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Learning about challenges facing top-tier hospitals: part 1 of 2

My visit to this premier university hospital and my conversations with both the senior administrator and diabetes educator were so rich that I have broken my visit into two blog entries. The first entry covers my interview with the senior administrator who is also head of the endocrinology department. The second entry covers my interview with the diabetes educator, my impressions, and the overall implications of what I learned. I arrived at 9AM for my interview with a senior administrator at a premier university hospital in Guangzhou. Patients who seek out this hospital know and trust that the diagnoses they receive here will be accurate. Already hallways were jammed with patients and doctors. 

As head of the endocrinology department, the senior administrator understands the critical need for physician and patient education and the difficulties in treating diabetes. She repeated statistics we have heard before—the rise in the disease incidence from 3.2% of the population in 1997, to 9.7% currently—that is reflected by the rise in the numbers treated at her hospital—from 30,000 cases of diabetes in 2004, to 70,000 last year. Her endocrinology department currently works with both community-based hospitals and the Chinese Endocrinology Association on education campaigns for physicians, patients, and the general population. Departmental seminars are held every week where endocrinologists share best practices for treating diabetes. A larger group of physicians convenes monthly for the same purpose. I asked the senior administrator what guidelines are used in treating diabetics. She responded that Chinese Medical Organization has created guidelines for physicians on educating patients how to self-manage their disease. She conceded that only about 10% of those patients who received the education maintained successful blood glucose control—partly because the nature of the disease requires dedicated and constant monitoring, something most patients, for a variety of reasons, cannot sustain.  When a patient with out of control blood glucose comes to an endocrinologist at this hospital, the patient’s blood sugar level is checked, and then a fuller “body check”[1] is done to find any diabetic complications. The results of the body check informs the doctor of the appropriate intervention, such as lifestyle coaching, prescription, and/or surgical. Afterwards, the patient goes to the diabetes education department.[2] Here, the patient learns how to self-monitor and manage the disease and is asked to return on a regular basis for further monitoring. The senior administrator acknowledged that the elderly are more receptive to diabetes education; those between 20 and 50 are too busy or are indifferent to learning about the condition. She thought the best way to reach the younger patients is one of two ways: preferably, through workplace interventions, or through community hospitals and health centers when patients have waited too long and complications have set in. I asked what influence the government has on improving diabetes care. The senior administrator replied that the government recognizes the severity of the diabetes crisis. However, she was concerned that the government has yet to provide hospitals with adequate funds for launching effective educational efforts. She was pleased with the education her hospital provided diabetes patients and suggested that I visit its diabetes educational department and talk to the doctor who headed up this department.

[1] “Body check” is the common term for physical examination.
[2] I did not see a diabetes education department at the premier government hospital or seven community health centers that I visited in China, leading me to believe that the presence of such a department was unusual.
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