About two years ago we noticed that our son’s foreskin didn’t retract properly and sometimes got infected. Nothing serious, but I wanted it to be checked and therefore took him then to United Family Hospital Puxi, where he was also born in 2012. The physician told us, that we should wait for another two years for the foreskin to open up on its own. A few weeks ago I consulted the same physician, Dr. Hatti Wang, again, and she said that a surgery is inevitable.
There was no further diagnosis neither an explanation of the surgical procedure, but both a pre-OP check date and a surgery date was arranged. I was then of the opinion that we would receive a complete diagnosis and an explanation of the surgery procedure during the pre-OP check, but realized yesterday during the pre-OP appointment, that a nurse waited for us to get a blood sample only. No physician, no surgeon, nothing of additional information.
I explained to the nurse, that I am still missing important information, e.g. a proper diagnosis or which kind of anesthetics will be applied. The nurse understood my concerns and called the head of the surgical department Dr. Zhang Zhuo. It is mainly this consultation which not only disappointed me, but actually confirmed my lost trust in a system of profit driven clinics. You simply can’t run a health institution on a capitalist foundation and employ morally corrupted staff.
Dr. Zhang told me that
- The medical condition my son suffers from is called phimosis.
- The probability, that our son’s foreskin opens up on its own, is at age 4 close to zero.
- A surgery is therefore inevitable.
- Delaying the surgery will lead to painful infections.
- Full anesthesia is mandatory for the safety of the child.
We arrived at these conclusions only because I insisted to get a complete consultation and I told Dr. Zhang that a parent does not want to perform surgery on his child if there is no imminent reason to do so. He said that he understood my concerns. But I couldn’t help to observe a sly salesperson’s smile throughout our conversation. And I have to give Dr. Zhang and Dr. Wang their credits: as medical doctors they have way more knowledge than the average patient. But, I told myself, didn’t they swear the Hippocratic Oath, i.e. aren’t they obliged to help their patients and must not do harm.
Well, lets not get into an ethical discussion here. Let’s stick to the facts:
- Our son does not suffer from acute pain nor were the infections serious or lasting. We therefore do not see an imminent reason to perform surgery.
- Wikipedia writes that physiologic phimosis, common in males 10 years of age and younger, is normal, and does not require intervention. Non-retractile foreskin usually becomes retractable during the course of puberty.
- A local anesthesia costs only a fraction of a full anesthesia.
It is not my intention to blame these individuals, although they, too, have a responsibility to take a step back and inquire into what they do and why. I rather ask here, why we develop such systems of greed and fraud. On several different occasions, and in different industries I have heard people say, that the worst features of humanity are produced when American capitalism merges with Chinese corrupted morals, i.e. when refined greed meets refined fraud.
Dr. Zhang told me during our discussion on the necessity of full anesthesia, that he worked in a local Shanghai hospital before joining United Family. There, only a local anesthesia is implemented on children, and he is convinced that from a medical point of view, a full anesthesia is safer. Well, I am not a physician, and there will be pro and con arguments for full anesthesia, but I know that United Family had a long negotiation with our insurance provider to explain the necessity of a 30k CNY surgery; a third of which for anesthesia.
This is also the time and place to do some self criticism. We are in the lucky situation that we have an international health insurance, which covers globally pretty everything apart from dental care. That’s luxury, considering that a substantial fraction of humanity must survive without any insurance at all. We have come to cherish this luxury, but we have also been trapped in the system. If high-end medical care is free of charge, one is inclined to stop reflecting about the necessity of services provided. I made that mistake, when I consulted United Family for our son’s condition.
We will therefore change this habit; and even though our insurance might cover some services, we will check ourselves if we really need them. I was already inclined to return to Vienna for the birth of our son, when I learned that United Family charges about 120k CNY, but it would have been too complicated. Our daughter was born in a lovely Viennese hospital and the public insurance covered the costs of 1500 EUR, a 10th of what United Family charged our international insurance provider in the end. Can medical service be really so much better? No. And it actually wasn’t.
Again. I am not bashing individuals. I ask what we can change about the medical system, which has clearly gone awry in both the US, which has the highest per capita expenditure of all OECD countries, and China, where medicine has turned into one of the least sought after careers. Even safe havens like Austria will have to change their health systems, which are essentially low productivity government extensions, with overlapping markets of municipal, provincial and national hospitals.
One path into the future was explained this June during a TEDx Caohejing event by Mr. Zheng Jie, CEO of Sulan Health Group. Mr. Zheng explored the future of medicine and referred substantially to the American physician Eric Topol (check out his TED talk), author of The Patient Will See You and The Creative Destruction of Medicine. According to him, we will see a deconstruction of the “Gods in White”, and an increasing number of intelligent patients empowered by digital medicine, who will use physicians only to execute a decision they have made themselves. Massive Open Online Medicine (MOOM), the Internet of Medical Things (IoMT) and an unprecedented amount of personal medical data will provide the patient the required information to wield the power of decision, whereas the physician can increase the amount time spent to interact with his clients.
Such a utopian scenario does not take the economic factor into consideration, but its at least a plausible way forward. Authors like Martin Ford in Rise of the Robots are pessimistic about how economic dynamics will actually hamper the positive development of our increasingly digitalized health systems. In any case its high time to increase our self-awareness and self-responsibility.