As one of the very few expat bloggers working in a Chinese hospital I feel it is my responsibility to share some tips on going to the ER in China, as well as a bonus helping of awful hospital experiences. Hopefully, you’ll never need to use these.
Bring someone with you
Chinese hospitals are not designed for the patient’s convenience, so even if you have excellent language skills, odds are that you will need someone to assist you while you are there. For foreign teachers I would strongly recommend bringing a co-worker or someone from the foreign affairs office since they will generally be able to use the school’s clout on your behalf.
As I mentioned in yesterday’s post, I saw a doctor, and then was sent to collect the prescription myself. Had I been in too much pain to move, I would have had to wait for one of the nurses to help me (and they are almost always busy or “busy”). Going with a friend will greatly speed up the process.
Hospitals also do not typically provide food for their patients, so you will need to arrange meals for yourself.
Example: On a trip to Hunan province, my friends and I ended up staying in a rural guesthouse. Around 3am it was clear that two of my friends had food poisoning (one of them is now my wife). By the time the hospital in town was open, both of them had vomited at least 5 times. My wife threw up out the window on the way to the hospital, again in the bushes out front, and in 3 or 4 random sinks in random offices, our other friend wasn’t faring much better.
Over the next 6 hours they both received 4 IV’s and a couple injections. I had to leave the ER to go to the pharmacy at least 6 times. I’m not sure how they would have been treated if I had not been there to help.
Bring cash
While a trip to the hospital isn’t nearly as expensive as it is in the US, few hospitals outside of China’s major cities are going to allow you to pay with a bank card, and none will provide service prior to payment (at least for ER treatment). I would suggest a minimum of 800rmb, but the treatment I received in yesterday’s case was only 25rmb.
Rough price guide
- Seeing a Dr. 5-10rmb, seeing a specialist 15+rmb
- staying overnight in a “common” room ~15-20rmb, staying in a VIP room ~800+rmb
- Most surgeries are less than 1,000rmb
- IV’s and injections ~30-40rmb
You are getting an IV
China has one of, if not the highest, rates of IV prescription. Nearly 80% of the time you go to the hospital you will be prescribed one. For anything related to vomiting or diarrhea you can expect them to hang one or two bags of saline which will help re-hydrate you, and bags of very strong antibiotics for virtually any infection.
While this isn’t considered to be a very good practice, when you are sick enough to go to the ER, it’s probably worth accepting their treatment.
Don’t expect comfort
I’ve heard that when women are waiting to give birth, the doctor will come by their bed, lift up the sheets, and give a pelvic exam without saying a single word to the patient. I have even heard of a woman getting slapped for screaming too loudly while giving birth, and that’s at one of the top hospitals in China.
Generally speaking “patient experience” is not a consideration, but you can be your own advocate. If they want to give you an x-ray without a lead vest, ask for one. If they try to use a needle that you did not personally see them remove from the packaging, ask for a new one. While they might think of you as the demanding foreigner, your health is worth the bad reputation.
Trust your doctors
Most of the doctors in China are better than the hospitals they serve, so even though the hospital may look awful you can probably trust your doctor. This is especially true when you need treatment for an infection, vomiting or diarrhea, since these are common diseases and of the local variety, your doctor has probably seen them hundreds of times. Also a dead foreigner is the last thing any hospital wants, and they are more likely to send you on to the next hospital than treat a disease they don’t know how to handle.
That being said, it is best to go to the highest level hospital you can quickly reach, and avoid clinics when possible. I have been told that clinics employ the doctors that hospitals won’t. Also only agree to having a surgery if it absolutely cannot be postponed. While it would be cheaper in China, it’s not worth the risk.
Example: In the dead of winter on a trip to Zhongdian, Yunnan my friend woke up in the middle of the night and began vomiting blood. We both knew it was altitude sickness, but the hospital wouldn’t open for another 10 hours. The hospital was unheated, and the IV bottles had to be warmed over the space heater to keep them from freezing.
When they tried to find a bed for her, it was like something out of the worst version of Goldilocks. The first bed was too bloody, the second bed had too many urine stains, and luckily the third bed was just right. After 3 IV’s and a few hours on oxygen, she was able to get on the bus and make it back down the mountain.
Excellent advice! As for someone who have spent ten days in a Chinese hospital, I think anyone going to a Chinese hospital should remember these. In my case it was a second scale skin burn in 10% of my body and the treatment wasn’t correct by Western standards.
Thank you Tom for writing about this. All the expats coming to China should read this.
Tom, this is a very informative article… i will share this on my facebook .. i have to agree with Sara and say that all expats coming to china should read this.
“none will provide service prior to payment (at least for ER treatment)”
What are you supposed to do if you’re dying, by yourself, and you haven’t got any money?
