In China, Questions About Cancer Care as Rates Rise - NYTimes.com

BEIJING ? China has many dedicated oncologists who care deeply about their patients, and as cancer rates rise ? partly as the result of environmental pollution, but also other factors such as an aging society ? they have their work cut out for them.

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Unfortunately, that work is being done within a system that isn?t easy for doctors to negotiate, is a main message of a new article in The Journal of Oncology Practice, published by the American Society of Clinical Oncology, as my latest?s Letter from China explores.

Hospitals may be quick to blame an individual doctor if controversy arises, such as over a ?bad outcome,? or death.

?Chinese patients, thinking they have or are diagnosed with cancer, will demand that certain tests be performed,? write the authors, Dr. David H. Garfield of the United States and Dr. Harold Brenner of Israel, and a Chinese oncology nurse, Lucy Lu. ?Physicians, rather than argue necessity, will acquiesce instead of having these patients complain to hospital administrators, when they must then defend their case.?

Why?

?In this regard, it must be pointed out that hospitals have two administrators: first, a conventional one, as in the West, and second, a Communist party member. A physician must take care. A bad outcome is felt to put physicians, particularly surgeons, at risk for administrative admonishment, lawsuits, or, worse, bodily harm,? the authors write.

The authors said they based their observations on the experience, in 2011, of being in a group that set up the first of several planned outpatient cancer centers in China, the article said.

China?s medical profession enjoys an often tense relationship with patients, who may distrust physicians, suspecting them of being motivated by personal gain.

Another key aspect of the trust problem: the country does not have a system of general practitioners who can get to know a patient well over a long period of time, ?resulting in no long-standing, physician-patient relationships,? the authors write. To make medical care more affordable, the government has kept it relatively cheap; but, tied to that, a doctor may need to see very many patients each day and time for examination is extremely limited, they write.

?During those few minutes, rarely is a physical examination performed. Several questions are asked and answered, with a brief look at images and laboratory tests, tumor markers, and so on; that is it,? the authors write.

And they offered a vivid story: a woman who stopped taking medication for fear of side-effects. ?Our Western oncologist convinced her, after much discussion, to continue tamoxifen by telling her the most important thing was to be alive for her 4-year-old daughter,? the article said. ?She called back later and said she really appreciated what we did for her because her Chinese physician had just given her the pills, not caring whether she risked her life by not taking them.?

Source: http://rendezvous.blogs.nytimes.com/2013/04/17/in-china-questions-about-cancer-care-as-rates-rise/

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