Hospital Service, Culture, and Satisfaction in China

This is over the entrance to outpatient services.

At the far west end of Tsinghua University grounds is the Tsinghua University Hospital.  During my period of time in China, I choose to observe and research this site, to see what distinguishes it from Western hospitals, and its implications of Chinese health and medicine as a whole.  Some of the observations were expected, others were very surprising.  However, all the observations helped me understand not only Chinese medical practices, but the cultural views and expectations of medicine in China.

This was the North wing, the entrance is for the emergency room.

The Tsinghua University Hospital (清华大学医院) provides health services to students and Tsinghua University residents.  While it serves as the University clinic, it also houses facilities for inpatient services and its own pharmacy.  The building itself is a multi-wing, multi storied connected complex.  In the outpatient (门诊) and pharmacy wing, the stories reach up to five high.  These are located in the South wing.  The North wing contains emergency services, surgical departments, and other facilities for long stays.  Each wing has its own entrance.  From the outside, and the views from the map, it appears as if both the North and South wing are approximately the same size, though I cannot say for sure as I did not tour the North wing.  Using Google maps, I’ve determined the total size of the hospital is close to two hundred by three hundred feet in depth and width.

View Tsinghua Hospital Research Map in a larger map

The interior of the hospital resembles those in the west.  The rooms and hallways are white walled, with various rooms adjoining the hallways to the right and left.  However, the services provided in the hospital varied from those in Western hospitals.  One aspect of the hospital design that I noticed was the large number and variety of specialized departments within the South wing.  Some of the more interesting departments were those dedicated to traditional Chinese medicine.  This includes both traditional Chinese pharmaceuticals, to procedures such as acupuncture and moxibustion (针灸).

The first floor of the Tsinghua University Hospital contains information services, hospital admissions offices (住院处), a pharmacy, waiting rooms for surgical patients, and other various offices and storage rooms.  The second floor of the hospital held various testing facilities, as well as the clinic (内科).  Also located on this floor was a health education classroom.  At the time of my visits it appeared unused, though I had visited during the summer, therefore I may have simply missed the weeks of when classes were held.  The third floor held departments for vaccinations, pediatricians, and a variety of research departments on health and disease.  This floor appeared to be the least used, as during my visits I only ever spotted two or three people on this floor, not including hospital staff.  The top accessible floor, floor four, held departments specializing in eye, ear, and throat examinations and care.  This floor was a bit more than half the dimensions of the other floors, I estimate around fifty to seventy square feet.

Now, my interests of this hospital first emerged when I, sick with a viral infection, visited it to seek medical care.  I did not deem my condition to be an emergency, and thus entered through the South wing entrance.  Here, I was required to pay the admissions fee, and was sent to the clinic on the second floor.  At the Tsinghua University Hospital, certain departments have their own waiting room, and thus was the case with the clinic.  There, I had my temperature taken by the nurse, who also held the clinics secretarial responsibilities as well.  When the results revealed my over one hundred degree Fahrenheit fever, I was then sent to the emergency room back on the first floor.  Here, I was lead to a small ten square foot room to meet with a doctor.  The doctor asked for my symptoms, and after review sent me to receive a blood test as to determine whether my illness was bacterial or viral.  The blood testing facility was back in the outpatient services on the second floor.  Patients receiving blood tests remained in a small hallway outside the room itself, and interacted with the nurses through two windows connecting the room and the hallway.  I was asked to sit down and present my hand through the window, allowing the nurses to take a blood sample.  The nurses followed the same procedures I’ve experienced in the West; first the finger was cleaned, pricked, and then the sample was gathered using a capillary tube.  The finger was then cleaned using a cotton swab.  However, I was given no bandage for the prick, and was instead asked to hold the swab to my finger.  After a few minutes, I was given the results, and returned to the doctor in the emergency room.  When it was determined the illness was viral, I was asked whether I preferred Western or Chinese medicine.  I replied Western, and was sent to the pharmacy to pick up some prescriptions, after which I left the hospital.  A few days later, I returned due to an incredibly painful throat.  The procedure was similar to my prior visit, thought I was sent to the fourth floor to have might throat examined.  This time, I was prescribed Chinese medicine.

There were two main distinctions from Western hospitals that seemed to define the culture of the Tsinghua University Hospital as uniquely Chinese.  The first was the amount of attention given to traditional medical practices.  In the West, “traditional” medical techniques may harken back to crude surgery or leeches.  From my observances it more often than not holds a negative connotation.  However, the opinions in China on traditional medicine are much more positive.  Perhaps this is due to an actual efficiency of Chinese medicine (中医).  Practices such as acupuncture, for example, have shown by clinical study to have significant beneficial effects on ridding certain ailments, if administered correctly.  And walking through the streets of Beijing, you can see the trust people place in acupuncture and moxibustion, as evidenced by the number of people that can be seen with moxibustion marks on their backs.

