted to be seen as one of  the 'angels in white' (ie female doctors in white coats).
However, when she started working at the Mianyang hospital she found that every activity involved putting generation of income for the hospital first. She said that practicing good medicine was constrained by the pressure to meet income targets. Patients were often admitted for treatment they did not need, and Dr Lan felt this was a breach of medical ethics. When she took her concerns to the director of the hospital, his reply was: "What are you on?"
As we reported last week, Dr Lan was stood down and barred from using her office in the ultrasound department in 2009 after she questioned the use of a cardiac pacemaker in a 53-year-old patient who had varicose veins. She said there was no need for a pacemaker in a patient who had a stable heart rate and who had already been cleared for vascular surgery.
Dr Lan also had another complaint - she said that the hospital had misappropriated thousands of yuan in earthquake relief funds donated in 2008 by Macau to aid survivors from the Wenchuan earthquake. As head of the ultrasound department, Dr Lan learned there was 235,000 Yuan in donations provided to buy a state-of-the-art Colour Doppler ultrasound scanner. However, when the machine was delivered it turned out to be an out-of-date model that was worth only 160,000 Yuan. It was not clear what had happened to the rest of the money donated from Macau. Dr Lan said she was so angry she left the old machine from the warehouse.

When the reporter tried to put these questions to the hospital management, he was told the hospital director Wang Yanming was not available. However, a deputy director, Feng Jianjun, tried to answer some of the questions.
First of all he rejected Dr Lan's claim that a cardiac pacemaker was not needed for the patient with varicose veins. He said it was usual for patients with vascular disease who needed surgery to have an atropine test. If the patient's heart rate was below 90 beats per minute then this indicated that they needed a pacemaker. In the case  raised by Dr Lan, the patient's heart rate was 60 per minute, showing that a pacemaker was clinically indicated, the hospital deputy director said. The pacemaker was needed to prevent the patient from having an adverse outcome during surgery, he said - so how could this be construed as overtreatment or inappropriate treatment?
Dr Lan ridiculed this claim, saying that it didn't make sense for a patient to be sent for tests after they had been deemed as ready for surgery - this was upside down, as pateints were alsways tested before being referred for an operation, she said.

The reporter sought comments on Dr Lan from other doctors at the hospital. An anaesthetist at the hospital said 'overtreatment' was a grey area and even clinical experts often disagreed strongly on what was the most appropriate treatment for a patient. Therefore, Dr Lan could be right or wrong.
Several doctors said Dr Lan was a hardworking and honest doctor, but with a stubborn individualistic streak and an obsessive personality. Some said she was  a loner who did not communicate or consult well with other doctors. One doctor described Dr Lan's self-image as the only 'pure' doctor as naive, while another said she was known to have strong and unbending opinions about subjects outside her area of expertise. A doctor in the obstetrics department said Dr Lan had often seen his patients and made treatment decisions on obstetrics matters that he did not agree with. She did not accept or understand that ultrasound was an ancillary branch of medicine and that it was inappropriate for her to criticise the diagnosis and treatment decisions of doctors outside her area.
Some doctors told the reporter that Dr Lan was the author of her own troubles, and that it was a joke that she chose to 'practice' in a corridor for two years. For this reason she had become know as "Dr Crazy" by some.
In Mianyang, authorities including the local health department said in a statement that they were now mounting multiple inquiries and audits into the claims made by Dr Lan. The inquiries would look in detail at her claims that patients were being overtreated only to generate income and that unnecessary and inappropriate treatments were being regularly used. As part of the investigation, authorities are  to review all CT scans and ultrasounds of patients for the last three years and check whether the treatments matched the diagnosis.

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