Why Do American Doctors Spend 30 Min with a Patient, While Chinese Doctors Only 5？

Out of three bullets fired by Luigi, a new folk hero of the U.S. was born, and the “bad guy” met his end.

Focusing solely on the death of the UnitedHealth CEO merely scratches the surface of the American healthcare system. It is hard to say who is more miserable: the patients who go bankrupt because they cannot get reimbursed or those who miss the best treatment time while waiting in line for appointments.

On the Chinese “Quora,” Zhihu, a question involving 38 million participants connects the current medical conditions in China and the United States. The question is: “Why are American doctors willing to spend half an hour with one patient, while a Chinese doctor only spends 5 minutes?” We chose the top dozen answers with the most likes and translated them as follows.

Many of these responses come from Chinese doctors who spend only five minutes with a patient, and some come from Chinese patients who were “dismissed” within five minutes.

Doctors:

Neurosurgeon’s Daughter:

@睡觉谁叫(74,000 likes)

My family member is a well-known neurosurgery expert, retired and rehired. According to the regulations, she only needs to see 20 registered patients a day, but because she voluntarily helps patients, she ends up seeing over 100 patients a day.

She has no performance pressure and no economic need to earn more for the family. She simply feels sorry for the patients who come from far away with difficult or unidentified cases, so she keeps adding extra appointments.

Her specialist appointment fee is 15 RMB, but scalpers resell it for over a thousand. When you go to see her and say, “Director Huang, I came from out of town, and I couldn’t get an appointment. My child has had a fever for three days, could you please take a look?” she will give you a small piece of paper with her name written in messy handwriting. With this note, you can save a thousand RMB (~$136.60 USD).

Her mornings last four hours. Before starting these appointments, she also needs to lead students on ward rounds. When she was the department director, she also handled administrative tasks. In one morning, she can see over 100 patients, often skipping lunch.

Fully utilizing her expertise, she resolves one patient’s concerns in five minutes. Isn’t this proof of her professionalism? Isn’t this so that severely ill children from remote areas would still stand a chance of being seen?

She is my mother, and I am proud of her for life.

One last thing: others may get five minutes, but when I’m sick, my mom just glances at me and says, “Take such-and-such medicine,” and then goes to work.

Orthopedics:

@脊柱微胖(30,000 likes)

A patient in my clinic brought a thick stack of films for examination.

The patient said they had been suffering from back pain for three months. They had visited several hospitals and even stayed in some big hospitals but still couldn’t find a cure. Some even suggested it was a tumor and required surgery.

I took a look at the film: the CT shows peri-intervertebral disc bone destruction, and the MRI shows high signal around the intervertebral disc. Report: nature pending, enhancement scan recommended.

I asked the patient one question: “Have you had any contact with cattle or sheep?”

The patient replied, “I’ve been selling lamb for a few months since winter began. No doctor has ever asked me this before. Why do you ask?”

I told the patient, “This looks like vertebral infection, most commonly tuberculosis. However, the high signal in your intervertebral space on the MRI doesn’t match tuberculosis, so I suspect a bacterial infection. In regions with thriving animal husbandry, brucellosis often causes vertebral infections. While Chongqing isn’t a livestock hub, contact with cattle and sheep can still lead to brucellosis, which should be considered.”

Diagnosed as “vertebral infection, suspected brucellosis,” the patient was admitted. The entire outpatient visit lasted no more than three minutes. After admission, the brucellosis diagnosis was confirmed, and an antibiotic regimen was devised after consultation with the pharmacy. The patient underwent conservative home infusion therapy and was discharged.

Because I don’t set appointment limits, that day was a holiday morning shift, with 120 slots to handle in half a day. That’s an average of two to three minutes per patient. If I couldn’t identify the disease accurately within two to three minutes, the patients behind would have to wait past closing time. After 12 PM, the radiology department closes, and no outpatient films can be taken. This means the patient would have to wait another day for the scan and then another day for results.

From the patient’s perspective, delays feel like their treatment is being postponed and extra cost of accomodation will be incurred for out-of-town patients. From my perspective, taking longer to diagnose would indicate a lack of experience,which I would compensate with skipping lunch.

Burns Department:

@過客(55,000 likes)quoted an article by “Dr. Abao” from the Burn Department:

In the U.S., appointment registration fees are generally around $120, while emergency visits without appointments cost $450–600. Emergency cases involving ambulances and fire trucks can cost $7,000 to $12,000.

