Un­healthy ca­reer

Se­ries finds dis­trust, dan­gers faced by China’s hospi­tal staffs

China Daily (USA) - - FRONT PAGE - Con­tact the writer at zhouwent­ing@chinadaily.com.cn

On Oct 21, the Supreme Peo­ple’s Procu­ra­torate, China’s top le­gal cham­ber, an­nounced that cases in­volv­ing vi­o­lence against med­i­cal staff will be re­garded as ex­tremely se­ri­ous, and the na­tion’s best lawyers will work on case re­views to en­sure the rapid ar­rest and pros­e­cu­tion of of­fend­ers.

The an­nounce­ment sig­naled the lat­est move to curb the abuse and vi­o­lence that have plagued the na­tion’s hos­pi­tals in re­cent years.

Sta­tis­tics re­leased by the Supreme Peo­ple’s Court in May last year show that 155 at­tacks on doc­tors and nurses in 2014 re­sulted in se­vere in­juries and even death. Last year’s fig­ures are not avail­able, but the me­dia re­ported 20 sim­i­lar in­ci­dents na­tion­wide in 20 days in June alone.

The scale of the prob­lem has been high­lighted by the TV doc­u­men­tary se­ries, Ren­jian­shi, mean­ing The Ways of The World of Men, jointly pro­duced by the Shang­hai Mu­nic­i­pal Com­mis­sion of Health and Fam­ily Plan­ning and the Shang­hai Me­dia Group. The pro­gram was first broad­cast dur­ing the sum­mer, but was re­cently shown again af­ter win­ning wide ac­claim.

The se­ries has 10 episodes, each ded­i­cated to a par­tic­u­lar topic, such as or­gan do­na­tion, hospice care and the am­bu­lance ser­vice. The direc­tors said the pro­gram aims to im­prove doc­tor-pa­tient re­la­tion­ships by pro­vid­ing the public with the fullest pos­si­ble pic­ture of the sit­u­a­tion in China’s hos­pi­tals and the ev­ery­day work of med­i­cal staff.

Doc­tor-pa­tient con­flict

“Hos­pi­tals are such spe­cial places be­cause some­times they are the last de­fense against death, so there are con­flicts be­tween doc­tors and pa­tients and their fam­i­lies when mak­ing de­ci­sions about treat­ment plans, and also when the treat­ment doesn’t save the pa­tient’s life,” said Dong Lux­i­ang, one of the pro­gram’s direc­tors.

“But af­ter spend­ing many, many hours shoot­ing footage in dozens of hos­pi­tals in the past two years, we found that med­i­cal ap­proaches are some­times lim­ited, and the doc­tors have to com­pro­mise their ded­i­ca­tion and pas­sion to fit re­al­ity. This is com­mon knowl­edge, but some­times peo­ple for­get.”

In the first episode, Sav­ing Lives, the team filmed two ma­jor sur­gi­cal op­er­a­tions and three other pa­tients be­ing treated for se­ri­ous con­di­tions. View­ers were shocked when three of the pa­tients died.

“That was un­prece­dented in Chi­nese tele­vi­sion his­tory, which has al­ways cast a veil over ‘fail­ures’. But the world is never per­fect and we have to face that fact,” Dong said.

Yao Li, a nurse at an elite hospi­tal in Shang­hai, said clin­i­cians want to save pa­tients for the sake of their fam­i­lies, but also be­cause of their own sense of worth and rep­u­ta­tion: “We have a say­ing: ‘The doc­tors want the pa­tients to live even more than their own fam­i­lies do’.”

That point was un­der­lined by Che Zaiqian, a doc­tor in the emer­gency de­part­ment of Rui­jin Hospi­tal in Shang­hai, who was filmed dur­ing an un­suc­cess­ful 16-hour bat­tle to save the life of a 24-year-old man with an in­testi­nal hem­or­rhage.

“Very of­ten the cases into which we put the most ef­fort and emo­tion are un­suc­cess­ful. We as­sume younger pa­tients have a bet­ter chance of sur­vival be­cause of their age, but we don’t have the right to choose,” said Che, who had worked 48 hours straight, as­sist­ing with the treat­ment of three pa­tients, one of whom died.

The pro­gram also showed the heavy work­loads faced by med­i­cal staff, such as Zhao Qiang, di­rec­tor of Rui­jin Hospi­tal’s car­diac surgery de­part­ment, whose team was filmed per­form­ing a heart trans­plant long af­ter mid­night, and Ge Junbo, di­rec­tor of the car­dio­vas­cu­lar de­part­ment at Zhong­shan Hospi­tal, who had se­vere hand cramps af­ter per­form­ing surgery for sev­eral hours.

Heavy work­load

The direc­tors said one of the strong­est im­pres­sions theteam gained dur­ing the two years of film­ing was that the med­i­cal staffs’ work­load is too heavy.

Dong re­called that the bat­ter­ies in the cam­era ran out of power when he fol­lowed a con­sul­tant sur­geon per­form­ing an op­er­a­tion that was sched­uled to fin­ish at 5 pm, but lasted un­til mid­night.

