Jon Le, MD, Shares Insights from his CA-3 China Rotation

Dr. Le recently returned from Hangzhou, where he learned about cultural differences in pain management and hospital operations, all the while enjoying the culture and sights of the region. 

What drew you to the SAHZU Rotation?

I was interested in seeing a different health care system. Considering that China has the largest population in the world, I wanted to see how its health care system handles such a demanding patient load while still providing quality medical treatment. 

Dr. Le performs a rectus sheath block at SAHZU.

How did patient attitudes and expectations differ at SAHZU?

The patients at SAHZU were extremely different than patients in the United States. This became most apparent at the chronic pain clinic. In the United States, we’re in the midst of an opioid epidemic.  There's no concern in China about a possible opioid epidemic. In fact, patients at the chronic pain clinic had to be persuaded, at times, to take medications prescribed for their pain. It's a cultural belief in China that medications are inherently unhealthy and they should be avoided, if possible. Symptoms such as pain were tolerable compared to the possible side effects of medications. 

Dr. Le lectures on the thoracic epidural anesthesia for the treatment of ventricular tachycardia.

In the operative setting, patients were more cooperative, as well. Patients tolerated awake central lines and alines with no sedation, including drugs like midazolam or fentanyl. In fact, I never saw the use of midazolam to treat anxiety before surgery. Patients also expected to have pain after surgery, and the administration of postop pain medication in PACU was exponentially lower there. All of these factors made it easier to take care of patients in the operative setting. 

What was the most surprising aspect of your rotation?

The most surprising aspect was learning about Traditional Chinese Medicine (TCM). I was fortunate enough to spend a day with a traditional Chinese doctor who treated pain, headaches, strokes, hearing loss and wide variety of other ailments. I saw him perform cupping, acupuncture, tui na (a massage modality that balances the body’s energy) and other treatments.  TCM is a well-respected field in China. Doctors who practice TCM go through rigorous years of training, just like doctors who practice western medicine. Patients have the same level of respect for doctors who practice TCM. 

The Hangzhou countryside.
The Hangzhou countryside.

How did the different resources available to you at SAHZU impact the care you provided?

Most of the drugs and medical equipment I use at UCLA were also available at SAHZU. However, there is a culture of using different drugs and anesthetics. For example, all surgeries performed there are done under total intravenous anesthesia (TIVA) instead of inhaled anesthetic. This includes heart transplants, lung transplants and basic cases like thyroids. This is not to say that they don't have inhaled anesthetic - all their machines have sevoflurane attached - they just choose not to use it. Regarding equipment, they are definitely less wasteful there. Surgical gowns and drapes are washed, re-sterilized and reused. Also, central line and aline kits have the bare minimum inside to perform the task required. There are no additional syringes, needles, wires, clamps or sharps holder inside. It became more challenging, at times, to perform certain procedures without certain items in a kit. I learned how to perform central lines without an ultrasound and thread alines without the use of a wire.

How will this rotation impact your future?

I will always cherish learning about the culture of China, and the kindness I received from everyone I met, both inside and outside the hospital. I was encouraged during my rotation to learn about the culture of China by visiting different cities, museums and sites. During my weekends off, I visited the Great Wall and Tiananmen Square in Beijing, the Terracotta Warriors in Xi'an, the Yuyuan Garden in Shanghai, and Yellow Mountain in Anhui. Everyone I met at these places was extremely welcoming.

This rotation allowed me to grow as an anesthesiologist. By seeing how little opioids were administered in the China, I realize treating pain is not solely about administering analgesic medications, but more about managing a patient's expectation of pain. If you can manage their expectation of pain, you can better treat their symptoms and prescribe less opioids. Furthermore, it made me more interested in learning about cultural differences in pain tolerance, and culturally-sensitive methods to treat pain, like TCM. Taking care of patients in a different country and culture was an experience of a lifetime that will forever change my practice in anesthesia.