China's anaesthetists are dying of overwork

by Michael Woodhead
The sudden death of a 40-year old anaesthetist at the Beijing Fuwai hospital this month has put the spotlight on the high work burden of anaesthetists in China and the shortage of doctors in this speciality. 

Colleagues of the doctor who died of a brain haemorrhage after a long shift are not only mourning him but also the dire state of their branch of medicine. Many of the deceased doctor's colleagues said it could have been them, given the amount of strain they are working under. As one doctor told the CCTV news station, anaesthetists were working such long hours that some of them took naps on spare operating tables. And it was well known that there have been more than 15 fatigue- and stress-related sudden deaths among anaesthetists in recent years.

A recent survey carried out by the Chinese Medical Association's anaesthesia branch found that more than half of the doctors were working shifts in excess of 10 hours a day and 80% believed they were working beyond safe limits to do their job properly. In addition, 70% of anaesthetists said they were dissatisfied with their branch of medicine.

These findings were confirmed in an interview with an anaesthetist in her mid 40s who told reporters that it was not unusual to do 12 hours shifts due to the lack of staff and it was even known for doctors to work right through a double shift of 24 hours.

The president of the CMA anaesthetist branch Professor Hou Ren  said the job was highly stressful as they literally had people's lives in their hands every hour of the day. The job was especially taxing because of the high workload and lack of time for preparation, which meant that an anaesthetist might be dealing with a frail elderly person one minute, then a person with cardiovascular problems the next and later a pregnant woman . Each of these situations required very different management and skills, he said and anaesthetist had to make decision and adjustments according to a patient's condition by the minute.

He said the main problem was that the anaesthetist workforce had not kept track with the increasing number of hospital patients and operations. There were 2.8 million doctors in China, of whom only 2.5% were anaesthetists, which meant there was a national shortage of about 70,000 anaesthetists.
And while some hospitals had enough anaesthetists in theory, in practice there were always shortages because anaesthetists were off sick, on study leave or because they had to teach students.

To remedy the problem some general physicians were being re-trained as temporary anaesthetists, but this was only a short term solution, he said. Another way of addressing the problem was to learn from foreign countries which had managed to use anaesthetists more efficiently through the use of technology and better staff management, he added. In the meantime, anaesthetists faced high levels of pressure and there would continue to be overwork, stress and potentially unsafe work situations.

Doctor shortage forces anaesthetists to work 12-hour days

In Shanghai's hospitals the anaesthetists start work at 8am and don't finish until as late as 8pm on many working days, doctors say. Medical groups are warning that anaesthetists are becoming dangerously overworked as they try to make up for a huge national workforce shortage in this medical speciality. According to official figures, China needs 300,000 to 350,000 anaesthetists to meet the need of surgical operations, but there are currently only 100,000 anaesthetists nationally. The lack of anaesthetists is not only leading to overwork but is restricting the capacity if hospitals to do surgery in many other areas such as orthopaedics and heart surgery, medical groups say.
In Shanghai thee are 376 anaesthetists to cover the 10 major hospitals, and they have to handle about a quarter of a million surgical operations a year. This means that each anaesthetists is responsible for two or three operating theatres, and it is not unusual for anaesthetists to be on duty for 24 hours and sometimes even 48 hours, working overnight on 10 operations. The Chinese Medical Association says there is a urgent need to train and recruit more anaesthetists to meet the workforce needs.
According to the Shanghai Daily,  one of the reasons for the shortage in Shanghai is due to elitism - as local health authorities refuse to recruit anesthetists from outside the city unless they have the rank of associate professor or higher.
“We want the authority to lower its standards, because we are in urgent need of skilled anesthetists,” said Dr Wang Xiangrui, director of anesthesiology at Renji Hospital.
“As people get wealthier, so demand is increasing for procedures that require a general anesthetic,” he said.

HPV vaccine delay | Baidu medical fraud | Malaria system success | Gassers in short supply | GSK case won't stop bribery

1. China may be delaying approval of HPV vaccines made by foreign companies until the country has a homegrown competitor, according to Global Times. The HPV vaccines Gardasil and Cervarix are still not available in China despite 30,000 women dying in China every year of HPV-related cervical cancer. Some Chinese doctors and officials claim there are ethnic differences in vaccine responses between Chinese and Europeans, and clinical trials that in Chinese people are needed to ensure of the vaccines' safety and efficiency on Chinese.

2.  Baidu earns its fortune by promoting fraudulent medical information at the cost of health and even lives, critics say. The search engine site is the main avenue used by illegal drug manufacturers and illegal hospitals to advertise in China, they claim. Many drugs that are explicitly banned by the China Food and Drug Administration (CFDA) are still on promotion on Baidu, an article in Daily Kos says.

3. A '1-3-7' system of dealing with malaria cases that is very successful and could be a model for other countries, researchers from the Jiangsu Institute of Parasitic Diseases claim. The system is based on case reporting within one day, case investigation within three days. and focus investigation and action within seven days.Since the system was implemented in 2012 the proportion of cases investigated in 3 days has reached 100%, and seven-day action rates are 50% and rising.

4. China has a shortage of 200,000 anesthesiologists as doctors avoid the speciality due to low salaries, heavy workloads and lack of a strong training system, experts say. A conference was told that China has only 100,000 anesthesiologists but needs 300,000. Eight anesthesiologists died of overwork last year, according to Yu Weifeng, head of the anaesthesiologist branch of the Chinese Medical Doctors Association.

5. A cure for the endemic corruption in China's healthcare system is still far away despite the scare campaign against executives of British pharma company GSK, the online magazine Caixin says. While the crackdown makes the authorities look like they are being tough on bribery for prescribing, the reality is that doctors still accept commissions and there is no fix for the 'demand side' of the bribery equation, the magazine says. The health ministry cannot afford to alienate doctors, who are central to the problem, it concludes.

Canadian doctor promotes pain-free childbirth program in China

A 10-year initiative called the “No Pain Labor N’ Delivery China Mission.” has been founded by Ling Qun Hu, M.D., a Chinese-Canadian anesthesiologist from Northwestern University Feinberg School of Medicine, Chicago. Dr. Hu’s goal is to establish more than 10 training centers in China to teach safe and effective labor analgesia practices, particularly epidural analgesia, over a 10-year period.
The vast majority of women in China do not have the option of pain relief during labor. The country also has the highest overall Cesarean delivery rate in the world and the highest rate by maternal request (no medical indication). Although Chinese women express concern about the safety of vaginal delivery and the pain associated with it, Cesarean delivery (in both first and third-world countries) is associated with higher rates of maternal death and severe complications.
“It has been a dream for Chinese women to give birth without pain and without compromising safety,” said Dr. Hu. “Common questions on Chinese childbirth websites include Where can I get labor pain relief? Which pain relief method is the best? and Is pain relief medication safe for my baby?”
Using the No Pain Labor system, the Shijiazhuan Gynecology and Obstetrics Hospital near Beijing initiated a labor epidural service and experienced dramatic results in the first six months. Before the study, none of the women took pain relief medication, and around 50 percent had Cesarean delivery. After six months, epidural analgesia was chosen by more than half of the women, even though 100 percent of the cost was assumed by the patient. Also, the monthly birth rate in the hospital went from 747 to 1,046, despite the fact that women in the community have a choice of several hospitals and two-thirds of area births take place in other facilities.

Read more: American Society of Anesthesiologists