An appendectomy in the U.S. costs approximately $26,000. Giving birth in the U.S., including prenatal checkups, delivery, and neonatal care, costs an average of $52,000. A single cardiac stent surgery can cost over $50,000. In 2010, total U.S. healthcare expenditures reached $2.6 trillion, averaging $8,402 per person.

Even after taking into account the difference in development levels between the two countries, the medical costs in China are so modest that they resemble public welfare- such as a Chinese top-tier expert’s registration fee of 15 yuan ($2.05 USD), a cardiac injection costing 6 yuan ($0.82 USD), a skin test costing 0.5 yuan ($0.07 USD), an intravenous injection costing 1 yuan ($0.14 USD), and a resuscitation costing 12 yuan (~$1.64 USD).

[Editor’s note: Our rough search indicates: In China, appendectomy costs range from 2,000 to 15,000 yuan ($273–2,049 USD), cardiac stent surgery costs range from 30,000 to 50,000 yuan ($4,098–6,830 USD), and per capita healthcare expenditures are 6,425.3 yuan.) ]

In the first quarter of 2024, the average outpatient visit cost in national tertiary public hospitals was 379.9 yuan ($51.83 USD), while it was only 241.1 yuan ($32.89 USD) in secondary hospitals. In other words, visiting the best hospitals in China, including registration, tests, medications, treatments, and surgeries, costs an average of only 52 dollars.

Thoracic Surgeon


@情歌医生 (4,629 likes)

You’re wrong. Chinese doctors don’t even need 5 minutes for each visit.
I’m an ordinary thoracic surgeon.

For most patients, 3 minutes is enough. In fact, even 1 minute would suffice. However, for a small number of patients, I need to spend more than ten minutes, even half an hour.

The time a Chinese doctor spends with a patient largely depends on the patient’s condition. If the condition is mild, then it’s definitely resolved in 3 to 5 minutes. But if the condition is really serious, even requiring hospitalization, it certainly won’t be solved in just 20 minutes.

The person asking this question is probably insinuating that Chinese doctors have a low standard of medical ethics, bad attitudes, and are lazy at work, while American doctors are held to a high standard of medical ethics, good attitudes, and are hard workers.

But I dare say, without considering the environment and language, if you invite Chinese doctors practice in the U.S., 99 out of 100 would be willing to do so. The patients are all referred by family doctors, and there won’t be a hundred people behind urgently waiting, so there’s ample time to communicate with patients. With a salary of several hundred thousand USD per year, who wouldn’t have a good attitude?

If you let American doctors practice in China, 100 out of 100 wouldn’t last a day. They don’t have the capability to diagnose one patient in a few minutes, placate anxious patients, handle difficult family members, and arrange tests and hospitalization.

Behind this, it’s actually an issue of the entire medical system and structure, not just the doctors. If you switch these two groups of people, after some time, they will both become like the other.

In 2016, Dr. Chen Lei from the Second Affiliated Hospital of Anhui Medical University spent an entire day working on an organ donation surgery. A scene of him after leaving the operating room was captured and went viral on the Chinese internet.

Cardiology


@悠悠 (1,379 likes)

Back in 2021, shortly after starting my job, this morning I did 70 electrocardiograms non-stop in an hour. In 2024, I can do 100 in one morning.

Patients

@phymath (2,927 likes)

A few years ago, my mom felt weak going up the stairs and wondered why she was feeling weak recently despite not doing anything.
I had a feeling it was something related to the cardiovascular system. I rushed her to the hospital and saw a neurologist.

The doctor was a woman in her thirties, she asked two questions: Had she done anything recently? And what had she eaten? Then she measured her blood pressure.
She immediately ordered a CT scan and told the CT room to ensure the results came out the same day, no appointments necessary.

She insisted on seeing the results, even if she had to stay after hours. The whole process took less than 2 minutes.
After the CT results came out, I showed them to the doctor, and after a glance, her face changed.

She told me she couldn’t treat this here but immediately ordered an MRI, and asked me to go to another hospital to have the MRI report reviewed.

I then saw a top neurosurgeon in a leading hospital in Shanghai. The doctor took one look at the film and said: Capillary-type hemangioblastoma.

She was hospitalized the same day and had surgery the next morning. The entire process of seeing the doctor took no more than two minutes.


In the pre-surgery conversation, I learned that the hemangioblastoma was located on the cerebellum, close to the brainstem, and it was rapidly developing. Within a week, the weakness could progress to complete paralysis.
The doctor said: Even a single sneeze could cause the vascular tumor to rupture.

@老杨叔聊志愿填报 (15,000 likes)

How can you ompare U.S. high-end medical care with Chinese public healthcare without mentioning the cost and workload?

