Mason MV, Ezrow K. Cultural Differences and Preventive Practices. JAMA. 1999;281(21):2056. doi:10.1001/jama.281.21.2056
Prepared by Ashish Bajaj, Department of Resident and
Fellow Services, American Medical Association.
A recent trip to China provided insights into the approach to
preventive medicine taken by Chinese physicians. As part of a global
management studies course, a group of us went to China to study the
national health insurance system. Although the goal was primarily to
look at economic factors, we were able to observe a different attitude
toward preventive medicine than that taken by most physicians in the
The Chinese government is in the process of reforming and expanding the
country's health insurance system. As medical insurance becomes
widespread, cost containment will become critical. This should lead to
an increased need for preventive services that diagnose and begin
treatment earlier in the course of an illness and, theoretically, save
money in the long run.
At present, Chinese physicians have little experience or training
in incorporating preventive practices into patients' overall care. The
medical students and resident physicians we met at one of China's
largest medical schools seemed puzzled by many of our common practices.
For example, we explained that a US physician would prescribe aspirin
to a patient with unstable angina to prevent a myocardial infarction.
The students and residents explained that the Chinese physician
believes that this approach only creates a new problem: gastritis.
According to those trained in traditional Chinese medicine, it is far
better to remedy a problem in ways that do not cause new problems.
Chinese physicians would opt for a treatment using one or a combination
of acupuncture, moxibustion, Chinese herbs, and qi gong ("energy
work"). Regardless of the preventive benefits of some treatments,
Chinese physicians would not knowingly prescribe a treatment that could
lead to a new complication.
Currently, only expatriates and wealthy Chinese patients can afford
most screening tests; these patients purchase memberships in
Western-style medical clinics that have integrated preventive medicine
into their practices. Although advanced medical equipment is now widely
available in many of China's city hospitals, the use of this equipment
is not yet integrated into medical practices.
Despite Chinese resistance to the Western approach to preventive
medicine, we should not overlook the potential patient benefits that
would come from integrating some of these practices into Chinese
medicine. We should share our knowledge and teach "best practices"
for screening examinations involving high-tech equipment and should
help Chinese physicians recognize the effectiveness of low-cost
interventions. Through medical exchange programs with Chinese medical
students and resident physicians, we can assist China in shaping
attitudes about best practices in preventive medicine and help develop
a system that uses medical resources wisely. In addition, their
perspective on treatment may hold lessons for us; additional exchange
programs may give us an opportunity to reshape our own thinking.