By Andy
I am still sitting in Shanghai nursing my wounds. A trip through the circus-like (but cheap) Chinese medical system last Thursday and Friday left me with a week’s supply of anti-inflammatory drugs, a two-week supply of some other pills that will supposedly help to regrow my cartilage (i.e. my degenerated menisci — I’m pretty sure the pills are just glucose and crushed seashells or something) and orders to rest for at least a week. For the benefit of family and other readers in the West who may not have had any exposure to the Chinese medical system, I’ll give a little overview of the experience. If you’ve been through it yourself there’s probably not much new in this post.
A little Interwebs research leads me to the Sir Run Run Shaw Hospital in Hangzhou, to which Evan is kind enough to accompany me (we figure his own experience with knee trouble and the Chinese medical system will be useful). I should preface this explanation by saying that my trip to the SRRC Hospital is the smoothest and least frustrating of my encounters with the Chinese medical system.
The hospital is massive compared to the others I have been to in this country. The first thing I notice upon walking into the lobby is that the place is clean, and no one is smoking — a relief after visiting my sister in a Sanya hospital where she was recuperating from an attack in a bar in which she had a couple beer bottles broken over her head. The main lobby consists of an information desk (where we are immediately given some incorrect information) and a row of ladies behind glass, resembling tellers at a bank. My only complaint about the SRRS Hospital (outside the dysfunctional medical system in which it operates) is that this row of ladies at computers acts as both the registration and payment center, which means everyone has to wait together to complete either task. Other hospitals I’ve been to separate these.
A trip to a Chinese hospital (which is pretty much the only way to see a doctor as private practices are basically unheard of) begins by standing in one of the lines in front of the tellers and paying the fee to see a doctor. Actually, this is where most of one’s time is spent. Like anywhere else in China, the concept of a “line” is not sufficiently evolved, and rather than simply waiting patiently to get to the front of the line, I’m forced to take part in a sort of territorial battle to fend off a constant stream of pushers, elbowers, “I-just-have-a-quick-question-to-ask” people, and general sneakers-in who think its their right to proceed directly to Go. As I’m about to reach the front of the line, I notice a sign saying that new registrants must first complete an entry form. Hoping the woman at the computer will provide me with one of the forms I stay in the line, but I am of course turned away and told to go to the information desk. After filling out the form, I butt in at the front of the line (when in Rome…), correct the woman’s spelling of my name in the computer about ten times and pay the 5 yuan (US$0.73) fee to see a doctor. Doctors’ fees are clearly not where these institutions make their money. That comes from unnecessary tests and prescriptions. I ask to see someone in the orthopedics department and am told they are on lunch break until 1:30. It is currently only 12, so we sit on a bench outside and read for an hour and a half.
At 1:30 we return to the hospital and find the orthopedics department, which is located on one side of a large, hexagonal room, the center of which is filled with waiting benches and feels like a bus station. In my hand I hold a paper printout with my number on it. An LCD screen at the front of my section lists the next patient in line, like we’re all waiting for sliced turkey in a supermarket deli. My number is called, and I shuffle into the orthopedics department to see Dr. Zhao, who after a brief examination tells me I need X-rays of both knees and Achilles tendons and MRIs of both my knees. Dr. Zhao refuses to speak to us in Chinese and speaks in a voice so soft I can hardly understand. He prints out order forms for each of the tests, and we head back to the cash register/registration area, stand in line and eventually pay for the tests. Nothing can be done in a Chinese hospital without paying up front, even in the emergency room.
A man in his fifties rushes past me carrying his infirm father on his back. Not even Sir Run Run Shaw provides complimentary wheelchairs, I guess.
At the information desk we ask where the radiology department is and walk to Building 3, Floor 2, the department of ophthalmology, where we are told radiology is actually Building 1, Floor 2.
We give my stamped x-ray receipts to the registration ladies in radiology and sit down to wait for our deli number to pop up on the screen. SRRC Hospital is the first computerized hospital I’ve been to in China. Previous experiences have required constant vigilance and territorial skirmishes at each successive test taken or specialist visited. Eventually, my number is called and I pass through a lead doorway into the x-ray room. “Wow, what advanced pants,” the x-ray technicians exclaim as I zip off the bottom half of my pant legs so they can x-ray my knees. “So dark! So big! You must be an athlete,” they snort as a roll my shorts up above my tan line.
X-rays taken, we wait in line for the printouts and then head back down to orthopedics to see Dr. Zhao, who already has the digital images up on his computer (oh, technology!) There’s a bone fragment in my right heel, he says, without giving any indication as to whether that’s a problem. He wants to see the MRIs before making any diagnosis as to the condition of my knees. In the meantime, he prescribes me some expensive, external medication to put on my Achilles “and anywhere else it hurts,” which doesn’t inspire me with confidence as to its necessity. We make another trip to the cash register and then over to the pharmacy. The MRI appointment isn’t until six, so we head to a restaurant across the street to pass the time.
