Shanghai’s public hospitals are responsible for providing medical care to approximately 24 million people. The leading hospitals are affiliated with tertiary institutions and graded Level 3A. Hospitals tend to specialize in particular disciplines, with doctors rapidly developing expertise with certain conditions.
What quality of care is provided?
According to a report by the Hospital Management Institute of Fudan University, released in December 2012, three of Shanghai’s public hospitals were rated among the top 10 hospitals in China: Huashan Medical Center, Ruijin Hospital and Zhongshan Hospital.
Despite the challenges and unfamiliarity, physicians and nurses are reportedly well-trained and professional, in general. However, some doctors are rumored to promote unnecessary medicines or procedures because of financial incentives from pharmaceutical companies. If in doubt of a diagnosis or proposed treatment plan, seek a second opinion elsewhere. Local hospitals are also generally best equipped to manage emergency treatment, especially in cases of trauma.
What can I expect at a local hospital?
“Public hospitals in China are crowded and chaotic,” says Dr Sisi Xu from Shanghai SKY Clinic. “It’s a complex system with little support for non-Chinese speakers. Clinics do not schedule appointments and medical personnel tend to speak limited English. Antibiotics are often administered intravenously, and basic pain relief minimal. The bedside manner of doctors differs significantly from the West too, and there is very little privacy. Expect to discuss your symptoms in front of curious bystanders,” she explains.
Navigating the system may be a challenge, especially for those without solid language skills or cultural knowledge, so consider asking a Mandarin-speaking friend to accompany you to the hospital.
How do costs compare?
Medical treatment at a local hospital is cheap by comparison to inter- national clinics, with a consultation and basic testing or medication costing as little as several hundred renminbi. Note that cash payment is expected before a patient is treated, even in emergency situations.
How to choose a local hospital
Shanghai hospitals are organized by a three-tier system:
Level 1: Primary hospital with fewer than 100 beds, and health centers that focus on the day-to-day health needs of a local community.
Level 2: Regional hospital with 101 to 500 beds, which provides inte- grated health services to several communities, and undertakes some teaching and research.
Level 3: Large city-level hospital with more than 500 beds, which pro- vides high-level medical and health services, training and research.
Hospitals are then classified as A, B or C, based on technology, management, equipment condition, and scientific research ability. Level 3A hospitals are the most authoritative.
My Chinese Hospital Experience
This past spring a slow lingering cold festered in my body for two months. Having never fully gotten rid of it through neglect I allowed it to develop into something much more serious. As the first week of May hit I was beginning to lose the energy to get out of bed. My throat glands were swelling up to the size of golf balls. It could not have been plainer that now was the opportune time for a hospital visit.
Having tried a western hospital before I decided why not try a Chinese hospital? The downside would be I’d have to have a good dictionary along. The plus side would be that I’d save money.
Arriving at Chang Hai (长海医院) Hospital near Fudan University, I had landed in unfamiliar territory. Not having the slightest idea of which department to go I went to the front desk, explained my symptoms to the nurses there. Miraculously, the nurses at the front desk told me which department to go to. By luck I had stumbled across the first step in the Chinese hospital diagnostic system.
The hospital is divided into different departments. Say you have a skin problem; you would go to the skin department. If you don’t initially know which department to go to, you first go to front desk, generally a circular desk with one or two nurses manning the table. There you can tell the nurse your symptoms and they will direct you to the first department to go to.
Once the nurses told me which department to go to, I couldn’t just simply march off to the department. First I had to pay a registration fee. I queued up in a long line to pay. But the registration line is not the last line, far from it. Once I had paid the 14 RMB registration fee, the teller handed me a queue number for the department I was going to see. Once I had hunted down the department I had to wait in line yet again until my number was called.
Once the doctor finally saw me, a ton of tests were done, and in this case, I received a muscular injection. I almost forgot, this is China, where one has to queue up for everything, hospital tests included. Fortunately, my Chinese was just at the edge of adequate, so that while taking these tests I could ask and find out what was happening to me. I have to admit; initially it was SCARY. Over time my Chinese and self confidence improved considerably. The more I understood the system the less I began to fear it and the greater sense of self-empowerment I felt.
My hospital visit was slowly coming to an end. Once all the tests were done and I waited for my results, I could go back to the doctor I initially saw (this time I did not have to wait in line) and get my final diagnosis and prescriptions. With those prescriptions I went to the main floor of the hospital, for one last queue. There I paid for my medication and waited for my name to appear on a screen. Once it had my medication were ready and I was all set to go.
Being an expat comes with certain stereotypes. One of those that is a deep mistrust in Chinese hospitals. Perhaps there is no better way to remind yourself of the country you’re living in, than full immersion. In Shanghai it can be quite easy to get caught up in the glitz and glamour of living an expat life. Let go of the stigmas associated with Chinese hospitals that you’ve been holding onto. Try it. You’ll come out learning more about the country your living in.
