Cross-posted from Chinadaily.com July 5, 2010:

http://www.chinadaily.com.cn/opinion/2010-07/05/content_10056660.htm

Quality psychiatric care is needed
Op-Ed By Dr. Maurice Preter (China Daily)
Updated: 2010-07-05 08:00

The recent spate of attacks on schoolchildren and the workers’ suicides at the Foxconn factory in Shenzhen have again highlighted China’s urgent need to balance economic progress with care for those left behind, and unable to cope with, the lightning speed of development.

Sustainable development is an avowed goal of Chinese government policy, and from a medical-psychological perspective, accessible, quality general medical and psychiatric care is a fundamental part of long-term, ecologically minded, peaceful societal progress.

However, it is an open secret that the medical profession in China is in disarray and rather ill-equipped to contribute to the solution of China’s larger societal problems. Chinese physicians are overworked. They routinely see several dozen, if not a hundred patients a day, including those in urgent need of expert mental health treatment.

They are forced to accept absurdly low salaries and are consequently, generally disrespected. Pharmaceutical sales productivity incentives imposed by hospital administrations and by the wish to supplement meager earnings lead to a medical assembly line mentality that short-changes patients and frustrates doctors.

It comes as no surprise that, according to data cited in this newspaper (China Daily, March 25, 2010: “Doctors at receiving end in medical reform”), there are high levels of stress and depression among Chinese doctors.

Coincidentally or not, this year’s most murderous school attack was perpetrated by a supposedly mentally ill physician.

This situation is unlikely to attract the needed numbers of highly intelligent and motivated students to the practice of medicine. This in turn stymies the development of quality medical care, and the future acquisition and transmission of clinical knowledge. However, the recent violent events are a cruel reminder that China must make the rational delivery of compassionate, sophisticated medical-psychiatric care an absolute priority.

Keeping in mind that for the foreseeable future, the majority of mentally ill and emotionally distressed patients in China will continue to receive their care from general (non-specialist) doctors, what is the current situation in my own field of practice?

Chinese patients seeking expert help for mental distress will often receive care from physicians educated without any knowledge of available non-drug based treatment options, such as psychodynamic psychotherapy, group therapy and other types of behavioral interventions.

While in the West the set ways of medicine, and especially psychiatric medicine, are increasingly coming under critical scrutiny, most Chinese psychiatrists limit themselves to simplistic, obsolete interpretations of Western biomedical models that de-emphasize empathic listening.However, quality medical care, and especially mental health care, begins with a well-trained and experienced physician who is able to create a therapeutic alliance with a suffering and often frightened, and ashamed patient.

By contrast, the lack of time spent with an individual patient (when there are countless individuals waiting to be seen), combined with the economic reality of multiplying one’s salary by writing huge numbers of prescriptions puts Chinese doctors under undue and undeclared influence from extraneous forces, namely the pharmaceutical industry.

In turn, patients are at risk of receiving sub-optimal diagnosis and care and are put in harm’s way by medication overuse.

On a positive note, the Chinese government is taking steps to alleviate the existing income and infrastructure discrepancies between the Eastern coastal areas and the countryside, which will improve general medical, and one hopes, mental health care.

Equally important, a whole generation of sophisticated, highly motivated psychiatric physicians and non-medical psychotherapists is coming of age (in the big cities), educated in part thanks to outside efforts by not-for-profit organizations such as the Chinese American Psychoanalytic Alliance (CAPA).

Regarding the proposed health care reform, China might conclude that there is little synergy between corporate business models and her huge population’s need for accessible medical care.

The conflicts of interest that have come to shake US academia will need to be addressed here as well. At the same time, doctors’ working conditions must be improved. Eventually, consideration should be given to the establishment of a rational tort system that does not simply copy the excesses of the US system. There is much reason for hope and much work to be done. Chinese society, patients and doctors will be better off for it.

The author is a US educated neurologist and psychiatrist based in New York City, and a faculty member of Columbia University and the Chinese American Psychoanalytic Alliance.

(China Daily 07/05/2010 page8)