Bound feet, pirate hospitals and frequent flyer patients: just some of the medical news stories out of China this week

Bound feet not all bad for bones

Women who had their feet bound according to feudal Chinese tradition are more prone to osteoprosis but their enhanced balance skills mean they do not have excessive fractures, a study has found. A review of more than 250 elderly women who had bound feet by researchers at Kunming Medical University found that they had higher rates of osteoprosis than women of similar age.
However they did not seem to be in worse health or be more prone to fractures, the study found.
"This might be explained by compensation in physical activity to improve body balance, implying the importance of improving or maintaining body balance in overall prevention strategies against fragility fractures," the researchers said.

Trademarks use to fight pirate hospitals 

The renowned Beijing Tianlun fertility hospital has trademarked its name after finding that other hospitals around China were setting up 'Tianlun' fertility clinics and claiming to be affiliated to the famous clinic.

Frequent flyer patient

A Jiangxi endocrinologist has been called to provide emergency inflight medical help to the same woman twice in a month, according to CAAC News. The doctor treated the women on a flight to Thailand after she fainted. On the return flight he again answered a call for help and found he was helping the same woman with the same problem.

More family doctors for Henan

The Henan government claims to have re-trained almost 10,000 doctors to work as family doctors in community clinics and township-level hospitals. The government said the re-training program meant that Henan could not make family doctors available to 60% of people in rural areas and 100% of people in urban areas.

 Guangdong gets locals to sign up for GP cover

The Guangdong city of Huizhou says it has  got 30% of target patient populations to enrol with a family doctor. The city health authorities want to arrange GP cover for children under five, pregnant women, the elderly and people with chronic diseases. The authorities say they aim to have 50% of people enrolled by the end of the year.

Tianjin hospital gets Dr Weixin

A hospital in Tianjin has set up a smartphone service to allow patients to get advice, information  and book appointments via their phones. However, users said the electronic hospital system was clunky, did not allow access to many departments and they still had to queue to pay for appointments

Serious disease insurance cover to be nationwide.

China's minister for social security has said that his department will fully introduce nationwide social medical insurance for serious diseases within the year. However, critics have saod that hospitals will use the cover to claim rebates for unneccessary treatments while local governments will not have the finances to support the scheme. Meanwhile a group from Renmin University in Beijing have suggested that micro-credit schemes be used to give poor rural people access to funds to pay for their medical bills. The scheme would operate in the same way as micro-credit programs running in developing countries to provides funds for business startups.

Family planning staff become child development aides

The staff of local family planning departments may move into child development work and away from enforcing the single child policy, if a pilot program in Shaanxi is successful. The program sees family planing agency staff assisgned to follow up children up to the age of three to ensure they are meeting basic development goals in care and education, according to Caixin.


And this week's violence against healthcare workers:

Zhejiang: An armed man opened fire in a Zhejiang hospital and had to be disarmed by police after he injured one man and threatened patients and staff in the Haiyang country hospital.

Shanghai: A drunk man took a hostage at knifepoint at the emergency department of Shanghai No. 9 People’s hospital yesterday morning and injured a policeman who intervened.

Hebei: a  gang armed with machetes smashed up the emergency department of Baoding Hospital and severed the hand of a man who was being treated for minor injuries from an earlier attack. The man had been involved in an earlier altercation with the gang and they had come for payback, police said.

Liuzhou: a man got 10 days administrative detention and was fined 200 yuan for attacking a female doctor at a Liuzhou hospital. The man hit the female doctor because he was unhappy with the treatment his father was receiving for a bladder problem.

Beijing: A patient with a grudge over hand surgery assaulted a surgeon at the Jishuitan Hospital. The patient had previously had eight stitches in his  finger and was unhappy because it did not bend the way it did before the injury.

China's move to a GP-based primary care system: lots of policy, little progress

In China the average salary for a GP is about half that of a hairdresser.

by Michael Woodhead

If you relied on the official Chinese media you could be forgiven for thinking that China's primary care system was the best thing since sliced bread. Hardly a week goes by without an article extolling the virtues of the new networks of general practitioner-based community health clinics.

Many cities such as Beijing and Shanghai are strongly encouraging all residents to enrol with the local community medical centre and to visit the GP for everyday ailments rather than going direct to hospital. The public are enticed to see GP clinics with incentives, such as the free or low cost availability of GP clinic services and ease of getting to see a GP with little need for waiting or queuing up for registration, as is the case with hospitals. Unfortunately, the great Chinese public are not buying it, and they continue to make a beeline for hospitals whenever they are sick.

This week a revealing commentary in the Quarterly Journal of Medicine paints a more realistic picture of China's fledgling GP system. In fact, fledgling isn't the word, foundling might be a better descriptor.

According to the article by Dr Kong Xiangyi and Dr Yang Yi of the Peking Union Medical College Hospital and Chinese Academy of Medical Sciences, the primary care system is in a kind of "Failure to Launch" status. They say the government's stated aim of training 150, 000 GPs by 2015 is pie in the sky. The problem, it seems, is that nobody wants to be a GP and nobody wants to see a GP. In China, to be a doctor in the community health service is a low-status position in an underfunded and unrecognised branch of medicine. As the two doctors point out, "the average annual income of a Chinese GP is less than half of a hairdresser and far lower than a specialist."

Part of the problem is that there isn't really any good local model for the would-be GP to emulate. There is no real definition of a GP, and currently many GPs are little more than barefoot doctors - local clinic practitioners who have received five years of basic training in health and medicine. They are employed to offer the "Six Basics" of health: prevention, health education, women and children’s care, elderly care, immunisations and physical rehabilitation. There is also a three-year postgraduate program for medical graduates to train as GPs, similar to that seen in western countries. However, there are very few takers for these courses and their impact on the national medical workforce has been minimal.