Please bear with me as this scenario is difficult to paint without going into such great detail that no one will read the post. But I hope that EVERYONE does read this and I welcome medical professionals and local Shanghainese to comment/defend/condemn what took place.
First, a little background. I am an American and my wife is Chinese (Beijing). We have been living in Shanghai since last July, prior to that we were living in Singapore. Before October 2018, she had never left China and lived in Beijing her whole life. I never lived with her in Beijing, so I can only take her word on how hospitals treat her. I do not speak any Mandarin, learning now…….
Over the weekend we both got a case of food poisoning; me first, then her about 24 hours later. I resisted going to the hospital until I was forced to by my wife. At that point, she called an ambulance. As part of the initial routine, the technician started a saline IV. Once at the Zhong Shan hospital emergency room (where I stayed for about 7 hours), I was very well looked after. A male nurse/technician even pushed my gurney to the toilet every time I needed to go (which was A LOT). The first time, he even held the IV while I squatted to collect a sample (this was before we found the private room with hooks for the bag). Sorry for the imagery, I just feel it is important to the story to understand the level of care I received.
Less than 24 hours later, my wife gets the same symptoms and decides its time to go to the same hospital, this time by taxi. The staff initially speaks Shanghainese to her, which she does not understand at all. The Dr. prescribes an IV and we go to the IV room to have it started. My wife sits at the counter (she is really sick at this point) and the nurse starts giving her instruction in Shanghainese – to which my wife just responds ‘what?’ (instead of telling her that she does not speak that dialect – again, she is very sick/weak at this point). The nurse, now frustrated, becomes very rude and starts prepping the hand for the IV. The needle goes in without issue, but then the nurse wants to pull a sample out while her fist is clinched and the tourniquet is on. She had a very difficult time getting the blood out and was pulling hard on the syringe. At this point she asks another nurse for help, who decides its a good idea to move the needle around in her hand – we could actually see the vein moving around and the needle pressing hard against her skin……I can’t imagine the amount of pain…..At this point I should say that I am embarrassed with how I handled the situation, had I not been about 30+ hours into a food poisoning daze with no sleep, I’m sure I would have done better. If nothing else, gotten the needle out of her hand.
They decide to give up on getting more blood, take the tourniquet off and start the IV. The pain now is so bad that my wife literally locks up – can’t talk, can’t move, every muscle contracted, pale as a ghost. They leave the IV running and call the doctor. The Dr. takes the IV out and tells her to relax and move to another chair away from the counter (the counter where there are other people). The three of them (the 2 nurses and Dr.) then stand back and say and do nothing; while my wife is white and basically in a fetal position in the chair. I finally get her to the point that I can move her to another chair and she asks me for some water. I go across the street and when I return, while she is sitting up, she is still unable to really move her fingers. It turns out that this was only due to the pain and not an adverse reaction to medication and after awhile she is able to go back to the consultation room.
When she sits down with the Dr., the first thing he asks is if she was done with the IV (WTF!)? My wife explains that the nurse really hurt her and that she would like his help with the IV. He tells her that that is not his job, pushes the paperwork back to her and calls the next patient. At this point my wife is irate (and we are both surprised how energy she musters yelling at him!). She gives up and finds what I can only assume was the ‘chief of staff’ for that shift. He talks with the Dr. and tells my wife that he can give her medication to take home…….At the same time one of the other patients in the consultation room is actually making fun of how my wife yelled at the Dr. (but not in a joking manner; in an insulting way – I don’t know Mandarin but some things even I can understand).
I have no doubt in my mind that once the hospital identified her as non-Shanghainese, they no longer cared about her. I don’t know what they would have done had she lost consciousness, but I would be very surprised if it was any more than move her to the location of their choice. This was not just one person; it was 4 people of the medical staff and another patient that had complete disregard for her well-being. Yes, I’ve taken steps to make sure nothing like this ever happens again…..and I will reserve my comments about this hospital. I will say that we went to the Shanghai No. 6 hospital and she was well cared for (or at least as well as can be expected for a local Chinese hospital).
My wife is the type of person that will go to the hospital to get rid of a bad hangover; she has plenty of time spent in Beijing hospitals. I don’t think I need to mention that she would not do that if she was ever treated in this manner…..
Dude, it could have been worse, you could have been in a hospital in one of the smaller city/province in this country.
I got into a car accident down in Fuzhou in July, Broke my leg and my hand, Didn’t know that at the time of course, 5 injured in the accident, took 30 mins for the ambulance to get there, only took 3 people with them, since I was able to hop around they told me to find other transportation.
A nice person driving by took us to the hospital, in there, they make me hop around on my broken leg to get all the financial paper done before even looking at me.
Took me to a room where all the plaster have fallen off the walls to fit a cast on me.
Recommended me having surgery there, said hell no and came back to Shanghai to have the surgery.