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A visit with a traditional Chinese medicine practitioner

It is hard to understand the Chinese health system without visiting a traditional Chinese medicine (TCM) practitioner. Located in most villages and cities throughout China, TCM uses both herbal and Western medicines to treat its patients. When Michael Shiu, a GBCHealth colleague, had a dry cough for a couple of days, he decided to visit the TCM to treat it. He didn’t need an appointment; he went when it was convenient to him.

On entering what appeared to be a pharmacy, Michael checked a board which had pictures of several doctors and descriptions of areas in which they specialize. The signs of those doctors currently available were in blue (others were in white with a list of their scheduled times). Michael chose one doctor who said she specialized in coughs. He paid the receptionist 30 yuan (the equivalent of US$5; based on current exchange rate of 1 yuan = .16 US dollar). The receptionist handed Michael the receipt, and he went upstairs to her office. She saw him immediately but explained that while she knew how to treat coughs, Dr. Ren was more experienced. She referred Michael to him. Since he was senior and very experienced, Dr. Ren charged a total of 50 yuan (US$8.34) Michael paid the additional 20 yuan (US$3.34) and was shown Dr. Ren’s office. We sat on the bench next to a large koi pond with a bridge crossing the pond. On the other side of the room was an herbal pharmacy where men in white lab coats stood in front of drawers with herbs ready to cook up patients’ prescriptions.  I was surprised that there weren’t a lot of patients waiting for the doctor. Michael explained that people in his condition could go to the hospital and be seen by a physician for between 1 and 2 yuan (US$.16 and US$.32), but they have to pay much more for TCM. As a result, the conditions here are not crowded, and the doctor spends much more time with each patient to discuss his or her ailment. Michael said the training for hospital doctors and TCM doctors is similar. The hospital doctors are usually paid between 5,000 and 10,000 yuan (US$834.00 and US$1,668) monthly salary with an annual bonus depending on their department’s performance; TCM doctors receive commissions, not salaries. Because of his recognized experience, Dr. Ren can charge the top amount in that office. Michael added that some doctors are leaving the hospitals with their relatively low salaries and practicing TCM for higher reimbursement.  

David Marshall at the counter of the herbal pharmacy

 A patient emerged from Dr. Ren’s office, and Michael and I went in. He had Michael sit down and asked about his symptoms – dry cough for two days. Michael laid his right hand on a small pillow on the desk, and Dr. Ren held the wrist with three fingers – I thought that he was taking a pulse. Michael explained that Dr. Ren was monitoring his internal system. After a minute, Dr. Ren switched to Michael’s left wrist. His head bowed and concentrating, Dr. Ren continued to monitor his internal system for another half minute and then asked Michael to stick out his tongue. Satisfied, Dr. Ren took out a pad and wrote down the symptoms on the left side and the prescription ingredients on the right. Before we left I asked Dr. Ren if some of his patients were diabetic. He said yes and explained that diabetes is in part a problem of digestion and a lack of balance in the internal organs. His therapy included warming the kidneys through a change of diet which would better control glucose levels. In cases of type 1 diabetes, Dr. Ren would use insulin to control the disease in addition to other medications. Since Michael had decided to just buy some more cough drops, we went to the pharmacy on the first floor. With receipts from the doctor and the pharmacy, Michael stopped at the reception desk and had the receptionist fill out the paperwork for him to file with his insurance company for reimbursement. That last part sounded familiar to me.

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