A personal blog by Xiao Yuan (2nd year medical student)
This past summer, a classmate and I shadowed surgeons in a teaching hospital in Nanjing, China, whenever we weren’t stuffing our faces with Chinese delicacies. Nanjing is the capital of Jiangsu province, located in eastern China, and is the second largest commercial centre in the east after Shanghai. The following are some observations I made while accompanying doctors on the wards. First however, I feel compelled to mention that although I was born in China, I left when I was 9 years old. Therefore, these observations are by no means fully culturally informed or representative of… well, anything but my own perspectives, really.
One of the most interesting observations I made while there was the nature of the doctor-patient interactions. The doctors speak to patients very frankly and briefly, without bothering to explore the patients’ feelings or trying to comfort them when delivering bad news. Patients are also extremely quick to accept a doctor’s recommendations — even about life-changing procedures. For example, when a doctor stated, “He has bladder cancer. It’s very likely to spread so we need to surgically remove his entire bladder. He will need to wear two bags, connected to his kidneys, to collect urine for the rest of his life,” I began to think of the significant impact of this statement on the patient’s life. I considered all the challenges and complications that accompanied having to wear the collection bags long-term: the risk of infection, limitations on daily activities and potential embarrassment in social situations. However, without hesitation or any display of negative emotion, the patient’s wife responded “OK, doctor, he’ll wear two bags. Whatever you think is best.” This sent my mind reeling with a flurry of ethical buzzwords: paternalism, patient autonomy, informed consent…Argh!
Later, I asked a doctor about this lack of emotional expression. His answer was what I expected; after all, a human is a human on the inside – regardless of cultural differences. “Of course they feel sadness and panic, they just don’t express it,” he said. “Many of them have already mentally prepared themselves for the worst news. Our role is to confirm the suspicions they formed before they arrived at the hospital.” Is the Chinese public so educated about health that they would already know about these things? I thought with astonishment. No. It can’t be. Too many fall prey to the false claims of phoney health products. Plus, we saw a 13 year-old male whose parents didn’t know he had bilateral undescended testicles until he recently had surgery for appendicitis. Are the Chinese generally pessimistic about their prognosis once they get sick? No. That can’t be it either. My grandparents (who both have chronic conditions) certainly don’t seem that way and patients fight too hard, with families too caring, to be chained by pessimism. I didn’t see many patients without family members present, even at 7:30 am rounds. Maybe the lack of money prevents patients from presenting to the hospital until a disease has progressed too far, and by then they know the outlook is grim. One patient we met had refused surgery for damaged bowels after a major car accident for financial reasons. A few days later, he had to have emergency surgery because his condition had deteriorated, like the doctors had warned that it would. Another rural patient had had hematuria for 3 months before finally coming to the city to see a doctor. He had bladder cancer too.
Although I never really found a satisfactory answer to my question, I came away from the experience with lots to think about. Many Canadians complain about the wait times in our medical system, amongst a myriad of other seemingly trivial “first world problems”. No system is perfect. I’m sure as conscientious medical students, many of us are aware of the wealth and health discrepancies seen across the world. Rather than succumbing to outrage and frustration with our system, I suggest we take a moment to appreciate how mind-blowingly fortunate we are to be here: living in Canada, on the way to becoming physicians. No matter where we end up in the world, let’s commit to making positive changes one step at a time.
~Xiao Yuan