"Do you have rounds where different specialties discuss the same patient together?"
Now, of course this happens occasionally. The New England Journal of Medicine's Clinicopathological Conference is a popular feature in that journal. "Tumor boards" involve meetings between different providers in relation to the care of the same cancer patient. But it's not a regular thing, at least in the general internal medicine division at which I practice at Johns Hopkins. Because there's no incentive to do so: any financial incentives to such a meeting of the minds would be outweighed by scheduling headaches. And yet, there they were, a hematologist, gastroenterologist, rheumatologist, and internist, sitting round a table, discussing a single patient.
Later, I was taken to Grand Rounds in one of PUMCH's oldest buildings, constructed in the 1920s. Rounds started in the lobby, in a way you don't often see anymore in the U.S., if at all: students crowded around a patient, being shown some bone abnormalities. (The picture I took purposefully obscures the patient.) Then we moved inside for a very technical series of lectures: another example of the ways in which, at least in this very privileged corner of the Chinese health care system, the direction of care has converged on the same priorities that are prevalent in the U.S.: narrowed expertise, a fantastic display of intellectual and research firepower devoted to the care of the individual patient with a rare, fascinating condition, of unclear relevance for the bulk of the nation's health.
I should mention an extracurricular activity: going to a bookstore. Not only a bookstore, but a large, iconic bookstore. What's more, it was packed full of people not mourning the demise of the written word, but purchasing it in many varied forms. I got a Chinese-Chinese dictionary, a phraseological dictionary, and a book of poetry by the modern Chinese poet Bei Dao.
Today I am giving a talk on public reporting of health care data and whether it matters to patient health. The audience will be made up, I am told, of doctors and administrators. Since public reporting is just getting started in China, I look forward to hearing their impressions.