Surgeons in China

[Randy W]

from the China File

 

Cut out of the Operating Room

Only a Tiny Fraction of Surgeries in China Are Performed by Young Doctors

 

http://www.chinafile.com/sites/default/files/styles/large/public/assets/images/article/featured/doctor-fea.jpg?itok=fUmpMpOI

 

 

Quote

Why the low surgical output? One reason is a dearth of hands-on training, such that when Chinese surgeons complete surgical training, many have hardly gotten a chance to cut. Then, they can spend years after training assisting senior surgeons or performing simple procedures. Writing in The Lancet in 2016, a group of Chinese public health experts affiliated with Sun Yat-sen University in Guangzhou reported that less than 5 percent of surgeries in China are completed by doctors under the age of 43.“The biggest challenge facing surgical trainees at all levels in mainland China today,” they write, “is the paucity of hands-on learning opportunities.”

 

As an American medical student conducting a study on surgical education in China, I arrived in China knowing these statistics. Still, coming from the “see one, do one, teach one” ethos of the U.S. system, where medical education jobs are among the most prestigious forms of employment for doctors, I was stunned by how little hands-on teaching there is in Chinese academic medical centers. I discovered it was typical for young surgeons to spend decades waiting for a chance to stop observing and start cutting. In America, surgeons grant trainees maximum possible autonomy given safety and practical constraints. American senior surgical residents are expected to complete many surgeries independently, with attending physicians merely supervising and assisting their work. Beginning my own surgery rotations, still two years away from getting an M.D., I was expected to be scrubbed in and ready in case a scalpel was handed to me, which it was, on my very first day.

 

In China, the learning is more delayed. Take, for example, an ophthalmologist at a top-rated hospital in Beijing, who asked that her name not be used in this story. After securing an M.D. and Ph.D., she graduated from a top residency program, and is now an attending ophthalmologist at a prestigious eye hospital. On top of her busy training schedule, she has managed to publish dozens of peer-reviewed research articles. I asked her how many cataract surgeries she’s done. “Zero,” she said. “I’ve seen a bunch but haven’t actually gotten to do any myself.” An ophthalmologist in the U.S. would have completed scores, if not hundreds, of such surgeries by her stage of career. She told me she hopes that she can begin operating in the next decade or so.

 

 

 

 

Edited January 3, 2022 by Randy W (see edit history)

[Randy W]

. . . and then there's this

 

Chinese hospital compensates man kicked off operating table and sent to pay US$2,200 bill

• Surgeons in Lanzhou say doctor demanded fee from anaesthetised patient that was seven times typical bill for procedure
• Poor regulation of private hospitals in China leads to cases where surgeons extort thousands of yuan in extra fees from people in their care

Modern Men’s Hospital in Lanzhou agreed to pay the patient 41,450 yuan in compensation after he walked from the table under local anaesthetic to a floor below to pay the fee the surgeon demanded.

The patient, surnamed Yao, a tourist from Yunnan province, had a consultation at the hospital in Gansu province on October 25 and paid the doctor 538 yuan up front, news site Thepaper.cn reported.

However, the unnamed doctor stopped surgery midway and demanded 15,300 yuan more from his patient or the operation would not continue.

 

 

[Mick]

I never had surgery in China, but did have my ear wax cleaned out once. The used a machine that had an engine that started with a pull cord, like a lawn mower. In terms of medical observation, the worst experience I had in my five years over there was the prostate exam. Before giving me the old finger job, the doc called in a steady stream of nurses to see my penis, which was circumcised. I guess that is a rarity over there. I'll wager at least 50 females took a gander at the old Johnson. A couple took pictures.

[Randy W]

I never had surgery in China, but did have my ear wax cleaned out once. The used a machine that had an engine that started with a pull cord, like a lawn mower. In terms of medical observation, the worst experience I had in my five years over there was the prostate exam. Before giving me the old finger job, the doc called in a steady stream of nurses to see my penis, which was circumcised. I guess that is a rarity over there. I'll wager at least 50 females took a gander at the old Johnson. A couple took pictures.

 

 

My prostrate exam was by a female nurse - they use ultra-sound now. MUCH more pleasant, and private

[Allon]

My latest was by a female doctor who was a nurse. She seemed to like doing it. I think in a way they like prostate exams as a form of punishment. Paybacks are hell sometimes. Other times, well, not bad.

[amberjack1234]

I never had surgery in China, but did have my ear wax cleaned out once. The used a machine that had an engine that started with a pull cord, like a lawn mower. In terms of medical observation, the worst experience I had in my five years over there was the prostate exam. Before giving me the old finger job, the doc called in a steady stream of nurses to see my penis, which was circumcised. I guess that is a rarity over there. I'll wager at least 50 females took a gander at the old Johnson. A couple took pictures.

Mick, it sounded just like my experience at Chapel Hill Hospital. Not only that they wanted to feel of it too. I was beginning to feel like a celebrity. One young gal got right between my legs with her head so she could get a better look. I was setting in a chair for a bit. Lost my shyness really quick up there.

