by Jingbo Wu
June 2009

When I talk to other expats who’ve used China’s local healthcare system, I hear a lot of the same comments – doctors are abrupt and uncommunicative and the whole experience is rushed.

But what they’re encountering is typical of the local doctor-patient relationship. It may look like a disregard for personal connection but it’s really just a classic cultural difference. Historical precedent, culture and economics all factor into creating the reality that is today’s doctor-patient relationship.

For one, doctors in a local hospital see on average 50-100 patients a day. Doctors in a comparable U.S. facility will see 10-20 per day. Given those numbers, their priority is to provide treatment to the hundreds of patients waiting so their illness doesn’t worsen by another day spent in line.

As a result, doctors naturally have to streamline their processes. They’ll examine and question a patient. The patient answers and then the doctor will prescribe treatment. Communication isn’t emphasized and their local patients don’t expect it, either.

Simply put, local doctors don’t have the same kind of time to spend with patients as they might in Shanghai’s international hospitals. Even so, for expats it’s disconcerting when a specialist doctor only says only “yes,” “no,” or “maybe.”   

As with most things in China, history plays a big part in a doctor-patient relationship that’s characterized by one-word answers. For example, Traditional Chinese Medicine practice didn’t emphasize the doctor-patient relationship and this has carried over into modern healthcare as a whole. In TCM, a doctor’s reputation is gained by how many patients he’s cured over the years and not so much on his particular degrees or documented qualifications.

Additionally, while the medical profession was not a well-paid one in China, having a doctor in the family was a point of pride for its members. In a bit of a turnaround, the past 20 years of economic growth has damaged – rather than boosted – the position of doctors in China.

A small group at the top will receive the best education, get jobs at the best hospitals and have access to advanced equipment and international training opportunities. The rest work 12 hours a day, 29 days a month. And the country’s large low-income population has forcibly limited doctors’ salaries.

Some doctors have been able to maintain their social status and upper middle class income level as opportunities become available at private clinics and hospitals open specialist, VIP and international sections. But for the majority of doctors, more than half of their income comes from a bonus tied to the hospital’s revenue. And that revenue comes mainly from prescribing medicines, conducting examinations and operations.

Without this bonus doctors’ incomes would fall behind even ayis. So it’s an open secret that some doctors prescribe more medicine and treatments than necessary to increase their own income. The result is that the bonus system has negatively impacted the image of doctors and the level of trust between doctors and patients – and the incentive to communicate has suffered, too.  

The government is currently working on reforming the medical industry, including breaking the tie between the doctor’s income and the hospital’s profitability. The hope is that this action will go far toward improving doctor-patient trust. Additionally, public hospitals will be limited on the extent of their VIP and international services. These services can’t exceed 10 percent of the hospital’s overall business in order to ensure public resources aren’t used only to serve higher income groups.

In the meantime, the VIP and international clinics of local hospitals are popular local alternatives for expats. More and more of these clinics are opening up and at these facilities patients get access to the best local doctors in a more relaxed environment.

Still, it’s important to keep in mind that you’ll encounter those same cultural differences in the VIP and international sections of local hospitals, too. You’ll need to initiate the conversation more than you would in a western facility. But doing so will help them switch their mindset from local to international. Sharing your medical history including showing them what medicines you’re taking will also help facilitate the conversation.