UW/China Exchange Advances Primary Care

Kenneth Kushner, PhD, a professor in the Department of Family Medicine (DFM) at the University of Wisconsin School of Medicine and Public Health (SMPH), still remembers that summer day in 2001, when he and other colleagues from the medical school who were in bustling Beijing, met one of the country's most influential doctors.

 

"She rode up on a bicycle," he says. "We were tremendously impressed by her. At first, we called her Dr. Red, because she wore a red dress and we didn't know her name."

 

The bicyclist turned out to be Du XuePing, MD, a vice president at FuXing Hospital in Beijing, a powerhouse in the Chinese medical community and a driving force in the development of family medicine in China.

 

She also spearheaded what has become an annual medical exchange program involving UW and Chinese physicians. The meetings of these medical minds have helped the two countries learn each other's methods of patient care.

 

"China is seeking help from the U.S. to develop new education methods and improve the efficiency of its family medicine programs," says Kushner, adding that FuXing Hospital and its affiliated Yuetan Community Health Service Center (where Du now serves as director) started one of the first family medicine training programs in 1997. "This exchange also offers American family physicians the opportunity to observe real-life traditional Chinese medicine practice in its original setting."

 

Kenneth Kushner speaks at the opening of the 2004 Beijing Symposium on Family Medicine and Community Health Serivces. To his right is Liang Wannian; left is Xu Xiuming, hospital president.

Kushner, who teaches the psycho-social aspects of family practice to UW residents and provides psychological services at Wingra Family Medical Center in Madison, says the exchange has provided the American and Chinese physicians insights into cultural differences, language barriers and global health concerns. It also has led to collaboration on scholarship.

 

Du started the wheels in motion in 2002, after she first visited the UW Department of Family Medicine to observe the operation of an American residency. Three years later, UW doctors were invited to FuXing Hospital, which is part of Capital Medical University, for a symposium focusing on family medicine in China. The annual Beijing Symposium on Family Medicine and Community Health Services has been a hit ever since.

 

"They've had up to 350 participants, including some who spent two or three days on a train to get there," says Kushner, who has made seven trips to China. "Dr. Du has network connections with a number of clinics in China, and gets people from all over the country to attend. We give talks about how we practice and teach. I think we go more as consultants than anything else."

 

Other Department of Family Medicine faculty members who have made the trip include Melissa Stiles, MD; Kathleen Walsh, MD; David Rakel, MD; Adam Rindfleisch, MD; John Frey, MD; Craig Gjerde, PhD; Jonathan Temte, MD, PhD; Rian Podein, MD; Luke Fortney, MD; Dave North, MD; Michael Ostrov, MD; Dean Funk, MD; and Jie Wang, MD.

 

Over the course of the program, groups of the Americans have visited the Chinese cities of Beijing, Shanghai, Xian, Xiamen, Fuzhou, Baiyin, Lanzhou and Chongqing.

 

Kushner says Chinese doctors often train much differently than American doctors.

 

"In China, you can call yourself a physician with anywhere from two to eight years of training," he says.

 

Some doctors, especially in under-served rural areas, have very little formal education. During the Cultural Revolution, "barefoot doctors" who only had a high school education learned medicine on the job at village or county hospitals while earning very poor wages.

 

Chinese officials are now placing greater emphasis on retraining its doctors rather than developing new residencies.

 

"They want to retool people already working in the community," says Kushner.

 

On the other side of the exchange, Chinese doctors spend time in Wisconsin, learning the operations of UW Hospital and Clinics. Their last visit came in May 2008 for a three-day DFM-hosted primary care conference. They took tours of Wingra Family Medical Center, the Access Community Health Center, the Health Sciences Learning Center and other parts of the UW Health system.

 

"They observed hospital services, Hospice and other places of interest," says Kushner.

 

One idea that the Chinese were eager to take home was patient-friendly pediatric waiting rooms with toys and other play things. Since laws allow most families to have only one child, Chinese place great emphasis on children and childbirth. For example, to avoid complications for women in labor, 50 percent of all births in Beijing are done through Caesarians, or C-sections.

 

"They don't want to take a chance with that one child," Kushner says. "One well-known Chinese obstetrician has been known to perform eight C-sections in one day."

 

Childhood immunization also has been a priority in China since the 1950s.