At six, we return to a significantly less crowded hospital and get MRIs of both my knees taken. The lone MRI technician pays me no compliments on my legs despite making me take my pants off all the way. I have a hard time keeping my legs still while the MRI machine clinks and clonks away.
The MRI images aren’t available until three the next afternoon, at which point we return, pick up the images, and wait in line to see Dr. Zhao again. Looking at the images on his computer, he asks, “Do you know what the ACL is?” I explain my understanding of it and he points it out in the images.
“Is there something wrong with it,” I ask.
“I don’t think so,” Zhao says. I wonder why we’re talking about it. “Your menisci are degenerated, your knees are inflamed, and you have fluid in your knees. I’m going to prescribe you some medication. Is that okay?”
“What medication,” I ask.
“I don’t know how to say it in English.” We try to get him to spit it out in Chinese, but he insists on fumbling around for the English. Eventually he writes “NSAID” on a piece of paper, and we guess that he means non-steroidal anti-inflammatory drugs. I start to feel like I might be missing part of the diagnosis due to the language barrier Dr. Zhao insists on imposing on the conversation. “You are young, but your knees are old,” he says by way of explanation for prescribing the expensive drugs.
“So, do I need to do anything? Will I be able to continue the bike trip? Is that bone fragment in my heel a problem?” I have about a hundred questions that I’m not getting answers for.
“I think maybe you should rest for at least a week. The bone fragment is round, so I don’t think it’s a problem.” We thank him, pay a final visit to the cashier and pharmacy and take a cab back to our hotel. The ordeal sets me back about 1,400 yuan (US$205), for which my insurance company may or may not reimburse me six months down the road.
The next day we pack all our gear onto our bikes and go to the bus station. I ride using only my right leg. I head back to Shanghai to rest for “at least a week” while Evan and Alexis continue on the trip. A friend meets me at the bus station to ride my bike into the city while I take the subway.
After trying to figure out if my insurance company will reimburse me for another hospital trip, I head to Shanghai United Family Hospital to get a second opinion on my knees, which are still not feeling up to task after a week off the bike. United Family hospitals are Western-style hospitals located in some of China’s major cities — bright, clean, friendly, English-speaking, and with a price tag to match. In contrast to my 5 yuan consultation at SRRC in Hangzhou, seeing a doctor at United Family sets me back 325 yuan (US$48). It’s almost worth it just to be treated as a customer instead of an annoyance and to be billed at the end of the stay as opposed to between every step. The doctor, a surgeon, says that my ACL is the problem and that the degenerated menisci will heal themselves. She refers me to the hospital’s sports medicine specialist. Did Dr. Zhao have something to tell me about my ACL when he pointed it out in Hangzhou? Maybe he was just trying to keep me from worrying…
My appointment with the sports medicine specialist is set for Tuesday afternoon. My one-week supply of anti-inflammatory drugs is gone just in time for a friend’s birthday this weekend. In contrast to our last rest in Shanghai, the drugs have thus far discouraged heavy drinking on my part. While the downtime is frustrating, I’m trying my best to make it at least valuable. I’ve reread Alexander Dumas’ Count of Monte Cristo and Franz Kafka’s Metamorphosis in English and Lu Xun’s (鲁迅) Diary of a Madman (狂人日记), Kong Yiji (孔乙己) and True Story of Ah Q (阿Q正传) in Chinese and learned the traditional forms of the top 1,000 most frequently used Chinese characters. Yesterday I started on the first book of Those Ming Dynasty Happenings (my translation, 明朝那些事儿). I had told myself that I would take plenty of pictures in Shanghai, and I’m sorry that hasn’t happened yet. Tomorrow’s the day, I promise.
I’ll update on progress with my knee after my appointment with the specialist on Tuesday. Hopefully Evan and Alexis will post something to get us up to date in the meantime. I’m about as in the dark as everyone else!
