Saturday, February 12, 2011


the inpatient ward is a bit crazy at the old hospital. up to 5 beds crammed next to each other. the old hospital can accomodate about 350 or so kids plus PICU and NICU beds, which vary according to how close they cram the beds together. and then there's the bunch who can't afford to be hospitalized immediately and instead get antibiotic infusions in the ward next to the ER and sit out in a courtyard area. I'm pretty sure I saw at least a handful of kids getting TPN out there too. in a sense, a lot of it is similar to our system with diseases and short comings. They have just 4-5 times as many as we do of each disease and then some rare ones too. They have great expectations for each child from the parents, especially since they typically just have that one kid. Most of the time, even if nothing is wrong, they get a prescription - either for some oral rehydration solution, antibiotic for 2 days, or some relatively benign Chinese medication. They don't have great follow up, so a lot of the even somewhat sickly kids are admitted. There must have been a special on HSP, because the old place had at least 30 or so HSP plus a lot of HSP nephritis. and your typical RSV as well.

the new hospital is pretty nice, with flat screens in all the rooms. i didn't ask about cost differences. once again, the parents do a lot and are typically always in the rooms with the kids. the parent is almost everything except drug admin and IV venipuncture. RT, child life, nurse tech? check, check, and check. actually since the parents don't know sometimes, the doctor doubles as all of those too. they have the same and more interesting monitors in the ICUs. I just feel like some of their knowledge base is lacking from Western medicine, b/c the required texts aren't always the newest U.S. ones. like the Nelson's and Harriet Lane, both Chinese versions, are available, but they aren't widely used. part of the problem is the delay in some translations to Chinese in the latest journal articles. They have to take PALS q2yr and they read Peds in review, just that those are in English.

another interesting thing is that docs typically know the prices for meds and such. why? the patient has to pay up front first and very few patients have private health insurance. even if they did, they know the cost upfront.

I don't think that U.S. patients realize how lucky they have it in the U.S. at least we treat first and worry about payment later. same for docs - we don't have to worry about the financial burden. I think that was the response given when I asked back in med school for why our CPOE system didn't just have costs for all the tests and meds listed in each row. the costs might bias us and our primarily roles are supposed to be health first.

next is culture and maybe life outside the hospital.

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