The Chinese doctor looks back to the future of medicine
While others look abroad for ideas to improve China’s health care services, Dr Yang Zhen, a surgeon and deputy chief of the hospital administration office in Shanghai’s Zhongshan Hospital, looks to the past. He has been collecting books, papers and photographs documenting the history of Western medicine in modern China for 10 years and is now writing a book on the subject. An expert in dealing with hostile doctor-patient relations, he tells Zhuang Pinghui how history holds some important lessons.
Tell us more about your book and why it is worth the effort?
It’s not a serious academic book and is meant mostly for ordinary doctors, especially the young ones. History is important because medicine is not just about technology. It’s about how we understand medicine. It helps us have a clearer perspective on many discussions in the health care industry now, as the famous poem suggests “the true face of Lushan is lost to my sight, for it is right in this mountain that I reside”. I think I have an advantage in being a hospital administrator, a surgeon and amateur history buff. I am surprised at the findings during my information collecting and, from the point of hospital administration, these documents are very useful. Western medicine entered China a little short of 200 years ago and you would have thought that by now it would have evolved and updated to a high level. Instead you find many of us are foreign to history that is only six or seven decades ago. Many problems that trouble us now had solutions long ago and we are not taking advantage of it, which is worrying.
Do you have some examples on how old solutions solve new problems?
Take the example of a big controversy in January about a girl complaining about how scalpers had made it difficult to see a doctor that month. In the 1950s, almost all hospitals provided advance appointment booking. Some programmes we have been piloting in health care reform – such as allowing doctors to practise in multiple registered places or scrapping medicine surcharges so that hospitals do not profit by prescribing drugs – existed long ago. Even the [idea behind the] New Rural Cooperative Medical System – public medical insurance for rural residents introduced on a trial basis in 2002 – existed in the 1930s. In some parts of China, some farmers paid a fee to a doctor who treated both farm animals and farmers.
Do you find anything strikingly different in historical approaches to medicine?
“Cure sometimes. Treat Often. Comfort always.” We used to focus on curing, but it was not possible and it should not be the only thing that matters in medicine. When a patient kneels in front of me because he has no money or he has all the money for treatment yet no cure after exhausting all the resources, I can’t help at all. We need education in humanity as part of our medical training and we need to find comfort for the terminally ill patient. Humanistic education is missing from our medical training. Western medical education in China came from the Soviet Union and taught that training itself could make a good doctor. Humanity and religion were rarely touched upon. I went through medical school training without education in humanity and for a long time I thought that was it, until I realised there was more to the training and that at a certain period of time in the past we had achieved that. Some medical schools now set up optional courses of medical humanities, but I don’t think that is something that you can pick up by just sitting in a course. It should be part of your life and education long before going to medical school.
It’s a different time now. Why not look at what other countries are doing to improve health care?
Many people are engaged in studying the health care systems in other countries for solutions to solve our own problems, but few are digging into our history. The barefoot doctors in rural areas in the 1960s, similar to general practitioners, once set an example to the world. Studying history makes you confident that problems solved in the past can also be solved in the present.
You have been dealing with doctor-patient disputes for a long time and there have been many attacks on doctors in recent years. What’s your take on the tension?
I believe China is in transition and along with this comes many problems, hostile doctor-patient relationships being only one of them. Greedy doctors who overprescribe drugs or examinations for money have always existed and doctor-patient conflicts are not the biggest conflicts in society, yet are some of the most obvious ones. At the moment we cannot see beyond the present and we need to turn to history for solutions. In olden times more than half of the services in hospitals were provided free to poor patients. A document I found proved that the social services department in the Peking Union Medical College Hospital was treating handicapped trauma patients and pregnant unmarried girls for free. But only in 2009 did the then Ministry of Health issue a circular demanding no hospitals decline emergency medical services to patients who could not afford to pay. Unaffordable health care brings many problems and doctors need to think through what medicine is really about.
Do you think the health care system makes scapegoats of doctors by exposing them to disgruntled patients?
Many believe the hostility results from a problematic system, and that’s not something doctors can do anything about, but doctors can contribute by preventing things from getting worse. Paying attention to how they talk to patients is one of them. Some doctors advocate denying medical services to patients, for example children, after being verbally or physically abused by the parent and many medical staff have echoed the suggestions. It’s alarming and worrying to me. I gave lessons in forgiving to young doctors in my hospital – that punishment is never part of medicine.
How do young doctors take the lecture?
It takes time for people to understand and accept it. Many were emotional and demanded to be armed and I always gave the example of myself. I consider it my greatest achievement after working in hospital administration that I have not gone mad. Sometimes the verbal and physical abuse by patients and their family members has been beyond imagination and I have been confused. It took me quite a while to change my mindset. Studying history helps a lot.
Is it difficult to find collectable articles?
It takes time, money, and a lot of energy to collect these articles. Some were bought and others exchanged. Still, being in Shanghai helps because there is quite a market for old books, papers and documents. I have found about 5,000 of them. Also, the internet makes it easier to search and verify information.
What count as collectable articles?
I have my own standard and it is not only about the monetary value of the document. It has to either reflect the medical administration, or the social judgment of the administration policy, or something personal about certain doctors.