Impressions of Shanghai Jiao Tong
Lillian Zhang - medical student from Sydney Medical School, undertook an Elective with Shanghai Jiao Tong University in 2013-14
I completed a four week elective placement at Renji Hospital, Shanghai in the Gastroenterology and Traditional Chinese Medicine Department. It was a most rewarding experience learning medicine in a different culture and health system.
The hospital mainly practised western medicine, so the management for common conditions such as reflux and inflammatory bowel disease are much the same as Australia. However the prevalence of conditions such as Hepatitis B and stomach cancer are much higher. Ward rounds conducted every morning at 8am often involve a team of 10 or more people including medical students, junior doctors and consultants. Although some students and most consultants can speak English, Mandarin and Shanghainese are the main languages spoken to patients, so ward rounds may be difficult if you can’t understand either. I also had the privilege of watching my supervisor perform many colonoscopies and endoscopies with great efficiency as most patients had no sedation or anaesthetics as this would double out-of-pocket costs! Sadly, I also observed many patients present late for treatment or use suboptimal treatment due to the high cost of healthcare.
My Traditional Chinese Medicine (TCM) attachment was very interesting. I witnessed many practises which included electro-acupuncture, moxibustion, cupping and acupuncture point injection therapy, none of which I have observed before. My supervisor explained that unlike western medicine which treats individual diseases, TCM believes that all diseases display similar characteristic such as hot, cold, damp, and therefore TCM can use similar treatment methods for different diseases. Although I found the theory involving qi and meridian points difficult to understand from an anatomy and physiology perspective, many Chinese people truly believe in its effectiveness. Interestingly, doctors who practice western medicine at the hospital who are sceptical of TCM still refer patients to the clinic for conditions such as paralytic ileus, neurological and rheumatologic conditions. It was interesting to observe the integration of TCM with western medicine in the management of conditions.
I thoroughly enjoyed my time at Renji hospital and especially appreciated both the students and my two lovely supervisors who took time to translate and teach in English. This elective not only taught me more medicine but also allowed me to have a better understanding and appreciation of alternative medicines and the Chinese medical system. Finally, I was also able to travel and experience the beauty and culture of Shanghai, visiting the traditional Yu Garden and filling my stomach with its famous xiao long bao (steamed buns)! I was also fortunate to be there at Chinese New Year, watching locals light fireworks and firecrackers in the streets to welcome in the year of the horse!
Alex Ng - medical student from Sydney Medical School, undertook an Elective with Shanghai Jiao Tong University in 2013-14
I completed four weeks at Renji Hospital in January of 2014, two weeks with the Department of Gastroenterology, and two weeks with Orthopaedic Surgery. I am thankful to both Shanghai Jiao Tong University and the Office of Global Health for this wonderful opportunity to understand a very different medical system, and contrast it the hospitals I’ve been placed in Sydney. In particular, having never formally done orthopaedics as a rotation, I thought it would be a great introduction to emergency and trauma medicine that I will start upon return to Sydney. With Australia becoming more culturally diverse, I felt it would be a great opportunity to understand the unique challenges Chinese patients experience back at home, and learn some Mandarin.
From day one, staff and students were very welcoming to me, keen to learn more about me and teach me about Shanghai. I realised it was a great challenge expecting to understand all the medical jargon with a mere knowledge of conversational Cantonese, but was very thankful when busy senior professors would often make special effort to retranslate the teaching and clinical cases to us exchange students. However despite the language gap, it was an excellent learning experience, and it was humbling to observe the great emphasis on clinical teaching by the department directors chairing the ward round. Being a major tertiary hospital, there is huge number of patients on each ward. In addition to addressing every patient during the round, each patient is also a rich learning opportunity to the several medical students attached to every team. It is sad that this level of daily clinical teaching rarely happens even in rural Australian hospitals. It was particularly valuable learning from professors highly specialised in their field, seeing patients with rare but important conditions such as autoimmune hepatitis (which was common on their ward). We were also invited to outpatient clinics, tutorials and the colonoscopy suite when attached with gastroenterology, observing the efficiency in patient flow because of the vast case load.
