Xinhua Insight: Family doctors for all citizens

It used to be a big headache for Xu Li when her children got sick.

She would search the internet for solutions and call friends for suggestions, but usually ended up rushing to a hospital where she sometimes had to queue for hours before seeing a doctor.

"I remember thinking, if only I had a doctor right downstairs," said the 36-year-old mother who lives in the Shangqingsi community in southwest China's Chongqing municipality.

Now things have changed.

Xu signed a contract with a team of family doctors with the community health center late in 2014, since then she has enjoyed a set of personal medical services around the clock, including the use of a family doctor.

Now she immediately calls the contracted doctor if any of her family feels unwell, and the doctor visits her at home and gives medical instructions.

"It gives me a sense of safety," she said.

Chongqing began piloting the family doctor program in 2012, under which community doctors sign contracts with residents and provide with them customed medical services, including health management, disease prevention and regular physical examinations at home.

A family doctor team is generally composed of at least one general practitioner, a nurse, and a public health physician, and in some places there is also a pharmacist.

They can handle most minor illnesses, while they will register and transfer patients with more advance issues to major hospitals through an internal fast track system.

The program means every family has a doctor that they can consult first, rather than the internet, said Fang Laiying, director of the Beijing municipal health and family planning commission.

Once a preserve of the rich, family doctor services are now becoming available to ordinary Chinese citizens.

On Saturday, two hundreds medical staff were sworn in to such a program, at a square in Kunming, capital of Yunnan Province,

Alongside Kunming, 200 Chinese cities will introduce such services this year. By 2020, China is planning to extend family doctor services to the entire population.

In Shanghai, 10.27 million citizens, nearly half of its population, have joined the program, which is mostly paid for by the government.

"It's not such a high-end medical service as private doctors. Residents covered by medical insurance only need to pay about 10 yuan for a single home service," said Dr. Liu Wei, who signed contracts with dozens of households at Gumei community, Shanghai. The money does not include the cost of medicines.

In Chongqing, a home visit from a general practitioner costs about 15 yuan, while other services, such as consultations and basic physical examinations from public health physicians, are free of charge

Liu Wei can visit over 20 families a day. He has also created a WeChat group of all his customers to keep close contact with them.

"I regularly visit my contracted families, examining and documenting their heath conditions. I know what they need," he said.

Jin Guoqing and Li Na are two such family doctors. At the home of a patient surnamed Liu in the Mayu community in Beijing, Li tests the urine of Liu, who just underwent surgery. Meanwhile, Jin takes Liu's blood pressure and examines her heart and lungs. They offer suggestions for her recovery.

"They [family doctors] are really useful. We do not have to commute between our home and the hospital for post-operation instructions and examinations," said Liu's daughter.

The family doctors have saved residents' time and money as well as reduced the heavy burdens of hospitals, said Meng Shan, head nurse at the Chongqing-based Southwest Hospital.

Liang Hong, dean of the School of Social Development and Public Policy, Fudan University, said that the program is key to establishing a tiered disease treatment system, which means different medical institutions receive different patients according to the severity of their illnesses.

The tiered treatment is seen as a solution in helping people to see a doctor in good time, as often patients have to wait for hours, even days, to get medical treatment at hospitals.

Many people are reluctant to bother small medical institutions or community health centers for mild symptoms such as coughing or vomiting,instead they go to big hospitals which they believe have the best doctors, making many major hospitals as busy as train stations.

These patients would be better handled by family doctors or guided to smaller medical clinics, said Meng, the head nurse of the Chongqing hospital.

The program will make use of community-level medical resources and ensure the long-term health care of citizens, Liang of Fudan University said.

In 2015, community health centers in Shanghai received 84.5 million visits, one third of that in the city's hospital, according to government statistics. In Beijing, the figure was 48.9 million last year, or 21 percent of total visits to all medical institutions.

CHALLENGES

The promotion of the new program has not always been smooth. In some places, people are used to the major hospitals, and family doctors, mostly from community-level medical institutions, are not trusted by some residents.

"On one hand, family doctors should enhance their professional skills and provide better services to win trust; on the other hand, we hope people can give us more support and be confident in us," said Zhu Lan, a Shanghai family doctor who received the nation's top award for doctors in 2014.

Zhu Lan has made friends with many of her patients.

"They trust me," said Zhu. "The tension between doctors and patients is eased when trust is built."

More efforts are needed to increase people's understanding of family doctors, said Gao Xiuping, a family doctor in Beijing, adding that many people still regard them as private doctors.

The Chongqing government said that in the future most family doctors will be general practitioners.

In June, the Sichuan provincial authorities invited family doctors and medical experts from the United States for a one-week training of local family doctors in a bid to improve their service and professionalism.

To attract more family doctors, the Chinese government has also promised to increase doctors' incomes and provide more opportunities for their promotion and advancement. Endi