医院是个有趣的地方，可以看到很多事。到医院看病在中国也是个要挺费心思的事儿。看病难是个经常被说起的事儿。我觉得按你这个经历来说已经比任何中国老百姓去看病容易而且简单多了。
先说明一下，中国的医院分等，三级甲等是最好的，医生也分等，诸如主任医师，副主任医师之类，一般好大夫会称为“专家号”。看大夫要先挂号，就是你拿到的那个带号码的条，医师的等级就用专家号跟普通号来区分。北京的医院，特别是大医院或者专科医院，比别的城市的好，全国各地慕名而来看病的人非常多。但是大夫也是人，精力有限，绝不可能把这么多的病人都看完，一般预先就定好每天只发固定数量的号，看完这个固定数量的病人就下班了，病人数量是每个大夫每天要看几十或上百的数量级。于是挂号就是能不能看上病的关键。每天都有凌晨甚至通宵在挂号处排号的病人，还有专业的号贩子。我觉得光挂号就能把健康人折腾出病来，别说是要看病的病人了。要么就退而求其次，去次一等的医院或者看普通大夫。
我妈是个老病号，她总是要我爸陪她去医院，不愿意让我跟着，是因为怕我嫌麻烦，用她的话说，“看病就跟打仗似的”。我上大学的时候有一次要去看牙科，托了一个学医的同学凌晨4点去替我挂号，因为他的宿舍和医院只有一墙之隔，实际上挂号处是早晨7点开始上班，所以我们是提前3个小时在那儿排队。结果是我们明显不是第一个去排队的，最后我好像是挂到10号左右，等到我看过大夫回去已经错过了吃午饭的时间。
不过在中国看病一般是只要去医院就可以看到医生，即便是周六也能去医院看病，一般只有节假日或者半夜才需要去看急诊，急诊的费用也会在保险范围之内。不像美国还要提前预约，要真是有急病就只能去看急诊，急诊确又太贵，insurance也不管急诊的费用。
I sure hope you find some resolution to this. I have some tender knees as well, resulting no doubt in some part from my long loaded bike tours.
My first suggestion is for you to get rid of some weight on those bikes. It seems like you’re carrying an awful lot of stuff. Make it easier on your knees.
Second, careful trying to ride while using the NSAIDs as they can mask pain and allow you to hurt yourself further. I know that from experience…
I’m rooting for you to get well and get back on the road. I need some more stories!
Phil, if I can get back out on the road, I’ll see about ditching some weight for sure, although I feel like most of the heavy stuff is camera equipment, which is pretty essential. Thanks for the advice about the drugs. I am currently finished with my supply and don’t plan on riding on them or any prescription painkillers for the exact reason you mentioned!
I’d like to translate Shuang’s comment here as I think it’s insightful and useful to hear a Chinese perspective. Please let me know if I’ve translated anything incorrectly:
A lot can be seen from a visit to the hospital. Seeing a doctor at the hospital is a very taxing task in China, and the difficulty of seeing a doctor is an oft-discussed topic. Personally, I think your experience was easier and simpler than that of most of China’s LBX.
I should first explain that China’s hospitals are classified in three grades, with AAA-level being the best. Doctors are also classified into grades, such as chief physician and deputy chief physician. Generally, good doctors are called “specialists.” To see a doctor you must first register, that is, you [pay to] get a slip with a number. Doctors are divided into specialists and generalists. Beijing’s hospitals, particularly large hospitals and specialty hospitals, are better than those of other cities, and they attract a huge number of patients from across the country. But doctors are still human beings with limited energy, and they can’t see everyone that comes through the hospital doors. Generally, they will decide to issue only a certain number of registrations for the day. After seeing that number of patients, the doctors get off work — each day each doctor sees dozens or hundreds of patients. Thus, registration is the key to whether someone will get to see a doctor or not. So people will start lining up in the early hours of the morning or even all through the night, and there are even “registration scalpers.” I think the registration process itself can make a healthy person sick, not to mention actual sick people looking to see a doctor. [If you can't register] you can only wait until the next day, go to an A-level hospital or see a general doctor.
My mother is a longstanding patient. She always takes my father with her to the hospital but is reluctant to let me go because she’s afraid of making me go through the trouble. As she says, “Seeing a doctor is like fighting a war.” Once, when I was in college, I needed to see a dentist. I got a medical student friend to start waiting in line for me at four in the morning because his dorm was adjacent to the hospital. The registration area didn’t actually open until seven, so we were there three hours in advance. In the end, we were clearly not the first in line, actually I think I was given the number ten. By the time I got to see a doctor and went home, I had already missed lunchtime.
However, in general, if you go to a hospital in China, you will get to see a doctor, even on Saturday. Generally only on holidays or in the middle of the night will you need to go to the emergency room, and the emergency room visit will be covered by your insurance. It’s not like in America where you have to make an appointment first, and if you need to go to the emergency room it’s extremely expensive and the insurance doesn’t cover it.
Thanks for the translation. I think the terms of “specialist” and “generalist” are different in China and your country, they maybe misleading in your translation. But it will be a long explanation to clarify that. An other point about the health insurance I just realized was, most of the citizens, with a non-peasant hukou as introduced before, are covered with certain insurance plans. For example my mom had cancer. As a retired Beijinger with a life-threatening disease, her insurance covers about 80-90% of most of the treatments. That’s how we can afford her treatments although my father has prepared to spend all their savings for her last days. But those peasants or the peasants who came to a city to make a living usually have no insurance at all, such as the workers in the noodle restaurants. So it is hard for them to access the heath services because every step in this system asks for fees in advance. I can’t imagine how they get through if they are diagnosed with any serious diseases.