It was also eye-opening being attached with the Trauma Orthopaedic team. Despite there being less patients leading up to Chinese New Year, I was given the opportunity to scrub into modern operating theatres with similar facilities and equipment to those in Sydney. Because an anaesthetic bay for patient preparation is not a common finding in hospitals, it was fascinating to see the surgical team’s work culture taking long tea breaks between procedures during preparation by other staff. However, it is also uncommon for cases on an operating list to be cancelled during a day even if there have been delays in earlier procedures – so staff teams may be required to work into the night. It was invaluable sitting in on clinics, viewing radiographs, helping with post-op wound care and receiving teaching in English on the ward round.
Perhaps the most fascinating learning experience was appreciating the sheer patient load in Chinese Hospitals, and how efficiently they cope with this. With a high incidence of gastric cancers, abdominal pain is a frequent indication for gastroscopy, and 4 patients are lined up outside the suite at a time, with each investigation taking as little as 15 minutes. Because of the added cost to the patient in a user-pays healthcare system, endoscopic investigations frequently took place without general anaesthetic. Spending a month in Shanghai allowed me to appreciate the unique challenges faced in China funding and treating such a large population, and implications to the patient-doctor relationship. There may be less time available for building rapport, or delving into biopsychosocial issues. Being interested in rural medicine, I hope the placement will allow me to appreciate the different approaches taken to provision of healthcare in the setting of limited resources.
The placement was also a great opportunity to be immersed in the culture and lifestyle of Shanghai. It was intriguing to have tasty, cheap food in some districts right next to shopping malls full of luxurious designer brands. With a Wild Animal Park safari, the traditional Yu Garden, famous museums, temples and a breathtaking skyline, there’s plenty of attractions to visit each weekend. The Science and Technology Museum is highly recommended, as is a visit to the nearby Hang Zhou or Su Zhou over the weekend if time permits. Staying for the Chinese New Year was an added bonus – where I was blown away by the quantity of homemade fireworks and firecrackers set off by locals on the street.
I’d highly recommend the placement experience to anyone who is interested to learn more about China, and is prepared to be surprised. Just be aware that without mastery of Mandarin, there may a lot you won’t understand, because patient notes, ward rounds and most clinical discourse occurs in Chinese.
Charles Betts - medical student from Sydney Medical School, undertook an Elective with Shanghai Jiao Tong University in 201213
I completed a five week term at Renji Hospital in January and February of 2013. I was assigned to upper and lower GI general surgery teams during my visit. It was a high quality learning experience and I felt included in the teams I was with. The team bosses were excellent hosts, many were proficient in English, and included special teaching in many of the activities I attended. I was also lucky to have worked with the medical students and junior doctors on the wards. This gave me a chance to interact with patients, amuse them with my attempts at Mandarin, and feel as though I was making a contribution to the medical care.
My Supervisor, Dr. Jie Zhuang, is a general surgeon who specializes in the treatment of gastric cancer. The prevalence of gastric cancer is much higher in China than Australia and our 50 bed floor was primarily dedicated to patients undergoing complete or partial gastrectomies. Many of the doctors on this team were either dedicated to researching gastric cancer or learning this difficult operation. This made for a unique training opportunity unavailable in most Western countries.
Time spent with the colorectal team was also excellent. Colonoscopy clinics were speedy and lacked the personal space we are afforded in Australia, although the patients seemed untroubled by this style of practice. Outpatient clinics were also interesting and expectedly busy, with the silhouette of the next patient always looming behind the examination room door. Scrubbing in with Prof. Tsong’s colorectal team was always interesting and he was quite keen to have the student as involved as possible.
Time spent with my fellow medical students on the wards was the highlight of the training. Medical students at Renji Hospital have numerous ward responsibilities which include being on call and working weekends. Students do most of the wound care on the surgical ward rather than nurses. Participating in this activity was highly rewarding and provided insight into the subtle differences in care between our two healthcare systems. I should point out that one patient did call a surgical consultant who was on holiday because the foreigner changed his wound dressing. Apparently this patient thought that he must have had a rare medical condition and they had brought in help from overseas!
It was an excellent and challenging learning environment and was also quite fun at times.
I arrived in Shanghai in early January for a one month placement at Renji Hospital, Shanghai. A keen first year medical student, I came armed only with my stethoscope, the Oxford Handbook of Clinical Medicine and warm jacket, but I left with many good memories and a unique experience of health problems in a different country.
Renji Hospital was the first western hospital to be established in Shanghai and the second in China. There are currently three campuses over Shanghai and I spent my time in the East campus, which is located in Pudong - the emerging business centre of Shanghai.
