Holding the Space for Expectations Challenged

Ray Great Wall 2016

Those of you who follow this blog know that I meet regularly with a group of insightful and engaging medical students. I have written about them here and here. At our meeting last month, one of them described his recent rotation in China, and I invited him to share his experience here. I’m so grateful for this continued connection to physicians in training—it keeps me grounded. It reminds me that no matter how old and wise I may consider myself, I always have much to learn from others.

Enjoy, everybody:

 

Expectations. In the United States, we have come to have certain expectations for how things should be. A meal at burger joint should include a burger, with a side of fries and a Coke. When we check into a hotel, there should at least be a TV and a coffee maker with complimentary coffee. These have become essential (American) assumptions, and because we are the “best in the world,” our way is the best way.

Similarly, when you go see a doctor, there are certain expectations, both good and bad. You expect that it may take a few days to get an appointment. You expect a reminder prior to your appointment. You expect to wait a certain amount of time to see the doctor and to fill out a ton of paperwork. You expect the staff to be courteous. You expect to see a nurse first, and to wait again in an exam room until your doctor arrives. You expect the doctor will listen to all of your health problems closely, and offer helpful suggestions regarding imaging and medications you can take. You expect those prescriptions to be sent to your pharmacy, and that you can to pick them up after your appointment. You expect to get better.

What if your reality ended up very different from these expectations?

Last month, I went abroad to see what the healthcare system is like in China, at an academic teaching hospital in the nation’s capital of Beijing. After spending a year deeply entrenched in the clinical wards of the United States as a third-year medical student, learning from the best of the best doctors, I thought I knew what it meant to provide good medical care. I expected that I could teach them better ways of delivering care based on what I learned in America. I soon found out that I was the one who had a lot to learn.

To provide some perspective on just how different the healthcare system is in China, imagine this scenario, based on an amalgamation of different patient experiences that I witnessed:

You are sick and want to see a doctor. You wake up the next day at 5 in the morning so that you have enough time to take the subway to get to the hospital by 6. When you arrive, there are already 30 people in line ahead of you, and the specialist you want to see only gives out appointments for 25 people for his morning clinic today. You don’t end up getting an appointment.

You go into the doctor’s office when he arrives at 8, bursting in the door with 10 other people who are sick but were unable to get appointments. You fight for the doctor’s attention during his first patient’s appointment, and, luckily, you get an add-on appointment, for after his 25 other morning appointments. You sit in the waiting room until 12:30PM, when you are finally called in.

You see the doctor. He only has 5 minutes to spend with you. As he is doing your physical exam, his next patient enters the room before being called, and watches everything. The doctor says you need imaging, which you need to pay for and schedule yourself. You then need to pick up hard copies of the images and bring them to your next appointment, so that he can make a diagnosis. You also need some medical equipment, and he suggests shopping for it online. He says you may need to be hospitalized, but it may take 2 weeks to get a hospital bed spot, so you should sign up for the waiting list now. You get the imaging and medical equipment, the doctor makes a diagnosis, and you get better.

Your total cost for everything was less than $50.

Your gut reaction to this story may be, “this is madness!” You may feel that your expectations of healthcare delivery, based on your experiences in the United States, are very different from the care provided in China–not only different, but almost certainly better. At least, that was my gut reaction. I was appalled on my first day of clinic; my mind raced with questions: How do patients put up with this disregard for their time and rights to privacy and respect? How are doctors able to treat patients adequately without hearing the patients’ stories? Can patients have a good understanding of their medical condition in this system of care? It made me feel grateful for what we have in our current healthcare system back home, with better customer service, shorter wait times in the doctor’s office, and more privacy during the appointment.

However, take a second to reflect: is our healthcare system universally better? In this compiled scenario in China, you got seen by a specialist on the same day you got sick, which happens on a regular basis for patients familiar with how the hospital system works (even those unfamiliar with the system can still be seen within one or two days). Your overall costs were low and did not involve convoluted paperwork from third and fourth parties. And, most importantly, you were still able to get better. These are all things that hospitals in the United States hope to improve on. By the end of my first week in China, I realized that my gut reaction on the first day was irrational, stemming from discomfort with things I was not accustomed to. As I distanced myself from my premature judgment on what I was seeing, I found that the differences were not bad, just different. China has the challenge of providing healthcare to the largest patient population in the world, and with that, factors like cost containment and short visit times are prioritized. In the United States, we have also had to prioritize certain factors, specifically patient satisfaction, due to our cultural values and our legal system. In both countries, though, positive patient health outcomes are the highest priority.

Dr. Cheng asked me what three things I learned primarily from doing a clinical rotation abroad. First, different does not equal bad. While China and the United States do not have the same priorities for or access to healthcare, both have well-functioning healthcare systems. Second, withhold judgment from your expectations. Your gut reaction may not always be correct and may limit you from fully understanding things unfamiliar to you. Third, be grateful for what you have. Though our own healthcare system has its problems, we should be grateful for everything that works well, and we should not take it for granted.

2 thoughts on “Holding the Space for Expectations Challenged

  1. This was a fascinating comparison of two very different healthcare systems. I really appreciated his description of the Chinese patients’ experience, his initial shock, and subsequent openness to different ways of looking at care and related processes. His three learnings from the experience show a wisdom that should serve him well in his chosen profession. Thanks to both of you for sharing this. You’ve given us lots to think about.

    Liked by 1 person

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