Technically the hospital is supposed to treat you, but I wouldn’t recommend counting on that. Hospitals are assigned areas to provide free medical treatment to, but they do this without an gov’t support.
Drugs in Chinese hospitals are overpriced/overprescribed and often fake.
I was diagnosed with a ‘cardiac arrhythmia’ at the Sino Japanese Hospital in Beijing. Fortunately, I asked for a copy of the reports (including ECG) and faxed them to a doctor friend in Australia. She quickly noted that the ECG was normal and the diagnosis was simply stress. The doctor had prescribed the latest US brand name drug, costing 800RMB. The Aussie doctor said a simple beta blocker was better, and it cost 10 RMB!
The mother of a friend was diagnosed with lung cancer at a ‘reputable’ Guangdong hospital and prescribed an expensive Astra chemo drug, Avastin. Turned out she didn’t have lung cancer at all, and the drug sold by the hospital was an expensive fake (3000 RMB/course – the real stuff is even more expensive)..
My advice: if sick, go to HK.
Excellent article. I lived in Tianjin for almost 10 years, and only got deathly sick once, (from bad octopus) but this still would have been good information to know, even at the end of my time there.
I can still remember the first time I had to go to the hospital in China. I accidentally wandered into the IV room, which seemed to stretch into infinity in my sick, delirious state. Staring at the ground, trying not to die, I glanced up and saw something that, while not really that gross in itself, gave me an immediate bout of hardcore nausea. The man nearest me was plugged into an IV drip while he was eating a Big Mac. He wasn’t just eating the burger; he was ravaging it, with lettuce and bits of burger and bun falling all over himself and the floor. Nearby a parent was allowing their toddler to urinate through the bench onto the floor while someone on the opposite side of the room seemed to be bleeding more profusely than would normally be expected from your average human being. Fortunately, they had plenty of bandages to apply pressure to the wound, leaving the used bloody ones in a pile on the floor.
Perhaps it was because I was really sick.
Maybe it was because my Chinese medical vocabulary wasn’t up to snuff at the time.
Maybe it was simply because this was my first time in a Chinese hospital.
But, I felt like I was living out the clown-hospital scene from Pee Wee’s Big Adventure.
“Exhibit A!”: http://www.youtube.com/watch?v=R7kw0WiUB5c
Also, I would add to the list, “Schedule an entire morning or afternoon for your hospital visit.” After you are told to go to A and do X you’ll probably have to go back to a counter to pay for X before you actually go to A. Factor in trying to find whichever department you’re looking for, even with a friend assisting, and you’re liable to spend most of your day in the hospital. In my experience, it goes something like this:
Buy registration card. Pay for appointment. Go to waiting area. Wait. See doctor. Doctor tells you to get a blood test, X-ray, etc. Go back to counter and pay for blood test and X-ray. Go get blood test and X-ray. Wait. Pick up blood test and X-ray. Go back to counter and pay for another consultation with another doctor. Wait in line for doctor to look at them. Doctor tells you to see other doctor. Wait. Doctor gives diagnosis and prescribes 10 different medicines. Go back to counter and pay for medicine. Wait. Pick up medicine. Leave. Ta da!
And, in case this is your first time in China, hold on to any receipts you’re given like your life depends on it because…well, your life depends on it.
I recently come in china, and leave near beijing. I was told before, that every countries in the world, f you have an emergency you do not have to pay, can you tell me about that, ex lets say, i have an emergency, and am not feeling well and need to go to hospital in china, will i have to pay? secondly another question, if i go to a chinese hospital, and do not have money to pay, what will happen? 3rd question how much approximately, is the cost, for an mri scan, and for a pus abscess removal?
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I was “lucky” enought to spend a month in a hospital in Shenzhen. It was quite and experience.
http://cek100248.wordpress.com/
My experiences were similar to those you describe, but my illness was never diagnosed successfully.
You poor man! How did you get arsenic poisoning – was it something you ate? You have put me off spending an extended period of time in China. So far I have had half a dozen short holidays and been fine. Will you return to China? Good Luck!
Great blog post. This conversation topic is always slightly heated between my boyfriend and I. Comparing proper treatment for various ailments between the West and China.
I had a case of strep throat recently where I went to the local health service center branch of my (very good by China standards) municipal hospital.
I explained to the lady that I have a persistent habit of ear nose and throat infections and, as per the instructions from the (excellent beyond belief) international clinic, I’d started myself on a course of Amoxicillin but it clearly wasn’t going to be enough and I didn’t want to wait until Monday to get an appointment.
She knew the international clinic (it’s a department in the municipal hospital). She knew the doctor who runs the international clinic (she’s a teaching doctor). She seemed to be attentive to me.
