Dr. Pietro Cecchi is an Italian pediatrician with more than 30 years of clinical experience. Two years ago, he was sent by the Italian government to Beijing as the head of the Italian side to implement a health cooperation project between the two countries. During his two years in the special needs clinic of Beijing Children’s Hospital, Mr. Cecchi, with the honest and perceptive eye of a Western doctor, observed an incomprehensible phenomenon that is currently prevalent in the Chinese medical community.
Why no or less medication
Mothers all over the world are afraid of their children getting sick, and when they do, they are terrified and take them to the doctor whenever they get sick. Fang just now, a child’s grandmother with her grandson rushed to see the skin disease, your pediatrician to draw blood tests on the child. I checked and saw that it was a mosquito bite, no need to draw blood. Finally, the old lady made a long-distance phone call to the child’s mother, who was working in Hong Kong, and the child’s mother was adamantly opposed to drawing blood for the child, so she let the matter go. As a result, I did not prescribe medicine for the child. This is the ignorance that belongs to the patient’s family.
The mother in Italy, 30 years ago, thought the same way, thinking that the effect of a medication with a needle stuck into the body (infusion) would happen faster than an oral medication. It’s not that I don’t use medication or use less medication, but there is no need to prescribe medication for these children. But their mothers would say, “Our children are sick, why don’t you give us medicine?” This is the problem of the parents, not the child itself.
Nowadays, children with colds, coughs and diarrhea are the largest part of the visits to Beijing Children’s Hospital. When the fever is below 39 degrees, our Western doctors never prescribe medicine for the child, but suggest parents to cool the child with an ice pack at home, and give the child plenty of water to drink, and the child will be fine in a few days. Generally, a child’s cough is his physiological instinctive self-defense reaction. Children do not cough up phlegm, especially when they sleep with their noses running down their throats and get up in the morning, and this does not require medicine. However, if a child’s cough is caused by bacteria, such as bronchial infection, pneumonia, or whooping cough, antibiotics are needed.
Diarrhea in children is usually caused by cold, or indigestion. Our doctors in the West will advise parents not to feed their children for 24 hours and to drink only water, and they will be fine soon. One mother of a child with diarrhea understood why I did not prescribe medication, and she happily carried her child away, and it turned out that the illness cleared up without medication. If the diarrhea is bacterial, then antibiotics are needed.
These are common symptoms in most of the children I mentioned, and they do not need to be prescribed, as long as they are explained clearly to the parents. The key is that the doctor must communicate with the parents when making the diagnosis and must find out the cause of the child’s symptoms.
You are accustomed to giving injections (antibiotics) to bring down the temperature of a child with a fever, but that is a forced reduction of temperature by drugs, which has no positive effect on the recovery of the child.
Nowadays, it is also popular to give children “flu shots” to prevent the flu. In fact, the flu cannot be prevented because the flu virus changes every year, so how can you prevent this year’s flu with the vaccine you researched last year? Western doctors and Chinese doctors know that there is no effective medicine in the world to treat and prevent the flu.
The dangers of antibiotic abuse
Last April, a parent brought an 11-month-old boy to us with swollen throat and tonsils and a fever that wouldn’t go away. The child was treated for a month at a hospital in Beijing’s Chaoyang District, where the doctors kept giving this little child all kinds of antibiotic medical treatment, but the child’s fever never went away, costing people more than $10,000. The child was already suffering from strain disorder and “resistance”, which is the result of antibiotic abuse.
I told the child’s father that if the child’s fever was above 38 degrees 5, he could have some fever-reducing medicine, but if it was below 38 degrees 5, he should not take fever-reducing medicine, but use physical cooling, drink a lot of water and use ice packs to cool down. As a result, the child’s father did what I said and soon the child’s temperature came down.
I did not prescribe any medication for this child. If I find that the child’s symptoms are caused by a bacterial infection that requires antibiotics, I will give the child antibiotics. Generally oral antibiotics are as effective as a hangnail (infusion), but the former is easier to treat. It is an incorrect notion to try to use antibiotics to prevent illness. I repeat, if the child does not appear to have a bacterial infection, antibiotics should not be used. If this child needs to be treated and prescribed medication, I will definitely treat and prescribe it.
Sometimes doctors have a hard time being mothers and always asking them to prescribe more and better medications. I think there is a very important issue between doctors and parents, that is, they must tell the child’s condition very clearly. Doctors need to communicate more with parents to educate them on how to look at their child’s illness, and to educate them on general health care. But it takes some time to get parents to understand the problem.
I must undress my child to examine him/her. Your parents are worried about what to do if their child has a cold. It’s impossible to examine a child without undressing, otherwise how do you know what’s wrong with the child? There was an 8-month-old girl with what appeared to be a cough, but I had to observe her physical condition to determine if her cough was caused by something else, so how could I tell if she was wearing clothes? That’s why it takes me an hour to see a child. That’s why it takes me an hour to see a child. It’s very difficult to implement such an outpatient model in China.
The imperfection of the health system
In Italy, we have outpatient clinics in every community, and every family has its own family doctor, and visits are free of charge. Patients who undergo heart surgery or hospitalization for less than 4 months are free of charge. Of course this is still very unrealistic in China at the moment.
Professional ethical issues
I think there are two qualities that a good doctor should have.
First, he must first be honest, humble and respectful of his patients. Doctors are certainly not saints, they also have to provide for their families, but they should earn money as the old Chinese maxim goes: “A gentleman loves his money and takes it as he sees fit”.
Be a doctor must be humble, their knowledge is not enough, can not see the disease must ask experienced doctors for advice, or ask experienced doctors consultation, do not be afraid to lose face in front of the patient, do not pretend to understand will cause misdiagnosis, bring great sorrow to patients and families.
Second, as a doctor must pay attention to their professional ethics, if you diagnose this patient’s disease really can not be cured, you should tell his family not to spend money on treatment. If you know that the patient’s disease can not be cured, you give him treatment, so that people spend a lot of money, which is very unethical.
In 2000, I was invited to Beihai Town, Fangshan County, Beijing, to see a boy who was only 11 years old at the time. This was a very good-looking boy who had muscle atrophy in both thighs, a disease called “Di He Er’s Myasthenia Gravis,” a rare, familial genetic disorder that simply cannot be cured.
I estimated that he could only live another 10 to 15 years before he had to leave this world. But his family has been taking the child to various hospitals for 10 years since he was born, spending a lot of money …… actually none of the doctors have told the child’s family what disease he has and told the parents that the disease is simply incurable. This is very unethical.
I say to the child’s family, you should not take him to the hospital for treatment anymore, infected with this disease, from the birth of the child can not be cured at all. If you really want to do him good, buy him a handicapped electric car and improve his quality of life.
Later, we Italians, who work in the embassies, companies and medical system in Beijing, donated to buy an electric car for the disabled and gave it to this child, who was overjoyed to get it. Ah, that’s a very beautiful little boy! He was so unfortunate.
There are also patients like those with malignant tumors, the vast majority of which are incurable and for which hospitalization is useless. In such cases, the doctor should advise the patient or his family not to treat the patient anymore, but to nurse him at home, as long as he can suppress his pain and give him pain medication when he is in pain.
In fact, there is no need to do this kind of surgery, the child will be fine when he grows up. In the West, doctors do not perform this type of surgery on children. It is important that a doctor should not make his patients spend too much money on unnecessary treatments. I think a good doctor should be honest, humble and respectful to his patients.