At the Tsinghua University Hospital, these demands were met with departments dedicated to traditional Chinese medicine, and their stock of Chinese pharmaceuticals.  When I made my request for Western medicine at the hospital, the doctor informed me that would limit my options for medicine, indicating a larger store of Chinese medicine compared to Western. Interestingly enough, it seems that the hospital not only had a supply of Chinese medicine, but a small production facility as well.

Chinese medicine itself is much more herbal compared to Western medicine.  In some of the Chinese medicine I received from my second visit to the Tsinghua University Hospital, the ingredients included flower roots, some fungi, and various herbs and leaves.  The taste was what one would expect from the ingredients; very grassy and bitter.  The fact that Chinese medicine utilizes a variety of ingredients has been cited as an important reason as to why it has not spread further world-wide.

Sample of Chinese herbal medicine

The second distinction of the Tsinghua University Hospital was the style of service.  In Western hospitals, an individual will be given their own room, and wait for the doctor to come and diagnose the issue.  At this hospital, the doctors stay within their own rooms, and the patient was expected to travel from department to department.  Each department would print a memo to be shown to the next, and for any test or pharmaceuticals, an individual would first need to pay at the admissions and receive a receipt.  There are a few reasons behind this service style.  First, each department is very specialized.  This limits the mobility the doctors have, as they’ll be most effective within their own wing with access to equipment and specific supplies.  The second reason is that China has been facing a lack of qualified doctors.  From discussions with locals, I’ve learned that setting doctor appointments can take months when there is high demand.  As such, to maximize the amount of work a doctor can do, they eliminate the doctor’s need to travel.  Moving between different rooms takes time, so that responsibility is placed on the patient rather than the doctor.  However, this likely contributes to the low levels of patient satisfaction in Chinese hospital service.  In most of my discussions with Chinese residents, I’ve been told doctors are grumpy and “mean.”

Interestingly enough, while many are upset with hospital services, most are satisfied of the outcome of hospital care.  This has been shown in a variety of research, as well as in my interviews.  One interviewee expressed her displeasure in the Tsinghua University Hospital service, believing it to be something the hospitals should improve upon.  At the same time, she felt the hospital was all-in-all good, and that their use of Chinese medicine was beneficial.  In addition, as a student, hospital prices were relatively cheap for her, as the University would give out some reimbursements.  However, while most seem satisfied with the outcome of outpatient care, I have been warned to stay away from the surgical department of Tsinghua University Hospital.  Stories include individuals who end up with injuries worse than what they came in with.  Surgical and other long-stay treatments have been criticized in China, with hospitals providing poor care and holding patients overly long, raising prices.

Overall, the nature of the hospital at Tsinghua University seem to place much of the responsibility on the patient.  One small matter that I encountered was that no bags or such were provided for the pharmaceuticals I received, thus making it somewhat difficult to store in my pockets as I returned to the dormitory on my bike.  After this, I noticed every individual who entered the hospital brought a large bag of some sort.  Most resembled those reusable grocery bags that you can find in the U.S.  Patients at the hospital also always seemed to come in groups.  While lone individuals were not rare, the large majority of patients were visiting along with a friend, spouse, or parent.  The age diversity of the hospital also surprised me.  As the hospital services a university, I had expected most patients to be young students.  However, there was an equal balance of children, adults, and elderly present.  This likely s peaks to the nature of Tsinghua University as well, having a large non-student population residing within the university limits.

My observations of the Tsinghua University Hospital revealed much on the culture of medicine and health in China.  As per my outside research, many in China have low satisfaction with hospital services, but simultaneously have faith in the care received and traditional Chinese medicine.  Not mentioned by outside research, however, was the responsibility placed on the patients over the doctors.  The style of service and behavior of the patients at the hospital seemed to that patients were expected to take care of themselves, and that the doctors were merely there to assist.  Overall, it was a unique experienced, of which I have now gained a better understanding.

Tang, JL, and TW Wong. “The need to evaluate the clinical effectiveness of traditional Chinese medicine.” Hong Kong Medical Journal. 4.2 (1998): 208-10.

Eggleston, Karen, Li Ling, et al. “Health Service Delivery in China: A Literature Review.” Health Economics. 17. (2008): 149-65.