One of the issues that will arise if you intend to operate an international standard facility in China is the steadfast belief that some/most of your Chinese patients will have in traditional Chinese medicine. The term TCM has come to encompass a wide range of often dubious practices such as outpatient saline drip, pulse diagnosis, cupping and other exotic practices that rely more upon incredulity than hard scientific evidence. While some TCM practices have been found to be effective, a large portion of the market under this term has to be approached with skepticism. Imagine the experience that one of my employees recently had when after four years of heart-breaking failure to conceive, she sought the advice of a ‘famous’ TCM doctor. This doctor was so popular it took her several weeks just to get an appointment. When her day finally came, the doctor put his fingertips delicately on her wrist feeling her pulse, gazed into space for a moment and announced that the reason she couldn’t conceive was that her left ovary was blocked. Oh, and the charge for this bit of sixty-second hokum? Over 1,200 RMB – $200! The tragedy of this was that my employee, a Western educated MBA, firmly believed in this ‘diagnosis’ and all of her hopes were raised only, of course, to be dashed later.
Saline drips are another particularly troublesome issue that requires some flexibility in your thinking. The inefficacious practice of giving a saline ‘drip’ in the ambulatory environment as a remedy for a host of medical ills ranging from infections to fever is absolutely embedded in your Chinese’s patient’s psyche. Chinese facilities will have whole rooms filled with reclining loungers full of patients receiving this absolutely essential component of their outpatient visit. Attempts at educating patients on this useless and needlessly expensive practice are met with stubborn resistance. If the Chinese patient doesn’t get their ‘drip’, they feel cheated and a recipient of poor service. Try refusing to provide this service and you would have a riot on your hands. Chinese physicians are poor at communicating this issue because, at heart, they also believe it is worthwhile and of value. Hospital administrators are not enthusiastic about eliminating this practice, regardless of whatever doubts they may have about its efficacy, because it’s a huge revenue generator. So the practice continues. The approach I’ve used in hospitals we manage is to attempt to educate the patient first but if that fails and the patient insists on receiving their drip, then we accommodate them.
One final issue on this topic and one where I refuse to accommodate cultural expectations is in the area of compounding homemade TCM medications in your pharmacy. These homebrews are typically made in circumstances far from GMP standards and generally of doubtful benefit. You can’t eliminate TCM medications (and you wouldn’t want to – despite their lack of scientific studies some are surprisingly effective) but you can insist that only TCM medications made by commercial pharmaceutical companies under appropriate standards can be used in your facility.
I could go on with numerous other examples. ‘Cupping’ or the application of heated glass globes to the skin of patients to suck out harmful ‘humours’ is a practice that was abandoned by European physicians in the Middle Ages but still commonly practiced in China today. Does the fact that this practice has continued in China for literally thousands of years mean that it must be effective? The placebo effect tells us that it will be effective if you believe that it is effective and that’s the situation for many of these treatments. Challenging these treatments with Chinese patients on the basis of logic and science is doomed to failure. But such are the challenges of trying to maintain international standards in your facility in China.