“We were feel­ing hun­gry and dizzy, so a nurse gave me some glu­cose. If I re­mem­ber cor­rectly, the con­cen­tra­tion of glu­cose was 30 per­cent, but I fin­ished it in one gulp, de­spite the overly sweet taste. But that’s the life the doc­tors live, and it’s like that al­most ev­ery day,” he said.

Med­i­cal staff ar­rive be­fore 7:30 am ev­ery work­ing day, ir­re­spec­tive of how far away they live or the weather, and they can never guar­an­tee what time they will leave, he said.

Ac­cord­ing to Yao, the nurse, humor helps to ease the bur­den. “Some­times we joke that a cou­ple shouldn’t work at the same hospi­tal, oth­er­wise the only time they willmeet is dur­ing con­sul­ta­tions,” the 29-year-old said.

Sun Xiaolin, who has worked as a nurse at a hospi­tal in Shang­hai’s Pudong dis­trict for four years, said the heavy work­load and long hours have prompted her to look for an­other job. Many of her col­leagues have al­ready left the pro­fes­sion.

“I don’t even dare to blink for the en­tire night when I mon­i­tor pa­tients who have just un­der­gone car­diac surgery, and some­times we have to per­form CPR at the end of an ex­haust­ing night. I brace my body and mind with just one thought: to save the pa­tient. At that mo­ment, I leave ev­ery­thing else be­hind, like the stom­ach cramps and men­strual pains I suf­fer some­times,” she said.

Ev­ery work­ing night, Sun cares for more than a dozen pa­tients sin­gle­hand­edly: “They ring the bell to the nurses’ sta­tion all night. In ad­di­tion, I have to cope with un­ex­pected in­ci­dents, such as pa­tients’ drunken rel­a­tives fight­ing with each other.”

Ac­cord­ing to Yao, the younger gen­er­a­tion will only want to be­come doc­tors when clin­i­cians re­ceive the re­spect they de­serve: “Oth­er­wise, when we get old, where will we find ex­cel­lent doc­tors?”

Hos­pi­tals are such spe­cial places be­cause some­times they are the last de­fense against death ...”

Dong Lux­i­ang, one of direc­tors of the TV doc­u­men­tary se­ries Ren­jian­shi

So­cial fac­tors

Dong and his team found that the process of bring­ing pa­tients to the hospi­tal in­volves a range of prob­lems that grass­roots med­i­cal work­ers have been un­able to solve.

For ex­am­ple, some­times am­bu­lance driv­ers have no op­tion but to ex­plain to a pa­tient’s fam­ily that they have been held up by traffic jams dur­ing rush hour. Some­times con­ges­tion de­lays rel­a­tives whoare needed to sign per­mis­sion forms for sur­gi­cal pro­ce­dures on be­half of the pa­tient.

More­over, some pa­tients show lit­tle re­spect for the emer­gency room, which should be a green chan­nel for those who re­quire treat­ment ur­gently.

One episode of the pro­gram showed a pa­tient from He­bei prov­ince who ar­rived at the ER at Shang­hai Huashan Hospi­tal nearly two months af­ter a mild stroke. The doc­tors told him that the ER is for peo­ple with acute strokes, but the pa­tient and his rel­a­tives in­sisted on be­ing treated be­cause they’d trav­eled a long way.

“We of­ten meet pa­tients like this and feel em­bar­rassed,” said Yu Hai, a neu­rol­o­gist at Shang­hai’ s Huashan Hospi­tal.

In­sur­ance prob­lems

The so­cial med­i­cal in­sur­ance sys­tem presents an­other prob­lem.

“Peo­ple who have their med­i­cal in­sur­ance in a cer­tain prov­ince but live else­where en­joy a dif­fer­ent level of re­im­burse­ment when they go to the doc­tor or have surgery in their ‘new’ home prov­ince. This may stop some peo­ple from choos­ing the best med­i­cal plan, which­may also be the most ex­pen­sive,” said Qin Bo, Dong’s col­league.

De­spite the prob­lems, many peo­ple are con­fi­dent that China’s hospi­tal cul­ture is turn­ing a corner and that doc­tor-pa­tient re­la­tion­ships will even­tu­ally im­prove.

“When my daugh­ter gave birth last year, she stayed in a pri­vate de­liv­ery room with her hus­band and a pro­fes­sional mid­wife at her side. Later, se­nior nurses came to the ward sev­eral times a day to tell the new moth­ers the dos and don’ts of tak­ing care of them­selves and their ba­bies,” said Wang Mingjuan, a 58-year-old Shang­hai res­i­dent.

“The hospi­tal also took pho­tos of the new­borns wrapped in cute rib­bons as gifts to the fam­i­lies. Those ser­vices were hard to imag­ine when I gave birth three decades ago,” she said.

HUA XIAOFENG / FOR CHINA DAILY

Hu Fan (left), a doc­tor in the emer­gency room at the West China Women’s and Chil­dren’s Hospi­tal in Chengdu, the cap­i­tal of Sichuan prov­ince, deals with pa­tients and their fam­i­lies.

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