 

The visiting physicians also were impressed to learn about the number of new School of Medicine and Public Health graduates who enter rural medicine, since wages for Chinese doctors working in the countryside are extremely low.

 

"Our visitors assume that rural physicians in the U.S. are paid much less than doctors in the urban communities," says Kushner. "It's a real eye opener."

 

Kushner says that unlike in the U.S., where there is usually a one-on-one correspondence between doctor and patient, Chinese family medicine involves greater use of population health, with programs geared toward protecting and educating the public on preventing the spread of infectious diseases.

 

"I think they are really far ahead of us in this area," he says. "For example, one doctor may be responsible for the average blood pressure of a population of patients, which could include thousands of people. It really took us aback that a general practitioner might have charts for patients who live in one building, and may be responsible for several apartment buildings."

 

Jie Wang, MD, clinical assistant professor of family medicine at the UW School of Medicine and Public Health, has been integrally involved in the exchange program. She earned her medical degree at the Shanghai Railway Medical University in 1991 before moving to Wisconsin in 1993. She says modifications in the Chinese healthcare system were triggered by the SARS outbreak in 2002-03, which began in China and spread to 37 other countries. Nearly 8,100 cases were diagnosed and 774 people died.

 

"It made the Chinese government realize that changes were needed in the healthcare system," she says. "If you have a good community-based clinic, then patients with fevers or colds can be treated locally instead of crowding the tertiary hospitals, which can prevent the spread of disease."

 

Despite advances in which doctors typically know their patients, do home visits, look for the sources of diseases and usually isolate and control them, Wang says receiving medical care can be a day-long process at Chinese clinics, especially in smaller cities where there may be a scarcity of doctors.

 

"There is no appointment system," says Wang. "You go in the morning, wait in line, get registered and see the doctors. It works like a round robin. If I have a cold and back pain, I wait in line to see different doctors for the different medical problems."

 

Wang says this system is not a problem for elderly people who don't work, but for younger people with jobs, it may not be as easy to take time off to receive medical attention. In those cases, people may treat themselves with the variety of drugs available at local pharmacies or go to the emergency room after work.

 

"There is a surplus of doctors in larger cities," she says. "But there are not enough well-trained physicians in smaller cities or the countryside. So sick peasants may not get proper care. And when the disease gets serious, they must travel a long way to bigger cities."

 

Kushner says his travels to China have led to some surprises; for example, the wide availability of Western medical treatments.

 

"If you go to the operating room or critical care unit at FuXing Hospital, they have everything you would look for," he says. "Even in smaller centers, they have integrated physical therapy and rehabilitation into primary care. It's like one-stop shopping."

 

Kushner also was amazed by the wide availability in Chinese hospitals and pharmacies of medications commonly seen in the U.S. Due to their cost, however, the Chinese government encourages use of less expensive traditional herbal remedies.

 

"Nowadays, the hospital brews the herbs and you often get a two-week supply," says Wang. "I think in people's minds, Chinese medicine is very good at treating chronic illnesses and in regulating the body toward wellness. However, many younger people may opt for Western medications."

 

Wang says use of other traditional medical treatments, such as acupuncture and therapeutic massage, also are encouraged by government officials.

 

Yet another aspect of the exchange is the development of rotations for UW medical students, family medicine residents and integrative medicine fellows to study traditional Chinese medicine (TCM) in China.

 

"Our relationship with Dr. Du has enabled us to observe how TCM is practiced in Beijing and in other parts of China," says Wang. "We are planning on offering the rotation again this coming summer."

 

Kushner gives kudos to Chinese medical professionals for their friendliness toward visiting colleagues.

"Their hospitality is overwhelming," he says. "That's something we can really learn from them."

 

Overall, Kushner considers his travels to China and the professional relationships he has developed to be very fulfilling.

 

"The exchange has been one of the most gratifying aspects of my 35 years as an educator in family medicine," he says, adding that it has helped give him a global perspective on the practice of primary care.

He says he is particularly impressed with the mutuality of the relationship.

 

"The Chinese and American health professionals have much to learn from each other," Kushner says. "I hope that we will be able to create strong enough professional bonds that it will carry over to the next generation."

 

by Mike Klawitter
This article appears in the winter 2009 issue of Quarterly.

 

Date Published: 02/16/2009