Best, Wang Shi Kai Email 5 Part 1

This post is part of a series we are calling "Best, Wang Shi Kai." Dr. Rich is an Emergency Medicine Physician from Los Angeles who picked up and moved to China where he is currently practicing. He was given the name Wang Shi Kai by the Chinese Medical Board. In this series of posts we feature his emails sharing his unique experiences practicing medicine in China. Here are the links to his first email which gives some background Email 1 Part 1,  Email 1 Part 2Email 2 Part 1Email 2 Part 2, Email 3 Part 1, Email 3 Part 2Email 4 Part 1, Email Part 2.

Ni hao!

I have come to the realization that I will not likely leave China without becoming PPD positive. Somehow, I managed to survive 22 years at County without converting, but I think I might not be so lucky here. China has the World's 2nd largest TB epidemic, trailing only India. There are over 1.3 million new cases here every year. Multi-drug resistance is a major problem. And international treatment recommendations are not followed very closely. I see many patients every day who present with a cough. I think cough, sore throat and gastroenteritis are the 3 most common chief complaints that I see. None of the patients with cough are screened for TB-risk factors. None are given masks or sent for a chest x-ray before seeing a doctor. It's not uncommon for me to be half-way through my history-taking when a patient reveals that he just came from another hospital where he was diagnosed with TB and now he's seeking a second opinion, all the while coughing and spewing mucus around the room. The general approach to someone with suspected TB is to send them home unless they are so sick that they require hospitalization. The work-up is done as an outpatient. The patient is told to wear a mask but they rarely follow that advice.

Patients with MDR-TB must often complete 2 unsuccessful courses of treatment with 1st-line anti-tuberculosis drugs before being eligible for treatment with 2nd-line drugs. And often, treatment of MDR-TB is started only after the diagnosis has been confirmed, a process that can take months, during which time the patient can potentially infect his whole family and the community. 

I have also come to the conclusion that the public's perception that doctors are driven only by profit has led to the widespread distrust towards doctors. I have seen many cases of violence towards doctors and nurses. A recent survey at my hospital found that almost 90% of respondents said they had been victims of physical abuse by patients. I have become a bit fearful of suturing children because the pressure is so high to leave no visible scar. I recently had a case where a few 6-0 Prolene sutures that I placed on a young girl's forehead were removed too early and the wound opened up a few millimeters. The family demanded their money back and threatened retaliation. The child was referred to a Plastic Surgeon who criticized me, saying that sutures should be left in place a few days longer in Chinese patients compared to Americans, something I had never heard of. If any of you can find a good study to confirm this, please let me know!

The concept that doctors are only concerned about profit is re-enforced by the overprescription of antibiotics and other medications for which the doctors get a financial bonus, and the requirement that all patients pay a fee before being seen by a nurse or doctor. I witnessed an interaction between a general surgeon and a patient who presented with abdominal pain. The patient had numerous lab tests, abdominal x-rays, ultrasound and CT scan which were unremarkable. The doctor told the patient that all the necessary tests had been performed and were negative, so the patient should go home and avoid spicy food. The patient continued to insist that something was wrong with him, to which the doctor replied "If I kicked you in your stomach it would hurt, but it wouldn't mean that something was wrong with you"! No wonder the doctor-patient relationship is broken.

The conclusion to this email in the next post

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Best, Wang Shi Kai Email 5 Part 2

Best, Wang Shi Kai Email 5 Part 2

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