I spent my time in cardiovascular surgery, cardiothoracic surgery and traditional Chinese medicine (TCM). The staff were friendly, helpful and eminent in their field. My supervisors in the surgical departments had spent time studying in Europe, had good English and were happy to explain individual cases to me on rounds. The residents sometimes had less proficient English and it proved difficult – although entertaining – to discuss cases. Nonetheless, discussion was encouraged, both to help with English skill before the residents embarked on overseas education and to help me understand practical aspects of cases, including tests, results and follow up procedures. I witnessed many amazing surgeries and had the privilege of working with a great team.
My time in Traditional Chinese Medicine was also enlightening. I saw treatment of countless pathologies using acupuncture and theory of the Meridian lines – although I would recommend having at least a basic understanding of these concept if you chose this specialty. The traditional Chinese medicine practitioners integrate treatments with western treatment to assist in treating for chronic conditions including asthma, stroke, allergies, pain, headaches and bloating. As well as understanding some details of the practise I was interested to see the role of TCM in modern healthcare.
The accommodation was surprisingly comfortable, with all overseas students housed on the same floor. At the time of my visit, there were only a few students and we had a room to ourselves with two double beds and reverse cycle heating (very much appreciated). There was also a department store, a WalMart and train station close by - making the exciting city easily accessible.
Shanghai is a fast-paced and diverse city with many different activities on offer, including museums and theatres, acrobats, the zoo, nightclubs and bars, restaurants and the high speed train. I would recommend anyone considering Renji Hospital as a placement option to experience what Shanghai has to offer in a time where Chinese healthcare is changing.
Kirby Campbell-Wood - medical student from Sydney Medical School, undertook an ILA with Renji Hospital, Shanghai Jiao Tong University in 201112
I recently completed my ILA in Shanghai, spending 4 weeks at Renji Hospital where I rotated through cardiology and cardiothoracic surgery. The experience was fantastic – I got to see a number of different procedures in both rotations, sit in on consultations, joined staff for ward rounds and received personal tutorials. While mandarin would have been an advantage, it wasn’t critical for my experience. The patients in the hospital tended to be older and speak mostly Shanghainese in any case and I was still able to learn effectively due to the ability and willingness of the staff to speak English.
China continues to develop at an incredible pace and this transition was very much evident in my experience of the medical system. While discussing Traditional Chinese Medicine with a member of the cardiology team I found that while it is still undertaken in parts of the hospital it was not a part of cardiology at all - contemporary Chinese cardiology had moved on and it seemed to be something they wished to distance themselves from. During other discussions staff also made it clear that they were pushing their training in the same direction as their western counterparts, and that all of their senior team members had undertaken placements in Western hospitals and were collaborating with international partners. On a technical level, MRIs are only just being employed for use in cardiology at Renji Hospital, and some catheter procedures undertaken in Australia are still not approved for use in China, it was clear however that while gaps remain, they are closing fast.
One clear cultural difference that emerged during my time in Renji Hospital was the different attitude to privacy. Curtains between beds in the wards were a rarity, and amongst the wards I visited tended to exist only in surgical wards where men and women were mixed in the same room. During consultations I attended in the Emergency Department and in a private clinic, doors tended to remain open, with patients wandering in and out at will. While rules regarding confidentiality would ensure this would not happen in Australia it was perfectly normal in Renji.
In terms of career benefits from the placement the experience has given me an excellent exposure to cardiology and cardiothoracic surgery early on in my training, and has certainly helped to define the direction in which I would like to head in further years
Lastly, there was the very important after hours component! You don’t need Chinese language skills to move around and enjoy Shanghai or the surrounding cities. There are lots of places to visit and go out and lots of opportunities for tasty and incredibly cheap local food.
Having read the student exchange impressions of earlier years, I came to Shanghai with quite a few preconceptions about what the medical system, the city and its people might be like. However few of these preconceptions matched what I found when I arrived early in December – a keen, green medical student just out of her first year.
Renji hospital, in the Pudong district of Shanghai, is a striking red-brick complex consisting of multi-storey surgical and internal medicine buildings larger and taller than any I’d seen in the Sydney hospital system. On my first foray into this vast complex – and unable to accurately decipher the Chinese signage – I was at a loss as to where our student accommodation might be. However several doors and helpful security guards later, I found the spacious rooms assigned to international students and settled in for the start of four weeks in my chosen specialties of anaesthetics and cardiothoracic surgery.
