In learning family medicine, China reaches out to osteopathic physicians
In June, Royce K. Keilers, DO, and AOA Trustee William J. Burke, DO, returned from China’s Guangdong province, where they spent one week consulting with government officials on how best to incorporate osteopathic principles and practice into Chinese curricula for family physicians.
The trip marked the duo’s latest foray to the country that has made the training of primary care physicians a priority to meet the health care needs of its 1.3 billion people. The visit, at the behest of Shenzhen city officials, also represented both an expansion and endorsement of osteopathic medicine in China, where Dr. Keilers, Dr. Burke and Ronnie B. Martin, DO, RPh, began counseling officials five years ago.
In 2006, the relief organization Heart to Heart International, which has medical missions in China, relayed to the American Osteopathic Foundation (AOF) the Chinese government’s call for help in training family physicians.
For decades, China had relied on minimally educated “barefoot doctors” to treat the majority of its residents in rural areas, explains Dr. Keilers, who was an AOF board member at the time. Physicians usually specialized and practiced in urban hospitals. Chinese often sought treatment in hospitals when their ailments—anything from sore throats to migraines—were beyond the scope of minimally trained clinicians. The system proved inefficient and expensive.
“Five to 6 million people had very little medical care, and the government determined that the only way to help them would be to broaden the base of medicine by adding family physicians,” Dr. Keilers says. “The central government issues a directive to each of the country’s 30 provinces to devise educational programs for primary care physicians.” China hopes to train 300,000 family physicians by 2020.
Five Chinese health officials from Sichuan province traveled to the United States in 2006 to meet with representatives of the AOA, the AOF and the American College of Osteopathic Family Physicians (ACOFP). “We told them we’ve been teaching family medicine for more than 100 years,” says Dr. Keilers, a family physician from La Grange, Texas, and a former president of the ACOFP. “They decided they wanted us to help them. So the three of us, joined at times by other osteopathic physician volunteers, have been traveling to Sichuan province twice a year since then to lecture and demonstrate OPP. We’ve also hosted two groups of Chinese visitors in the U.S. and have shown them how we train physicians in our medical schools.”
From specialist to generalist
Sichuan health officials have set a goal of retraining 8,000 specialists as primary care physicians. The physicians-in-training attend primary care education centers where they follow a nine-month primary care curriculum developed by the provincial health bureau. Many of the physicians being retrained have attended lectures on OPP and made rounds in hospitals with Drs. Burke, Keilers and Martin.
But Dr. Burke points out that he and his colleagues have played only an adjunct role in the re-education program. “I don’t think there’s anything specifically osteopathic in regard to our structural examination and treatment techniques that they have put into their curriculum,” says Dr. Burke, who planned the osteopathic medicine education presentations for the Chinese physicians. ”But they have embraced our osteopathic residency training standards, and have recognized our osteopathic medical training by granting us temporary medical licenses.”
The DO ambassadors’ presentations have covered the role of family physicians, the differences between osteopathic and allopathic medicine, and the osteopathic principle of considering the patient’s entire health and how family and work can impact well-being. For the most part, their classes were composed of Chinese physicians who in turn will become family medicine educators.
Delivering the message in China has its challenges—from securing the assistance of a Mandarin interpreter familiar with medical terms to conveying the spirit of family medicine.
“You can educate someone about what a family physician does, but to then teach them how to be a family physician is more difficult,” Dr. Burke says. “Developing that heart for patient care and the ability to integrate yourself into that patient’s family and life is different from their normal way of thinking and how they’ve been trained.
“The most effective education we provide is to role-model the behavior of osteopathic physicians as we visit patients with the students in hospitals and clinics. We will sit down with a patient, hold her hand and proactively anticipate questions the patient might have.”
Liu Ya was among the Chinese physicians-in-training who visited patients with Drs. Burke, Keilers and Martin. “The most important lesson of osteopathic medicine is the concept of regarding the patient as a whole,” says Liu, who studied endocrinology at Peking Union Medical College.
Through observation and discussion, Chinese physicians review the common ground shared by osteopathic medicine and traditional Chinese medicine. “They know that mind and spirit are very important aspects of health,” says Dr. Martin, the vice dean of graduate affairs at the Edward Via Virgina College of Osteopathic Medicine—Virginia Campus in Blacksburg. “So one reason we’ve been readily accepted there is because they see osteopathic physicians as a blend of Western medicine and the values they believe in very strongly.”
While for the first couple of years, Drs. Burke, Keilers and Martin restricted their efforts to the Sichuan capital of Chengdu, more recently they’ve been visiting training centers in the province’s smaller cities. With each visit to the province, they’ve noted progress toward its goal of expanding family medicine. “During the past five years, we’ve seen thousands of physicians who have been retrained as general practitioners,” Dr. Burke says. “And many new general practice residency programs have opened throughout the province.”
And the U.S. DOs clearly see gains in Chinese family medicine: “We have seen them come to embrace what they refer to as general practice,” says Dr. Burke. “With each trip, we see how enthusiastically they work on their own and with us to transform their health care system.”
Dr. Keilers, Martin and Burke plan to return to Sichuan province in the spring.