Hope you’re feeling better, Andy.
I have had my share of fun hospital experiences but generally they have been positive, as have most of the experiences of other foreigners I know. I cannot recall any incident where I felt sincerely underserved by the hospitals here; inconvenient, yes, but I’ll make that trade for the cheaper bills 99% of the time. I am an annoying and troublesome patient and have had some excellent doctors and nurses here. United Family is cheap in Shanghai! It costs a fortune in Beijing. I got quarantined there for suspected H1N1 and they attempted to get me to pay for being checked in for the night – 10000 RMB, if I recall correctly…thanks but no thanks, guys. Just leave me in the ditch out back.
Some of the ‘foreigner’ parts (read: more expensive) of the AAA hospitals are not really anything special, though – it’s just a pass to the front of the line rather than a separate area. I guess that’s better than some I’ve seen, such as a hospital in Chengdu that has an entire wing for foreigners, sitting completely empty and well-equipped.
Hey Andy, I go to college in the US and I’m originally from Shanghai. I’ve been reading your blogs for a few days and found it really interesting.
I’ve been in the states for almost 3 years, and my experience of going to the hospital is not very pleasant. My school is right cross the street from the Texas Medical Center, which is the biggest medical center in the world. The hospitals here are nice and fancy, but the low efficiency drives me nuts.
Another big issue is the expense, even though people have medical insurance here in US, but the deductible is around 500 USD and that’s not a small amount of money (at least to college students). When I was in Shanghai, I never remembered having to spent more than 1000 RMB even tho I didn’t really have insurance.
The medical systems are indeed different and I don’t know which one is better, it will be an interesting thing to pay attention to during your trip, especially when you visit the small towns.
Good luck with your journey and I’ll visit a lot! You probably get this a lot, but 你的中文说得真的很好！
It seems like you guys are “gulping” this experience rather than “sipping” it as you would a fine champagne. Pushing yourselves to get in as many miles as possible doesn’t make sense unless you are in a race-perhaps a rat race.
Janice Villarrubia (aka, Evan’s mom)
Mike,
I definitely agree that in the good hospitals in first-tier cities you can have a perfectly acceptable experience, speak to some very knowledgeable people, etc, for a fraction of the cost of going to a hospital in America or to United Family in China. It can be a worthwhile trade-off if you’ve got the time, patience, and language ability. I have yet to meet with a doctor in a Chinese hospital who could sufficiently communicate with me in English. Obviously that’s a pretty high bar to set, and I wouldn’t expect a Chinese person to go to the States and be able to find a Chinese-speaking orthopedist very easily. A diagnosis and prescription for a simple problem I’m happy to go to a Chinese hospital and speak to someone in Chinese. The reduced cost makes it well worth it. If I am trying to see a specialist for a complicated problem, I would prefer for there to be as little bureaucratic hassle as possible with paying up front for everything, etc, and I would love to be able to communicate effectively. Unfortunately, that hasn’t happened this time around with my knee, even at United Family. The first doctor I saw was a Chinese surgeon who simply referred me to an orthopedist/sports medicine specialist (RMB325). The specialist was also Chinese and could not communicate effectively in English. Speaking about a complicated problem, my Chinese was not up to snuff. A general idea of what’s going on, some meds and a referral to a physical therapist set me back RMB1,700. Today I finally saw the physical therapist, an English woman who I finally got some answers from but who was not an orthopedist qualified to look at my MRIs and really tell me what was going on. The magic ultrasound wand + a lesson on stretching set me back nearly 1,800 kuai, and they expect me to go back like five more times. All in all, neither the Chinese hospital experience nor the Westernized hospital in China experience has been very satisfactory.
Also, in terms of the “foreigner wards” in the Chinese hospitals, it’s definitely the equivalent of just bribing yourself to the front of the line. You pay 10-20 times what the Chinese people pay to see a doctor, and then get whisked around the hospital and shoved in the front of all the lines. I remember once I had to get an ultrasound of my intestines. I felt horrible to be pushed to the front of the line in front of a bunch of sickly and tired looking soon-to-be mothers.
Mrs. Villarrubia,
I imagine through your reading of our blogs you’ve probably seen that we would hardly equate modern China to a champagne worth enjoying slowly.
That said, you’re definitely right that I’ve pushed myself too hard too fast. If I can get back on the road again, I will certainly try to work my way back slowly!