The authors of the article say that there appears to be little real enthusiasm for creating a genuine general practice system in China. As they put it, there is a lot of policy, but very little concrete support for funding and training programs. There are no primary care institutions or programs in China: the speciality is a career dead end, and the cream of China's medical expertise and social status is still centred around the big teaching hospitals.

The solution, according to the authors, is for China to emulate foreign countries that operate well-funded and high status family medicine programs. The aim must be to create a gatekeeper system in which patients are triaged by the GP before being allowed to see a specialist. And conversely, GPs must be enabled to provide follow up care after a patient is discharged from hospital. To do this, the health ministry needs to harness the skills and the prestige of the major hospitals to implement such programs.

Until that happens, patients will continue to avoid the community medical clinics, which are underfunded and have poor quality and outdated equipment. The lack of funding means that GPs have to charge commissions on drugs and medical supplies, further eroding trust in their services.

"China’s current reforms still do not emphasize enough the value of GP led primary care," they conclude.

Family doctors arranged for Tianjin eco-city residents

A family doctor service was made available to residents of Tianjin's developing eco-city on Friday as part of an effort to build a Singaporean-style community in the northern China port city.

A doctor will be assigned to care for every 300 to 500 households, and each resident's health records will be monitored electronically.

The service, along with green-energy buses, apartments with energy conservation systems and a recycling center for kitchen garbage, is part of a development plan for an eco-conscious community.

The Tianjin eco-city, which is to serve as a model for future Chinese cities, was jointly planned by the Chinese and Singaporean governments.

Built on a salt pan, deserted beach and water areas, the eco-city, covering a total of 30 square kilometers, has so far attracted more than 2,000 households to move to the area.

"We are expecting more households to move in as more infrastructure is built," said Cui Guang'an, deputy director of the city's administration committee.

The eco-city, which has been under construction since 2007, will also have two rail transit lines to encourage residents to use public transportation.

Modeled after the Singaporean notion of the "neighborhood center", the eco-city will build community centers to handle grassroots and enrichment functions such as community management, healthcare, culture and sports and business services.

Liu Yang, 30, said he moved to the community because he was impressed by its facilities and focus on green technology.

Source: China Daily

China to train 60,000 GP teachers

The Chinese government will train 60,000 general practitioner (GP) teachers by 2015, according to a circular published by the Ministry of Health on Wednesday.
A GP is a medical practitioner who treats acute and chronic illnesses and provides preventive care and health education for all ages and all sexes.
Jointly issued by the Ministry of Health, the Ministry of Education, the Ministry of Finance and the State Administration of Traditional Chinese Medicine, the circular says candidates for GP training will be classified into three categories: core GP teachers, clinical GP teachers and grassroots GP teachers.
According to the circular, training will last no less than two months and focus on clinical GP teachers and grassroots GP teachers, with the goal of training 6,000 core GP teachers.
The circular stipulates that clinical GP teachers should have a bachelor's degree or above and be qualified as an attending doctor or above. Grassroots GP teachers are expected to have finished junior college and be experienced in clinical practice and public health service.
The Ministry of Health will set up a database of core GP teachers, while provinces nationwide will establish their own databases of GP teachers, the circular said.
Source: EastDay

Health minister launches China's GP training program

2012 will be the first year of formal implementation of general practitioners standardised training system. At a meeting of the national medical education reform work conference, Health Minister Chen Zhu pointed out that the cultivation of high-quality GPs is a priority for the current reform of medical education and medical and health system. The establishment and implementation of the GP training system will be at the core of the new reform of medical education.
　　Currently qualified GPs are in very short supply. Of the General Medical Register, GPs account for only 8 million practitioners, accounting for 4.3% of the total number of practicing physicians. Of great importance to the the grassroots health of countries and regions,  GPs generally account for more than a third or half of the total number of physicians. Minister Chen Zhu pointed out that for reforms to establish a system of general practitioners a priority is to promote the reform of medical education, and speed up the high-quality medical and health personnel training. If it is possible to train a large number of qualified GPs, primary health care teams can establish a GPs at the centre of care, and this will enable the effective prevention and control of major diseases, and raise the level of people's health and achieve reasonable control of  medical expenses.
　　For standardisation of GP training system to be implemented, Chen Zhu proposed a four -point proposal:
1. To focus on the overall planning, development of a practical phased training plan;
2 Establishing the GP management system and business incentives;
3. Selection and construction of qualified general practitioner training base, focusing on the general medicine faculty training;
4. Emphasis on the culture of quality control to ensure that the standards of qualified general practitioner training.
Minister Chen Zhu pointed out that the current system of training general practitioners in China has made ​​it clear "a model for the two paths, three unified, four channels of top-level design. This is a model that will gradually standardise training GPs in a "5 +3 "mode: five years  clinical medicine undergraduate education, then three years as a GP internship. There will be "two paths" that "standardized training after graduation" and "clinical professional degree education" to gradually transition to graduation.
Uniformity in training will be achieved after standardization via "three unities": unified GP standardized training methods and content, the unified GP practice access conditions, and unified general medical degree award criteria.
There will be "four channels" that the transition to GP practice in four main ways, including vigorous grassroots on-the-job medical training and retraining, enhanced skills training, targeting of training GPs to enhance grassroots educational levels in the postgraduate doctors, to encourage large hospital doctors to offer basic services.

Read more: China General Practice