Anaesthetics at Renji turned out to be a wonderful way of getting a taste for all types of surgeries. My tutor Dr Zhu, who was a native speaker of Mandarin and Shanghainese but also a fluent in French and English (so no major language difficulties for me!), gave me a free run of almost all the surgical theatres over two levels of the surgical building – I was able to watch CABG and valve replacement heart surgeries, a liver transplant, lung resections, caesarean closure, endoscopies and many many other procedures, with occasional impromptu tutorials from the surgeon operating. In cardiothoracics, our tutors were equally generous in giving their time and resources to teach us suturing and knot-tying techniques, even – quite memorably – late on New Year’s Eve.
There were some drawbacks to watching so many surgeries in Renji – one was the relatively little contact with Chinese patients, and the other was the strong emphasis on modern Western surgical techniques with therefore not much chance to see a traditional Chinese practice of medicine. Nonetheless, since I am not in the habit of watching multiple surgeries per day in Sydney, I found more than enough learning opportunities to satisfy the most knowledge-hungry medical student.
Living in Shanghai was also a far more comfortable experience than I’d initially imagined. We had the best of both East and West in the less tourist-ridden district of Pudong. A five-minute walk from the hospital took you up Nanquan Rd with all the strange sights and delicious tastes of bustling Chinese shops and marketplaces, while another short walk in the opposite direction took you to a monolithic Walmart where you could satiate random cravings for peanut butter and baguette loaves.
I would hugely recommend Renji hospital in Shanghai to any medical student thinking of doing their ILA internationally. The doctors there are warm, generous with their time and very interested in speaking with Australian medical students, and I greatly value the experiences – both medical and cultural – that I can take back from my stay in Shanghai.
There is nothing more amazing than to experience the vibe of a developing city. Ten years ago, Shanghai looked like a small town, while today, Shanghai is probably the most quickly developing city in China!
During my time in Renji Hospital, I saw many things that I would not experience in Australia. Most people that come into the hospital is usually in the late stage of their disease, because not everyone can afford such expensive medical treatment in China. I felt that life is very fragile in China. Sometimes at night while sleeping I would hear families weep for their deceased love ones. I also witnessed a death for the first time in my life and remembered vividly that the intern was doing CPR to revive him. When he knew that the patient could not come back, I saw tears in his eyes. However he had to hold his emotions because there were many other people who are very sick and waiting for him to treat them.
All these experiences in Shanghai has definitely contributed to me becoming a better doctor because even with the huge amount of people to treat in Renji, every doctor gave their best to save their lives no matter how tired they are. These experiences will remind me to press on even at difficult and sad times during my life as a doctor.
The main cultural lesson I learned with this placement was that Chinese people take their illness with their whole family. You would see patient families sleeping in the staircase area just to maximise every moment to see their loved ones! I was amazed at how Chinese people took the burden of the patient's disease as a whole family, instead of being more individualised in Australia.
An ILA in the renowned Renji Hospital in Shanghai has broadened my understanding in medicine not only in China, but by way of comparison, our own system in Australia. We were part of the Cardiothoracic surgical team, under close supervision of consultants and were given personal tuition. We gained access to extremely valuable learning opportunities in both developing understanding of the specialty, our own surgical skills, and witnessing pathologies unusual in Australia. Through the OGH we were placed in accommodation within Renji Hospital, and we were also able to intimately observe the Chinese health system and the doctor-patient relationship in China.
With internal migration from the rural areas to metropolitan areas, unprecedented in human history, enormous strain is placed on the resources of Shanghai's healthcare system. To whom subsidised healthcare is available and the extent to which subsidies are given, depends on the patient's registered place of origin and their medical insurance. This has deep implications in the allocation of health resources to different patients, as well as expected outcomes. Appreciating this, as the key difference to our own universal healthcare, was a gradual and poignant process. It was almost surreal to discover, however, how little difference there was once I stepped into the sterile Red Zone, where lifesaving surgery took place. Ultimately, this experience gave me a much better understanding in the allocation of resources in health, which underpins the sustainability of a healthcare system.
