PATIENT ON DOCTOR VIOLENCE
Will US Health Care Follow in China’s Bloody Footsteps?
Patient violence against doctors in China is shockingly common, and it’s increasing as more citizens get insured. Could the US see this kind of violence under Obamacare?
In March 2012, 17-year old Li Mengnan walked into a Beijing hospital. Armed with a three-inch fruit knife, he stabbed three staffers and killed a medical intern, then tried to kill himself. He said he no longer wanted to live after the poor medical care he’d received.
Last month, The New Yorker published an article that told Mengnan’s story in the greater context of China’s health care system, where violence against doctors is common. There are now some 27 attacks on physicians per year, per hospital. Patients attack physicians in America, but it’s still relatively rare. And yet, I can’t help but wonder if we will soon begin to resemble China in this way, as we already do in so many others, with our shrinking middle class and widening wealth gap.
China’s efforts to bring health care to the masses already have mirrored our own, with modern medical facilities located in big cities, leaving the rural areas largely without coverage. The Chinese government has also granted health insurance to nearly everyone—and now 95 percent of its citizens are covered, up from 30 percent just a decade ago. This has resulted in a huge influx of patients into an already strained system. Could Obamacare do the same?
Li Mengnan had a crippling back condition, but it took years to get treatment. I recently outlined two cases of American patients receiving shoddy and indifferent care within our medical system—and it took years for both patients to find someone to listen to them. These stories are so commonplace, it’s obvious to even the most casual observer that our system is failing. Access to care remains a major problem in both the US and China. Mengnan traveled 10 hours from Mongolia to see a doctor—and over the course of two years, he made the trip six times. Likewise, patients in rural America often have to travel for hours to see a physician, since our doctors tend to like to settle in cities. This is a big problem in states like Alaska, Montana, the Dakotas, and the plains states.
Brief visits compound patient frustrations. Doctors in China can see patients every seven minutes, sometimes as often as every two minutes. In America, physicians are seeing patients for 10 to 15 minutes. One of the many problems with hurried patient visits is that it’s easy to miss a diagnosis—a common problem in America. This is exactly what happened to Li Mengnan.
The doctors wrongly diagnosed Mengnan’s back pain as “synovitis”—which led to the wrong treatment. He received a series of shots that left him so crippled that he walked bent over “like an old man.” Eventually the doctors diagnosed “ankylosing spondylitis” (AS)—also known as “bamboo spine”— an autoimmune condition wherein the vertebrae in the back and neck fuse together.
Ankylosing spondylitis is a frightening diagnosis. Patients with advanced cases are completely disabled, with spines so frozen straight they cannot turn their heads. Mengnan was told it was incurable, but that there was one medicine, Remicade, that might help. However, it was expensive. Imagine how trapped he must have felt—how utterly without options. The medicine would cost more than $6,000 USD, and he made little more than $100 a month in his job as a “rub down” boy at a bathhouse. His insurance covered only half the cost, so he had to take money from his grandfather’s pension and beg from friends and family.
For decades in America, angry patients have been speaking out about how insurance wouldn’t cover the cost of some high priced drugs, but the doctors told them the drugs were the only option. How trapped and panicked they must feel. In America, pharmaceuticals can cost more than a car, and in some cases more than a house, with price tags into the $300,000 range—while our median income is still around $50,000.
For Li Mengnan, all the money in the world must have seemed worth it, because the treatment worked. He was described as running around his backyard joyfully. But drugs have potentially devastating side effects, and Mengnan developed tuberculosis (TB), an infection that can be deadly. How trapped did he feel? How utterly without options? Mengnan was forced to stop the expensive but helpful Remicade, and undergo months of TB treatment, which also had terrible side effects, while his spine continued to fuse together.
At the end of the TB treatment, Mengnan received more bad news: the infection wasn’t gone and he needed three more months of antibiotics, which meant three more months of his vertebrae fusing together. The doctors did not tell the young man to his face; Li was left in the hallway while they spoke to his grandfather.
At least in America’s system, when a patient gets shoddy care and feels ignored, he or she has the option to sue. But the malpractice system is not robust in China, and patients feel powerless. So, Mengnan returned to the hospital and killed a man in a white coat. That man was just a young intern named Wang Hao. He had nothing to do with Mengnan’s case.
The promise of modern medicine is a dazzling one. It’s a promise of swift diagnoses and rapid deployment of pharmaceuticals. It claims that medicine has all the answers because it has the backing of science—and it has made the public think they are dependent on this dazzling-science-based medicine to relieve what ails them. These days, traditional medicines and naturopathic approaches are derided as “magic-based.” People flock to hospitals and conventional doctors—because when your life is hanging in the balance, few people are going to opt for magic when science is available.
Ironically, while medicine in China has moved away from traditional approaches, fed-up American doctors are seeking out instruction in traditional Chinese medicine, functional medicine, and other alternative modalities to get out of the trap of rapid diagnosis-and-treatment.
China’s embrace of the Western medical model—and the violence that has erupted—has shown us a hyped-up version of our own system and exposed the cracks in it. We prescribe medicines by guidelines that are heavily influenced by pharmaceutical companies, based on large studies that work for the “average patient.” But no one patient is average. If the doctor had time to work with Li, he might have seen that his back pain was atypical and detected AS in the first visit. If the doctor had time, he might have been familiar with the literature—which clearly shows that many patients with AS get better on low starch diets. Li’s treatment might have been free, and he would have ended up healthier—instead of immunologically suppressed and deranged by his shoddy, assembly line medical “care.”
The New Yorker article neatly summarizes how China’s health care system has come to resemble our own assembly line model. The pivotal change occurred in the 1980s when the leadership dismantled regional healthcare “collectives” and hospitals began to operate for profit. To increase profits, hospitals did what they could to increase “customers” and they lowered physician salaries. Doctors, who were overworked and underpaid, began taking bribes to provide care. The Lancet concludes, “China needs to make medicine an attractive, respected, rewarding, and safe profession again, to protect the doctors of today and those of tomorrow, for the benefit of patients.”
A 2012 commentary in The Lancet called “Ending Violence against doctors in China” notes, “There are many possible reasons why Chinese doctors are under threat…and include negative media reports about doctors, poor public understanding of medicine, unrealistic patient expectations about treatments and catastrophic out-of-pocket health-care expenses for families.” It sounds familiar—right down to the media drum beat to lower physician pay.
It’s a lovely sentiment, but restoring respect can’t be done without reforming the system entirely. You can’t suddenly double the visit time or doctor pay without disruption. Hospitals are not going to give up their take, and pharmaceuticals will not suddenly start pricing fairly just because it’s the right thing to do. Our attempts at health care reform have done nothing to address these two major drivers of the ruined doctor-patient relationship. Instead, our “reform” will simply load more patients into the broken machine—and expect physicians to take less money and run harder to make up the difference. And it’s going to fail.
We will know that it’s failing, not because we are listening to physicians and patients cry out about the problems in the system. We will know it’s failing because violence could quite possibly erupt—China is showing us that. The health care workers will probably be the victims, and the hospital, insurance, and pharmaceutical companies will still be dictating the way we practice medicine—and making a killing.