Seemed is the operative word.
I said “I am big and tall and not Chinese. I weigh 96 kilos. You cannot give me the same amount that you would give a Chinese person.”
I even invoked the name of the doctor who runs the international clinic because this woman clearly knew her as a teacher and it never hurts to invoke someone’s teacher when you want better service.
The prescription was for the right drug.
RIght drug.
Wrong amount.
Instead of increasing the dosage based on my body weight, she wrote me a prescription for approximately two thirds of the recommended dose on the box.
Moral: not only do you have to show up at your average doctor’s visit knowing what drug you should be prescribed, it’s also a good idea to know the dosage because they will frequently get it wrong.
excellent point here. I would also recommend checking the prescribed drug online, as there are many that have not been approved in the US or EU but are allowed here in China. My first hospital visit ended with a prescription for a drug that had been strongly linked to colon cancer.
[…] 《中国见红》博客：老外在中国看病注意事项：找个同伴，带现金，准备吊盐水，不要指望舒适，相信你的医生。 […]
When you get the final bill on leaving hospital, insist on an itemised bill listing every little thing that was done to/for you, as bills are often padded with treatments and/or medicines that were not provided. If they won’t provide it, don’t pay until they do. This may involve sitting by a computer screen in the doctor’s office and copying everything down, but you may get hundreds of yuan off the bill by doing this.
Great tip Roger. While i would hate to call it “common practice” some hospitals will try to squeeze extra pennies out of their patience. Also be clear that the medications and treatments given to you are actually necessary, as many drugs come with dr. kickbacks.
I’ve been in China for eight years now and don’t hesitate to be treated at Chinese clinics and hospitals. As the author said, the doctors are well-trained and more than competent to handle routine illnesses. Sure, the facilities and treatment aren’t nearly on-par with modern American hospitals, but my wife and I always have received excellent care. I tell my young American colleagues who flee to Hong Kong or Beijing for treatment that they are lucky they never had to use military hospitals in the 70’s. The hospitals back then were much worse than anything I’ve seen in China and the doctors here are much better trained.
Great and useful post – thank you! I would add: bring hand sanitizer/sanitizing wipes to the hospital, as restrooms will often not have soap…and don’t expect the doctors to know the “universal” Latin/Greek medical terminology (just in case you are a smartass and think there’s a way past your bad Chinese ;-).
Great little piece. I had my appendix out in China in 1990 when I was teaching in a small town in Sichuan Province, and got to relive it through your piece (no food avail, bring cash, doctors better than the hospitals) I was 22 and spoke good chinese, but was glad I had students and teachers from the school there with me (spending time with me in 8 hour shifts for 24 hours), glad I had my 2 lao wai friends Kevin and Peter, and glad I had the dean of our English dept (professor Yang, my Chinese dad). My operation was the one year anniversary of June 4th, so every year I am reminded…
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Fascinating post and a great blog! I’m a family doc at an international clinic in Beijing and your perspective is very valuable. I was just discussing the differences between local and international hosptals on CCTV’s Crossover last week; your insights into the typical expat experience are dead-on and very common. I’m glad that many commentators have found good doctors at local hospitals; unfortunately, laowai automatically get VIP treatment at any hospital, and the average Chinese experience at local hospitals is usually less impressed. I constantly discuss the idea of “value” with my expat patients who want to go to local hospitals instead of “expensive” international clinics. As many mention, the cheaper cost is often far outweighed by sanitation, privacy and excessive tests and medicines…
[…] Going to the hospital in China – A few tips for medical emergencies in the Middle Kingdom […]
My experience in a Chinese hospital in 2003 was remarkable. I had broken my leg. Patients in the room supplied me with lots of spareribs, vegetables and fruit. Chinese friends and colleaugues rallied around me. It was an experienced which exemplified the purity and simplicity of the Chinese heart. I learned so much about family and culture from this experience. Having said that, there are horrors stories galore, but should never be trivialized.
what happen, if i go to the hospital in china, and do not have the money to pay, for a mri scan or x-ray, do they ask me to pay first. second question? in case of emergency? do i have to pay for the ambulance to take me to the hospital if i have an emergency and to be examined. I recently come in China 2 weeks ago, and live near beijing, I was told when I was in England, that in China, you don’t have to pay if it is an emergency but someone told me here, you have to pay even for emergency? can you give me informations about that. And I would like to know, approximately, how much will it be to have a scan done?
I would not expect treatment without paying first, even in emergencies. To the best of my knowledge the only emergencies they are required to treat would be from accidents or trauma. The cost of scans varied widely between hospitals depending on how nice it is. I would ex