Spending a month in Shanghai also allowed me to gain valuable cultural lessons. Despite being of Chinese ethnicity, I was initially in culture shock. Everything, from the pace of life, work ethics, to bedside manner were very different to what I was used to. The greatest cultural lesson was the notion of the Chinese family in the context of illness and hospitals. It was not unusual to find families; from spouses to distant relatives, to surround the bedsides of the sick. Even in the ED, everyday paraphernalia of the relatives adorn the already cluttered wards: many relatives of rural patients stay in the hospital days at a time to provide some of the care to the patient. This highlighted the value of Chinese families and the roles they play in healthcare. It also enforces the human aspect of disease, which we, as future doctors, can sometimes overlook.
- Derrick Wong - medical student from Sydney Medical School, undertook an elective at Renji Hospital (Shanghai Jiao Tong University School of Medicine) in 200910
- Johnson Zang - medical student from Sydney Medical School undertook a placement at Renji Hospital (Shanghai Jiao Tong University School of Medicine) in 200910
- Nathan Lum - medical student from Sydney Medical School undertook a placement at Renji Hospital (Shanghai Jiao Tong University School of Medicine) in 200910
- Owen Lee - medical student from Sydney Medical School undertook a placement at Renji Hospital (Shanghai Jiao Tong University School of Medicine) in 200910
- Jennifer Li - medical students from Sydney Medical School undertook a placement at Renji Hospital (Shanghai Jiao Tong University School of Medicine) in 20078
- Kevin Wang - medical student from Sydney Medical School undertook a placement at Renji Hospital (Shanghai Jiao Tong University School of Medicine) in 20078
Derrick Wong, a medical student from Sydney Medical School, undertook an elective at Renji Hospital (Shanghai Jiao Tong University School of Medicine) in 2009-10
"I spent the better part of two months at Renji Hospital in Shanghai where I rotated through Cardiology, Cardiothoracic Surgery, and Traditional Chinese Medicine (TCM). Having never visited Shanghai before and having never stayed in Mainland China for an extended period, I really didn't know what to expect when my taxi pulled up to the hospital accommodation. From attempting to decipher patient charts and medication lists written in Chinese, to experiencing the sheer volume of patients that pass through the hospital doors each day, I learned quickly how different the medical system in China is compared to what I've been acclimated to in Australia.
One of the most interesting concepts I took out of my placement at Renji Hospital is the complementary role that TCM can play alongside Western Medicine. Both in outpatient clinics and in surgical theatres, I witnessed the benefits of acupuncture as a therapeutic tool and a means for anaesthesia. Because the concepts behind TCM are so different from what I've learned in Western Medicine, I was very impressed with the results that can be achieved from techniques for which I have so little understanding.
Outside of the hospital, I experienced first hand the rapid development of the city in preparation for the 2010 World Expo. Anywhere else, the term ‘development’ would be misused to describe the transformation of a city over a two-month period. In Shanghai, I literally watched train stations constructed from scratch, entire sections of the city repaved, and buildings erected at a pace only US$45 billion can buy.
With all the anticipation of the World Expo officially opening its doors on May 1st, my only regret for my time in Shanghai is that I had to depart before that day arrived. I highly recommend all future medical students to consider Shanghai as a placement destination for both the world class medical training that Renji Hospital has to offer, and the opportunity to experience one of the most vibrant cities in Asia."
Johnson Zang – medical student from Sydney Medical School undertook a placement at Renji Hospital (Shanghai Jiao Tong University School of Medicine) in 2009-10
“Being exposed to Traditional Chinese Medicine in my final week of my elective term provided me with an alternative way of thinking about medicine as a whole. By relating the symptoms and signs of the patient to the concepts of Yin (decreased Qi) and Yang (increased), counter-measures may be utilised to suppress the symptoms and signs without finding the aetiology of the problem. Sometimes this is an efficient approach to treating patients, as aetiology may not always be found in every case.
I learnt that the medical knowledge of the general population was very limited and as a result there could be numerous misunderstandings during any one medical consultation. Adding to this the quality of consultation is sometimes limited due to the number of patients a doctor needs to see in a day further providing confusion for the patients to fully understand their diseases and subsequent management, leading to recurrent illness and medication non-adherence.”
Nathan Lum - medical student from Sydney Medical School undertook a placement at Renji Hospital (Shanghai Jiao Tong University School of Medicine) in 2009-10
“The placement in China opened my mind and eyes to its people, medicine and developing healthcare systems. I learnt from inspiring and committed doctors who work tirelessly to provide their patients with the best possible care (despite limited resources) and who nevertheless endure low social status and financial reward. I could easily observe the fulfilment derived from and contributing to rapid economic development. These major issues play an important role in a competitive society with strong desires for recognition and financial success and can make life for doctors in China difficult.