The data is the most intuitive. Peking Union Medical College Hospital, China’s top hospital, sees 2.26 million patients annually with 4,000 staff.

Mayo Clinic in the U.S. sees 1.16 million patients annually with 61,100 staff. This means Peking Union sees twice the number of patients as Mayo Clinic with only 1/12 of the staff, and the staff load at Peking Union is 24 times higher than at Mayo.

Mayo’s outpatient fee is around $500, while Peking Union’s registration fee is about 50 RMB (around $7 USD).
Expecting to enjoy the same level of service for 50 RMB that you would get for $500 or more in the U.S. might be a bit excessive.

@珈 (8,831 likes)

As long as you are willing to pay, the international departments and various foreign private hospitals in China can generally provide the “American doctor” experience you imagine.
Beautiful environment, private rooms, doctors and nurses all smiling and chatting with you, even gossiping and joking around.

I once visited a top expert in the international department of Peking Union.

The doctor was kind, patient, and explained everything in detail.


Later, when I urgently needed a follow-up, I added the fastest regular outpatient appointment with the same doctor, which was the last slot of the day.

The doctor was impatient, interrupting my questions all the time. It wasn’t until a few minutes later, when I described my condition accurately and clearly, that the doctor spoke in a gentler tone.
Let me compare the cost here: the international department registration fee was 1,200 RMB ($165 USD), while the regular department was 100 RMB ($13 USD).

The cost difference is just one part. The key issue is that the international department doesn’t use China’s public health insurance, it’s fully self-paid (5 to 10 times more than public health insurance), or covered by commercial insurance, all of which are aimed at generating revenue for the hospital. There’s no need to consider if it’s covered by the unversal health insurance , if the patients have the ability to pay, or whether they need accommodation if they’re from out of town… All the irrelevant issues when seeking medical treatment are avoided.

The attitudes of public hospital doctors are a result of their busy schedule. Public hospitals in China offer high-quality welfare to society by exploiting doctors.

2024.4.11 Update: After the surgery, the hospital arranged two follow-ups, which took 2 minutes and 1 minute respectively.


The 1-minute one was with a doctor from the international department. After a quick glance, the doctor said I was fine and even told me to refund my registration fee, which was 900 RMB ($123 USD).


The round-trip drive took two hours, parking for half an hour, and the doctor’s visit took one minute.


So, if you really have no problem, the international department also doesn’t need 5 minutes, and even refunds your fee. They don’t want the money.

On September 18, 2015, a 2-year-old girl named Xin’er cried uncontrollably before her heart surgery. Dr. Shi Zhuo, the Deputy Director of Cardiac Surgery at Zhejiang University School of Medicine’s Children’s Hospital, played an animated cartoon from his phone that his own daughter loved to comfort her.

Other


@KnightRan (4,925 likes)

Hahaha, we have a doctor in our department who’s a real character.

A patient came in with cholecystitis, no insurance, looked not wealthy.


At that time, the doctor had a chest-related research project with the orthopedic department. He thought this patient would be a good fit and could reduce medical costs by participating in the project.

So, he called the orthopedic doctor in front of the patient.

The patient waited for 20 minutes. It’s rumored that when the doctor came to see him, he thought he had a terminal illness and had already started calling his family to leave a will.

@猫小苗 (3,578 likes)
You asked the question wrong.

It should be: Why do American doctors take half an hour to see a patient, while Chinese doctors only take 3 minutes?


The reason is that Chinese doctors have to see a week’s worth of patients in one day, while American doctors don’t.

@罗莎莉娅 (2,566 likes)


American doctors don’t need half an hour to see a patient. I went to the health office for an allergy last year, and the American doctor at our school saw me for less than two minutes before telling me he couldn’t treat me.

Conclusion:


Why do American doctors take half an hour to see a patient, while Chinese doctors only need 5 minutes? From the Chinese perspective, the truth is bitter yet gentle. China’s medical system is the most stressful for doctors, yet it is also the most compassionate for patients.

China doesn’t have Avengers like Luigi, not because it’s a medical paradise—many advanced medical devices are still imported, such as proton-heavy ion therapy, which is costly for patients; China’s pharmaceutical research is still behind the U.S.; China slashes drug prices by leveraging its large market, leading some high-priced foreign drugs to withdraw from China; and China also severely lacks doctors treating gunshot wounds. Not to mention the criminal loopholes in the system itself.

But for most people in China, they are not treated as customers of the hospital or clients of insurance companies. The trust between doctors and patients, encapsulated in those 5-minutes visits, is the true cornerstone of China’s medical system.