Hanna Lovbrand (right) and Diana Sylwander from Sweden work with a Chinese doctor in Ruijin Hospital. The Swedes are in the city on an medical exchange program. Shanghai health authorities are using the exchanges to collect ideas on how to improve medical care. — Wang Rongjiang

　　FOREIGN medical students on exchange programs in China are often taken aback by practices here that contrast sharply with those back home.

　　Like the absence of family doctors as gatekeepers to specialists. Like clinic doors left open, allowing sundry people to wander in and out while a doctor is seeing a patient.

　　When people need a doctor in China, they normally go to local hospitals, which are usually crowded. Foreigners are amazed at the workload Chinese doctors bear.

　　“Chinese doctors work so quickly,” said Hanna Lovbrand, a senior medical student from Karolinska Institutet in Sweden. “They have to make decisions within minutes because they treat so many patients a day. In my country, by contrast, a doctor always talks with the patient for about 20 minutes.”

　　She and fellow Swede Diana Sylwander are in Shanghai for a 10-week exchange program with Shanghai Jiao Tong University’s School of Medicine. At Ruijin Hospital, one of the city’s leading public health facilities, they have rotated through three departments to view medical practices.

　　“We are interested in learning about the Chinese healthcare system, Chinese medical practices and traditional Chinese medicine,” Lovbrand said.

　　There are an increasing number of exchange programs being initiated in Shanghai to foster sharing of information and experiences between the city’s healthcare system and those of foreign countries. The exchanges bring foreign medical students here and send Chinese medical students abroad.

　　Lovbrand said she and Sylwander found that Ruijin Hospital’s operating theaters, medical equipment and basic surgical procedures are similar to those of Western countries. What is different is the doctor-patient relationship, she said.

　　“What interests us is how Chinese patients know which specialists to go to for their ailments,” Lovbrand said. “In Sweden, we must first visit a family doctor, who then refers us to appropriate specialists.”

　　Shanghai health authorities are using the exchanges to collect ideas on how to improve medical care here.

　　“We are pushing cooperation with Western counterparts,” said Gao Hong, an official of Jiao Tong’s School of Medicine who oversees exchange programs. “It will help the young Chinese medical professionals to learn from countries with more developed healthcare systems. For example, our medical students can learn about respect for patient privacy.”

　　It’s not only foreign students coming to China who benefit from exchanges. Chinese medical students going abroad also come back with experiences that shape their professional attitudes.

　　Dong Liang, a senior medical student at Jiao Tong, said he was surprised by the practices he saw on a two-month exchange program in Canada. While there, he was assigned to the internal medicine department at Toronto General Hospital and also visited general practice clinics in the city.

　　“In a Western hospital, a doctor is only part of the medical team,” Dong said. “The team also includes nurses, social workers, therapists and a patient’s family doctor. They receive daily briefings on a patient’s condition and handle all related care, such as rehabilitation and psychological support. Patients there have a better recovery rate. We don’t have such a system in China.”

　　Chinese medical students are also surprised to see the respect to patients and their privacy, he said. “It is prohibited there to take photos or print out a patient’s record,” Dong said. “Doctors can’t check the information on patients not under their care. All these practices are unheard of in China.”

　　Dong said he would like to see China’s healthcare system develop a frontline of primary care, which means general practitioners seeing patients before specialists. That would ease the workload of big hospitals and deliver better health care, he said. “Though Shanghai has started to promote use of general physicians, the training and promotion of family doctors lags behind the medical systems of the West,” he said.

　　Jiao Tong’s School of Medicine is collaborating with the University of Ottawa in Canada to establish a joint medical school aimed at providing global physician education.

　　Jacques Bradwejn, dean of the University of Ottawa’s Faculty of Medicine, said family medicine will be an important segment of the joint program. “Family medicine is well developed in the United States, Canada and many Western countries,” he said. “People get primary care in their local communities, and the same family doctor follows a person’s health track for a long time. We will train Chinese medical students in family medicine, and we hope it will provide a demonstration platform for Shanghai and China.”