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Bringing Doctors to Locals' Doors

At nine o'clock on a hot and suffocating Wednesday morning, doctor Liu Zaiwu started her regular house calls to patients on her bicycle. There are three visits in her morning schedule.

Home-care service for elderly patients with chronic diseases is a part of the daily work of a general practitioner or so-called "family doctor" like Liu of Qinan Community Clinic on Yuetan Street in Xicheng District, Beijing. The residents can make an appointment simply by calling the clinic.

The first patient Dr Liu visited was Liu Guoshi, 91, who had difficulties moving and speaking.

The old man had brain surgery 37 years ago to remove an auditory nerve tumour. Though the surgery saved his life, he was left partially paralysed and also lost his hearing.

Now many complications inflict the old man, such as hypertension, diabetes and brain infarction.

After measuring his blood pressure and heart beat, Dr Liu tried to communicate with the old man and find out which parts of his body he felt uncomfortable by writing some words on a paper.

Though the old man's words were quite hard to read, Dr Liu understood that he had stomach pain and then gave him a massage.

Dr Liu's conclusion that the old man's medical condition was quite steady dispelled his wife's worries.

"Every day he struggles, on the verge of death. Without home-care service, definitely, he could not live that long," said Xu Li, Liu's wife.

It is an arduous work to take her husband to the hospital. At least four people are needed to carry his wheelchair into a minivan. Then they need to wait in long queues at the outpatient department.

Now the home-care service saves the couple from these troubles. Each time Liu has some acute diseases, Dr Liu could always come in time.

On a table in the living room was a notebook, in which Dr Liu wrote down the detailed procedures of how to take different medicines as well as dietary advice on what and how much to eat.

Much needed help

Many households in the Qinan community are empty nests, and their situation is much like Liu and his wife's.

This is due to the fact that China is very quickly becoming an ageing society, especially in its big cities like Beijing and Shanghai. The percentage of older people in Xicheng District is even higher than the average. For example, nearly one-fifth of the population in the Qinan community is older than 60, according to Du Xueping, head of Yuetan Medical Centre.

As people get older, their risk of suffering chronic diseases increases. Community clinics are catering to the elderly people's needs for a convenient healthcare, said Du. The Yuetan Medical Centre has 10 affiliated community clinics like Qinan Community Clinic.

In fact, more than 70 percent of people the clinics are servicing are older people with chronic diseases. According to a recent questionnaire survey conducted by Yuetan Medical Centre, 40 percent of queried families had at least one member diagnosed with hypertension, one-fourth with hyperlipemia, one-fifth with diabetes, 17 percent with coronary heart disease, and 10 percent with brain infarction.

Continuous and long-term healthcare provided by family doctors can make a major difference for these sufferers.

"When a patient with chronic diseases is in a dangerous situation, family doctors rather than specialists in large hospitals are better at giving the proper treatment because we better understand their health conditions," said Dr Hou Wuzi, head of Qinan Community Clinic.

Now, a lot of residents visiting the community clinic are willing to have their health managed by the family doctors in the long-term.

About 80 percent of the visiting patients have their health records created at the clinic. The records encompass a complete description of the patients' personal disease record, the family disease history, as well as their living habits.

Gao Wenzhen, 69 and a resident in the Qinan Community, came to the clinic to get free blood pressure measurement. She had her health record created just a week ago.

"Nearby my home, no need for a registration, quick service and good attitude of the doctors finally made me decide to write the clinic to be one of my three medical insurance designated hospitals," she said.

Working against bias

Ever since family doctors appeared, a bias has emerged among the public that their medical skills are inferior to those of the doctors in large hospitals.

Dr Liu admitted she had the same idea when she had to choose family doctor as her career due to the strong competition of entering the large hospitals.

Before becoming a family doctor, she was sent to different departments in large hospitals to receive three-year interns.

This experience gave family doctors an advantage in their later work to better understand and manage the patients' general health conditions. They are up to date on a wide range of medical subjects, such as internal medicine and surgery.

Dr Liu's confidence is building up as more patients came to seek her medical advice after they saw a doctor in large hospitals. At that moment, she believes she can offer a helping hand.

"Nowadays, the departments in large hospitals are subdivided too much. Very often, after seeing a few departments, the patients may get rather similar prescriptions. With my suggestions, they could avoid taking unnecessary medicine," she said.

The daily responsibilities of community doctors go far beyond medical treatment. They also cover disease prevention, health education, and even medical insurance reimbursing accounting.

Qinan Community Clinic holds regular lectures on osteoporosis prevention in the afternoons. During some of her lectures, Hou has shared with the residents a set of exercises for them to try.

However, though winning popularity among local residents with their public health education, limited staff at the clinic makes it hard for practitioners to balance all their responsibilities.

Now there are only two doctors and two nurses at Qinan Community Clinic. Hou hopes that there could add extra staff specially focusing on public health promotion and other affairs.

"Doctors should spend more time on the medical treatment and their skills improvement," she said.

Each year, Yuetan Community Medical Centre sends its doctors to visit family clinics under Wisconsin Medical School in the United States. Hou took part in the programme in 2004.

She observed that an American family doctor who delivered a child is then responsible for his or her lifetime medical care. "That is the kind of family doctors we want to be, giving a healthcare from birth to death for all," she said.

(China Daily July 5, 2006)

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