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Cultural Differences and Preventive Practices
Mary V. Mason, MD, MBA
Kenneth Ezrow, MBA
JAMA. 1999;281:2056.
A recent trip to China provided insights into the approach to preventive medicine taken by Chinese physicians. As part of a global management studies course, a group of us went to China to study the national health insurance system. Although the goal was primarily to look at economic factors, we were able to observe a different attitude toward preventive medicine than that taken by most physicians in the United States.
The Chinese government is in the process of reforming and expanding the country's health insurance system. As medical insurance becomes widespread, cost containment will become critical. This should lead to an increased need for preventive services that diagnose and begin treatment earlier in the course of an illness and, theoretically, save money in the long run.
At present, Chinese physicians have little experience or training in incorporating preventive practices into patients' overall care. The medical students and resident physicians we met at one of China's largest medical schools seemed puzzled by many of our common practices. For example, we explained that a US physician would prescribe aspirin to a patient with unstable angina to prevent a myocardial infarction. The students and residents explained that the Chinese physician believes that this approach only creates a new problem: gastritis. According to those trained in traditional Chinese medicine, it is far better to remedy a problem in ways that do not cause new problems. Chinese physicians would opt for a treatment using one or a combination of acupuncture, moxibustion, Chinese herbs, and qi gong ("energy work"). Regardless of the preventive benefits of some treatments, Chinese physicians would not knowingly prescribe a treatment that could lead to a new complication.
Currently, only expatriates and wealthy Chinese patients can afford most screening tests; these patients purchase memberships in Western-style medical clinics that have integrated preventive medicine into their practices. Although advanced medical equipment is now widely available in many of China's city hospitals, the use of this equipment is not yet integrated into medical practices.
Despite Chinese resistance to the Western approach to preventive medicine, we should not overlook the potential patient benefits that would come from integrating some of these practices into Chinese medicine. We should share our knowledge and teach "best practices" for screening examinations involving high-tech equipment and should help Chinese physicians recognize the effectiveness of low-cost interventions. Through medical exchange programs with Chinese medical students and resident physicians, we can assist China in shaping attitudes about best practices in preventive medicine and help develop a system that uses medical resources wisely. In addition, their perspective on treatment may hold lessons for us; additional exchange programs may give us an opportunity to reshape our own thinking.
Member-At-Large, AMA-RFS
John Olin School of Business
Washington University
St Louis, Mo
Prepared by Ashish Bajaj, Department of Resident and Fellow Services, American Medical Association.
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