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.