Eric's Beijing Diary

Got my back X-rayed today. I had been planning to do it for sometime, because I have had occasionally had back problems. I do not suffer from constant back pain like some do, but it just seems that my back goes out a little more often than it should. Some time ago, I had mentioned to my friend, who is an orthopedic surgeon, that I had gone to a TCM (Traditional Chinese Medicine) doctor for my back (see June 6, 2006). He strongly discouraged me from going to such places, and invited me to come to his hospital for an X-ray. Well, I have been putting it off for sometime, but when I cut my head open recently (see January 28, 2008), the kid who stitched me up suggested that I might be wise to have a specialist look at my MRI. So I called Shawn and asked him if he knew a neurologist at his hospital who could give it a gander, and let me know if there was any problem, then I could get my back X-rayed at the same time.

I took the subway to Jishuitan and walked to the hospital. Shawn had arranged to take the day off so he could help me. Fortunately, he had a friend at the hospital who was a neurologist, so we went there first. A few doctors were watching a ball game on a big screen when we walked into their office. The neurologist put my MRI plate up on the screen and asked me what the kinds of symptoms I was experiencing. I told him that I didn't have any symptoms, just that the doctor who did the suture thought I should have it looked at. He told me there was no problem. Got that part over with. Then we went to take the X-ray. Not being a medical person, I had mistakenly allowed myself to think that I would get a better picture of just what is happening to the discs in my lower back, but Shawn told me that the X-ray could not show any soft tissue, only bone structure. The only way to see what is actually happening with the discs is an MRI, which he did not believe was called for in this situation. But the X-ray did show a classic degenerative condition. It didn't really tell me anything I didn't know, but was still useful, I guess, in giving me a little better understanding. Basically, the X-ray showed that I have the body of a 50-year-old man. I suppose I should accept that, since I am 53, but it's hard. I'm too young to be that old.

Shawn and I spent a good bit of time discussing comparative medicine. For us, it was not really a discussion of the differences between TCM and western medicine. Rather, it was a discussion of how health care is facilitated here in China as compared with the United States. A few personal observations....

If you evaluate health care strictly from outward appearances, then perhaps you would come down on the side of American health care pretty quickly. American hospitals definitely look fancier than Chinese ones. No question about that. But as a patient in a health care system, there are three other issues that come into play pretty quickly. They are access, cost, and quality. I tend to lump access and cost together, since the inability to pay for a service effectively limits your access. For example, when I was living in the United States, I tended to neglect my teeth because I simply could not afford to go to the dentist, even though I had dental insurance. So I will evaluate Chinese medicine in those two areas--access and quality.

Access. I live in Beijing, so much of what I say is influenced by the fact that I live in relatively close range to some of the best doctors in China. The third teaching hospital for Peking University is right across the street, and the Jishuitan hospital, which is the fourth teaching hospital for Peking University, and also perhaps the top orthopedic hospital in China, is not far away. So from a strictly geographic point of view, I am in a very good place. But, as I said, cost is the other part of access, and that is where the Chinese system really shines. It is just much, much cheaper than medical care in America. Of course, it is a matter of perspective. Shawn told me today that the relationship between doctors and patients in China is not good, because patients are always angry about how much they have to pay for medical care. For all its progress, China is still a peasant society, where 800 million people live on a dollar a day or less. For these poor people, what looks cheap to me, coming from America, where medical costs are downright wicked, seems as prohibitive as American medical care seems to me. But perhaps a comparison would help. The last time I went to an emergency room was back in the summer of 1999. I had just come back to Arizona from a weekend church mission to Mexico, with a very mean case of Montezuma's revenge. My case of the creeping crud had actually passed it's apex, but for some aggravating reason, I had developed a condition that did not allow me to rehydrate orally. I would begin to wretch every time I tried to drink even the smallest amount of fluid. At a time like that, it is hard to describe the feeling as "thirst," but I knew I was in desperate need of fluid, and I had good insurance, so I went to the emergency room and had them fill me full of fluid. It made a big difference. I went home and slept like a baby, and a couple days later, I was hiking in the mountains. Needed medical care instantly applied at no cost to me. But now, let me break this down. If I remember correctly, the price tag was about 600 US dollars. I had insurance, but what if I hadn't? You know, in America, they're really nice to you if you have that little card in your pocket, but if you don't, life can be really miserable. I would probably have passed it up, and may have gotten better, but not necessarily. Diarrhea is uncomfortable, but dehydration will kill you.

In China, when you go to the hospital, they give you a little slip of paper for every procedure. You then go to the cashier window, pay for it, and get it stamped, and then to and get your stuff done. The MRI was about 250, the suture procedure about the same, and then a little for odds and ends, like the bandages. Just over 500 RMB. That's just over 70 US dollars at today's conversion rates. Now, as I said, it isn't as fancy. The young doctor who stitched me up did not have the level of training that his American counterpart would. In China, doctors have bachelor's degrees. Medical school is basically five years of college after high school. Shawn told me today that that is changing. China is moving toward an eight year MD program. But getting back to the kid who sewed me up. He was confident, and seemed to know what he was doing, and he did a good job. When I lay down on the table, there was nothing to prop my head up with, so Wang Li-hua kindly folded my coat up so that I could put it under my head. The alcohol and whatever else he put on the wound dripped down in my coat, but that's no big deal. It's just that, well, medical procedure just isn't as fancy in China as it is in the States. But even though medical insurance in China is not very good (one friend told me recently that there is no such thing as family medical), you can almost afford to be self insured. Today, I spent 180 RMB for the X-ray, and another 7 quai for having the doctor look at it. If I consider what today would have cost me in America--transfer of medical records, consultation from a neurologist, X-ray and doctor visit with the physician who looked at my X-ray, I think it would have been quite a bit more than what I put out. Also the system is much less bureaucratic. You don't have to worry about transferring medical records, because they don't keep them for you. When I took the MRI, they put it in a paper sleeve and gave it to me. Same thing at the dentist. If you have X-rays taken, they put them in an envelope and give them to you. You can do whatever you want with them. So if you move to a different part of the country, or just want to go to a different doctor, you don't have to go to any pains to transfer your records. You have them in your possession.

There is much more to talk about from a Chinese doctor's point of view, but perhaps I will let Shawn share his thoughts at some other time. What I would say, in summary as a foreigner living in China, is that since health insurance isn't that great in China ( I think my college pays about 1000 RMB a year for the policy they have on me), if you have major problems, such as a heart bypass, then perhaps the American system would be better (high cost, covered by insurance). But for a single person in reasonably good health, the Chinese way is ever so much simpler.