A pi­o­neer­ing physi­cian’s free­lance odyssey

China Daily (Hong Kong) - - CHINA - By YUAN QUAN

Gong Xiaom­ing has a pre­scrip­tion for what ails China’s health ser­vice: Set the doc­tors free.

The physi­cian, who trained at the pres­ti­gious Pek­ing Union Col­lege Hos­pi­tal, has 15 years ex­pe­ri­ence of work­ing on the wards, and is highly re­garded. In fact, the spe­cial­ist in uter­ine fi­broids once dis­cov­ered that scalpers sold ap­point­ments for con­sul­ta­tions with him for 3,000 yuan ($444), 400 times the of­fi­cial price.

“I should be proud,” said the 45-year-old gy­ne­col­o­gist.

How­ever, in the win­ter of 2011, he was told a pa­tient had waited overnight in tem­per­a­tures of -4 C to ob­tain a ticket for a con­sul­ta­tion.

“I was shocked,” Gong re­called. “How could pa­tients suf­fer like that just to see a doc­tor?”

China’s med­i­cal re­sources are ex­tremely un­bal­anced: 80 per­cent of pa­tients live in ru­ral ar­eas, but the best hos­pi­tals are con­cen­trated in big cities, such as Bei­jing and Shang­hai. Last year, an es­ti­mated 7 mil­lion pa­tients from He­bei prov­ince alone vis­ited hos­pi­tals in neigh­bor­ing Bei­jing.

Gong ad­mires his coun­ter­parts in the United States, whose pa­tients have no dif­fi­culty ac­cess­ing treat­ment. Af­ter vis­it­ing a clinic in Cleve­land, Ohio, he said seek­ing treat­ment there was “al­most en­joy­able”.

In 2013, Gong quit the pub­lic hos­pi­tal sys­tem, where he worked as a con­tract doc­tor in hos­pi­tals in Shang­hai and Shen­zhen, Guang­dong prov­ince. Last year, he went free­lance and set up China’s first gy­ne­col­o­gist group, at­tract­ing more than 100 spe­cial­ists as mem­bers.


At school, Gong was shy and unso­cia­ble, but he was the top scorer in the na­tional col­lege en­trance ex­am­i­na­tion in his home­town in Zhe­jiang prov­ince. He fol­lowed his fa­ther’s ad­vice to study clin­i­cal medicine at univer­sity.

He be­gan his ca­reer as a gen- eral prac­ti­tioner, but was frus­trated at deal­ing with so many pa­tients with ter­mi­nal ill­nesses. In re­sponse, he be­came a sur­geon be­fore mov­ing into gy­ne­col­ogy.

Gong earned his rep­u­ta­tion by con­duct­ing a five-hour op­er­a­tion to save a young woman’s uterus, re­mov­ing 419 fi­broid tu­mors in­di­vid­u­ally. Other doc­tors had sug­gested a hys­terec­tomy.

“I think about each pa­tient’s fu­ture,” he said.

He now works in pri­vate hos­pi­tals where a con­sul­ta­tion usu­ally costs 420 yuan, about 60 times the of­fi­cial fee when he worked in pub­lic hos­pi­tals.

Some peo­ple have crit­i­cized Gong for “only work­ing for the rich”, but he coun­tered by point­ing out that doc­tors at pri­vate hos­pi­tals save pa­tients hours of wait­ing, and more im­por­tant, give more time to each con­sul­ta­tion — at least 15 min­utes.

“The doc­tors and the pa­tients both ben­e­fit,” he said.

Since 2009, gov­ern­ment reg- ula­tions have al­lowed doc­tors to reg­is­ter at more than one hos­pi­tal or start their own clin­ics, but Gong has been a lonely pi­o­neer.

By 2015, about 45,000 doc­tors had reg­is­tered at more than one hos­pi­tal, but only about 37 per­cent came from top pub­lic hos­pi­tals.

Those who hes­i­tate to break away fear the loss of pa­tients, be­cause top pub­lic hos­pi­tals al­ways have thou­sands more cases than pri­vate es­tab­lish­ments.

“Chi­nese peo­ple pre­fer to judge doc­tors by the hos­pi­tals they work for,” Gong said. “They trust pub­lic hos­pi­tals and trust the med­i­cal staff. So free­lance doc­tors, who have been stereo­typed as quacks in the past, have to com­pete in the mar­ket.”

In­ter­net medicine

Doc­tors must of­fer ex­cel­lent ser­vices to please their pa­tients, ac­cord­ing to Gong, who estab­lished a web­site called China Ob­stet­rics and Gy­ne­col­ogy in 2000.

Ini­tially, he used the site to share re­search and pro­fes­sional es­says from over­seas, but af­ter he up­loaded a video about a new method of treat­ing post­par­tum bleed­ing, he re­ceived a mes­sage: “I saved a uterus to­day af­ter learn­ing about the treat­ment through your on­line video. Thank you very much.”

That mo­ment made Gong re­al­ize the huge power of the in­ter­net.

In 2012, he wrote an ar­ti­cle in which he claimed that many women were di­ag­nosed or even pre­scribed treat­ments for “cer­vi­cal ero­sion”, which is not a real con­di­tion in his opin­ion. He put the es­say on Sina Weibo, where it was quickly re­posted 33,000 times and gar­nered more than 4,000 com­ments.

He also has mil­lions of fol­low­ers on WeChat and other on­line clin­ics that share med­i­cal science and ad­vice. He also of­fers two preg­nancy apps.

Now, about 90 per­cent of his pa­tients come to him through the in­ter­net.

The gov­ern­ment is step­ping up ef­forts to im­prove med­i­cal ser­vices. Dur­ing the 13th FiveYear Plan (2016-20), med­i­cal con­sul­ta­tions via fam­ily doc­tors will be en­cour­aged, and the gov­ern­ment will pilot a hi­er­ar­chi­cal med­i­cal sys­tem in 85 per­cent of China’s re­gions. Med­i­cal com­pe­tence at the grass­roots level will be im­proved and more re­sources will be al­lo­cated for lower-tier in­sti­tu­tions.

Gong and his team have also be­gun work­ing with pub­lic hos­pi­tals in sec­ond- and thirdtier cities, see­ing pa­tients and con­duct­ing surg­eries at hospi- tals in the prov­inces of He­bei and Zhe­jiang.

Gao Xia, vice-pres­i­dent of the Zhangji­akou Women and Chil­dren’s Hos­pi­tal, said Gong’s ser­vice not only at­tracts more pa­tients, but also helps to train lo­cal staff: “Pa­tients do not need to go to Bei­jing to see good doc­tors.”

Ev­ery month, Gong flies to two or three cities, and even though his life is busier, he feels freer.

“I will keep work­ing hard to im­prove health­care in China,” he said.


Gong Xiaom­ing ex­am­ines X-rays at his clinic.

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