As China continues to flourish, the society is evolving and it is with a profound sense of hope that the basic, educational and health needs of the people do not get overlooked, so the richness of its history, culture and place on the world stage is nurtured, respected and treasured.”
Owen Lee – medical student from Sydney Medical School undertook a placement at Renji Hospital (Shanghai Jiao Tong University School of Medicine) in 2009-10
“As a well-travelled Canadian I have encountered health care systems from developed countries such as those in Canada, England, Hong Kong and Australia, where the standards of care are amongst the best in the world. With the tremendous development of its economy, I was curious to see how the health care system in China is.
I was lucky enough to be a medical student in the General Surgery, Orthopaedic Surgery, and Gastroenterology departments for a total of 4 weeks. The professors I was assigned with gave me a lot of freedom. The surgeons provided me with opportunities to scrub in to surgery with them. This way I could observe the operations closely. This was the first time I really had a chance to do this and I gained a lot from it. In addition I also had the opportunity to be a part of the orthopaedics team on call in the emergency department.
In Shanghai, all the different medical and surgical specialties put a team in the emergency department, so when a patient has a particular concern the nurse at the reception quickly assesses which specialty will be best suited to the condition and you go directly to that room in the emergency department. Apparently on average, the patient only has to wait for about 10 minutes before they get medical attention - quite different from my experience in Canada and Australia! However, patients also have to pay for most of their treatment and that can be a bit of a problem when an important operation is too expensive.
During my week in gastroenterology, I had the opportunity to examine patients in the ward, help out in the out-patient clinic, and watch doctors perform gastric endoscopies, and colonoscopies. As you can imagine there were many patients and doctors in the hospital. It was so busy!
Living in China was also quite an experience. Once you step out, you can sense how busy the country is. Construction sites everywhere, with busy traffic surrounding each block. Obviously I had a chance to eat a lot of cheap Shanghainese Chinese food, which was great. All in all, I felt lucky to be there, and it was a wonderful learning experience for me both medically, and culturally.”
Jennifer Li – medical students from Sydney Medical School undertook a placement at Renji Hospital (Shanghai Jiao Tong University School of Medicine) in 2007-8
“During the placement two patients stood out. Both were patients who were severely ill and passed away a few days after seeing them. My experience seeing patients is limited but my gut feeling was, ‘this patient looks like their time is near’. As a medical student, it was an experience which was both saddening but memorable. Also, the patient is often the focus, but that's no reason to ignore those affected by the patient as well. As a student seeing their families visit them everyday reinforced the importance of considering the wider picture, especially when death is nigh.
After spending time in the hospital in Shanghai, one of the most populated cities in the world I thought to myself, ‘doctors/interns in Australia have far more resources and support than our Chinese counterparts’. So, as doctors here in Australia, when there isn't enough, the question becomes, ‘how can we make use of what we have to make it enough?’”
Kevin Wang - medical student from Sydney Medical School undertook a placement at Renji Hospital (Shanghai Jiao Tong University School of Medicine) in 2007-8
“On my recent placement to China, I experienced an epiphany while looking down at the Renji Hospital outpatients lounge. (View photograph below.) Seeing the multitude of people who have lined up since the wee hours of the morning, I realized that patients everywhere are seeking something in common. That is, regardless of where people have come from, when they come to see a doctor, they have come to seek that one thing, comfort. Comfort in knowing that there is someone who cares for them, someone who will not forsake them.
This placement has lifted me out of my comfort zone to personally attest to this universal truth of the practice of medicine. In years to come, when I will take care of my own patients on the wards, I shall always reflect on that particular moment of realization. As we say, ‘to cure sometimes, to relieve often, to comfort always.’
One of the key cultural lessons that I learnt from my placement, is the role that alternative medicine plays in certain cultures of the world, especially in a country such as China where traditional medicine has been so ingrained as part of the cultural ideology. I feel that to properly understand and interact with the practice of medicine in a place, it is imperative that one first show respect to the value of the incumbent local practices, before beginning to make an assessment of its scientific worthiness. The cultural value of alternative medicine is deeply relevant to optimal patient care. After all, even in this day and age of evidenced based care, medicine belongs as much to the field of humanities as it does to the sciences."
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