[Mick]

My latest was by a female doctor who was a nurse. She seemed to like doing it. I think in a way they like prostate exams as a form of punishment. Paybacks are hell sometimes. Other times, well, not bad.

 

Your assessment of the procedure as a "form of punishment" may be right on the money. I swear, once this guy went to work it was the most painful prostate exam I had ever gone through. I felt like asking him for a smoke when he had finished.

[Dennis143]

That's the reason why I always try to chose a female doctor. If anyone's gonna give me a digital exam, I hope it's a woman. Of course, preferably after dinner, wine and a movie.

 

One time at the VA clinic a young (early 30 something) female physician's assistant sat me up on the gurney and when she had finished listening to my heart, looking in my ears and throat etc. she stood between my legs looked me in the eyes and said "Now that you're here today Mr. Conner, is there anything else that I can do for you?" OMG, and no, I didn't ask for a rectal exam, but boy did the rush of bad, er good thoughts run through my head. I could not believe she was so naive to ask such a question and do I really look that old and harmless? I sheepishly answer, "No".

[amberjack1234]

I liked that Dennis. I was going to the VA in Durham, NC about twice a week for kidney stones and there was an old gal up there that would give me a finger wave every time I would go. After almost a month I finally ask her "do you really think this is necessary after two times a week for a month" She says I guess we can skip this one and she never did give me another one. She really helped me out when they sent me to the VA in Memphis so I guess it paid off. She got the wife a plane ticket to go with me and a room for us to all courteous the VA for 4 days as well as a limousine ride from the airport to the clinic and then back instead of the VA shuttle bus.

[Randy W]

More on the subject from the Sixth Tone

 

Why China’s Young Doctors Want Out of the System

Low pay, long hours, and conflict with patients are pushing once-idealistic medics out of public hospitals.

 

http://image5.sixthtone.com/image/5/15/628.jpg

 

 

Many of those who leave public health care cite low pay, overwork, and conflict with patients as reasons for getting out. A white paper published last year found that the average starting salary for China’s junior doctors is around 4,850 yuan ($730) a month — significantly lower than Shanghai’s average graduate starting salary of 6,000 yuan. In addition, while most Chinese doctors officially work an average of 50 hours a week, lengthy unpaid overtime hours are virtually mandatory, doctors say. And abuse directed against medical professionals is rife in China’s public health system, where around 100,000 violent incidents are reported each year.

 

[amberjack1234]

No wonder they want under the table money if they give you preferred treatment.

[Allon]

Warning: not for the faint of heart and long but might be instructive:

 

I worked surgery as an OR tech in a military hospital for 4 years aside from my days as an EMT also military. Certainly the working conditions were not as described in China but it was, after all, the military. The hospital specialized in the region for OB-GYN issues. I have seen thousands of women have D & C's, C sections, hysterectomies, and trauma along with all the other general surgical stuff you see in a hospital. (That does not qualify me as an expert. These were the slash and burn days before cryosurgery and medicine has changed a lot since.)

 

I saw a lot of mistakes and a lot of really fine surgery. The best was done by a Chinese (Mongolian) surgeon named Dr. Meng. He was tall and extremely polite (unlike most surgeons I ran across) and had some trouble with English. When a young teenager came in for an appendectomy, before she went under, she asked the doc to make the scar as small as he could. He smiled.

 

After she went to La La land, the beautiful work we had done prepping her was greatly diminished by his skill. It was standard then to shave all hair including pubic hair from the belly button to the anus. (Try that sometime....) And then scrub the area with BetaDine solution. Standard opening cut was called the McBurney's incision from one inch to the side of the iliac crest to the junction of the mons about one inch above the pubic bone. There are two main muscle groups to cut through. A true slash and burn operation. Average time under was 90 minutes. The teenager had a beautiful body (need more?) so I understood her wishes.

 

Dr. Meng palpitated right near the joining of the appendix with the large intestine. He literally felt the swollen appendix and made a small cut about 2 inches long and to the left of his finger, where the neck of the appendix lay. After some further small cuts through muscle and fascia, he reached in with one finger and pulled the entire appendix out and asked for a basin to put it in. After we got out of shock, I got him an emesis basin and he plopped the appendix in it, tied the neck of it in 2 places and cut between. Blood and pus came from the organ but it went all inside the basin. We closed up and left a suture line of about 2.5 inches. I noticed the clock time was 40 minutes. Our surgical team, including the nurses looked at him like he was the Second Coming. He just smiled.

 

He was Chinese, a big contrast to what I have seen otherwise from Chinese doctors.

 

When I saw the C Section scar on my wife and daughter and another friend of theirs, I was just appalled. You could see where they had not sutured properly and left gaps where the incision separated and finally granulated over to shut the wound. They must have bled a lot and been in some pain for a while after.

 

But some other stories show there is some talent in China. Surgery is a challenging job and I loved working there except when I handled combat wounds. I am saddened to see the reasons why patient care is so bad in China when clearly they have some gifted people.