Learning while healing

Xu Chenke watches closely as a young British doctor prepares to insert a needle into the liver of a middle-aged woman in need of a biopsy.

The procedure is already familiar to Xu, a doctor in the Department of Ultrasound at the Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, in Zhejiang province. But something else catches his eye.

The British doctor is in his third year of training, and, with a senior doctor standing by, this is the first time he has performed a liver biopsy. The patient is aware that he is training, but is supportive.

"She completely understood that this was his first time doing the procedure, and she was entirely cooperative," Xu said. "What impressed me was the level of trust between the patient and the doctors."

Xu is among around 40 Chinese doctors taking part in three-month placements at British hospitals, including St George's Hospital, University College London Hospital, King's College Hospital, and Hammersmith Hospital.

Representing specialties including ultrasound, anesthesiology, obstetrics, gynecology, and neurology, they have been observing British clinical practice and sharing their own experiences.

And their placements have offered a close-up view of two very different healthcare systems: the United Kingdom's National Health Service, or NHS, with its emphasis on primary care, standardized pathways, and patient participation; and China's system, which is characterized by rapid specialist access and high patient volumes.

Rebecca Addison of King's College Hospital described the experience as "very positive and rewarding".

"One of the most valuable aspects has been seeing how colleagues from a different healthcare environment approach clinical problems and patient care," she said, adding that the exchange has encouraged UK clinicians to reflect on why they practice medicine in particular ways and whether other approaches could be equally effective.

Striking differences

For several of the Chinese doctors, one of the most striking differences has been the amount of time British clinicians spend communicating with patients.

Xu also noted that doctors in the UK generally do not wear white coats when seeing outpatients, contributing to a less formal atmosphere.

"The relationship between doctors and patients feels more like a conversation between ordinary people," he said.

Wu Xiaodong, from the Women's Hospital, School of Medicine, Zhejiang University, said British outpatient consultations can also be considerably longer. A doctor may see six to eight patients during a morning clinic, spending around 20 minutes with each, compared with 20 to 30 patients routinely seen during a busy morning in some Chinese departments.

Within the NHS, doctors known as general practitioners serve as gatekeepers to most specialist services, helping distribute resources and provide community-based care. But the referral system can also mean longer waits.

Chen Xin, deputy director of the third department of neurology at Xingtai People's Hospital in Hebei province, has been on a placement at King's College Hospital and said the contrast was particularly apparent in neurological testing.

Neuroimmunology tests in the UK can take close to a month, while cerebrospinal fluid cytology can take two to three weeks, she said, noting that delays can affect the optimal timing of treatment. She said major Chinese tertiary hospitals would expect to see results in about two days.

China's rapid testing capacity, centralized laboratory management, and the urgency with which medical workers approach serious illnesses are all areas from which UK healthcare can learn, she said.

Qian Xiaoyu, a head and neck surgeon from the First Hospital of Jiaxing, highlighted the accessibility of specialist treatment in China, saying: "China's specialist healthcare is highly accessible and efficient. Patients can often complete examinations, diagnosis, and treatment within a relatively short period."

But the speed comes with trade-offs. China's leading tertiary hospitals can be extraordinarily busy, limiting the time doctors can devote to each patient. The UK faces almost the reverse challenge: more time and structured pathways, but sometimes slower access to specialist care and diagnostic results.

Best practices

Rather than concluding that one system is better than the other, the visiting doctors say such exchanges help them identify best practices.

Yuan Kaiming, deputy director of the Department of Anesthesiology at the Second Affiliated Hospital of Wenzhou Medical University, has been undertaking a placement at Hammersmith Hospital and has been particularly impressed by the standardization of care in the UK, where in a cardiac unit, the doctor responsible for a patient may change from one day to another, but detailed handovers and established protocols ensure continuity.

Yuan also highlighted UK cardiac anesthetists' use of transesophageal echocardiography during surgery and multimodal approaches to postoperative pain management.

Xu similarly identified evidence-based guidelines and patient safety as areas of strength in the UK.

"The core value isn't bringing the entire NHS system back to China," he said. Instead, doctors should identify practices that can work within China's healthcare environment.

For Qian, one example is University College London Hospital's "one-stop" thyroid service, where specialist consultation, ultrasound, biopsy assessment, and treatment planning can be coordinated through a single pathway. After returning to China, he hopes to explore greater coordination among thyroid surgery, ultrasound, pathology, and nuclear medicine.

"High-quality healthcare isn't only about technical ability," he said. "It is also about whether we can make the patient's journey more convenient, efficient, and humane."

Wu, meanwhile, has been impressed with professional inpatient care in the UK, which relies less on relatives. Wu said UK hospitals rely more heavily on nurses and healthcare support workers for patients' everyday needs — tasks relatives have traditionally done in China.

At the same time, UK doctors can learn from China's huge patient volumes and Chinese doctors' extensive experience with complex cases and procedures, said Xu, who has discussed with UK peers Chinese expertise in ultrasound-guided interventions, including tumor ablation and drainage.

Qian has shared experience of conventional and minimally invasive thyroid surgery, including techniques designed to minimize visible scarring while maintaining appropriate cancer treatment.

Yuan believes China's high surgical volumes similarly contribute to technical proficiency, while rapid emergency and specialist pathways, and extensive digital systems covering appointments, payments, and test results also offer potential lessons.

Addison said the discussions have made British clinicians more aware of the value of looking beyond their own healthcare system and expressed a keen interest in China's use of artificial intelligence, computer science, and robotics.

"It is also about being curious about what is happening elsewhere, sharing ideas, and seeing whether we can learn from each other and potentially work together on new ideas in the future," she added.

Building relationships

Max, a doctor at University College London Hospital who only wanted to give his first name, has worked with the Chinese visitors and said they quickly became part of clinical teams.

"They're curious, engaged, and always keen to understand why we do things in a certain way," he said. "They've fitted into the team very well, so it felt like working with colleagues, rather than hosting visitors."

For Addison, the longer-term benefit may be these professional relationships created during the placements.

She said these could lead to continued sharing of clinical knowledge and education, as well as collaborative research and academic projects.

"Having professional connections with colleagues working in a different healthcare system could open up new perspectives and opportunities to learn from different approaches and experiences," she said.

The exchanges reveal two systems facing different pressures and possessing different strengths. The NHS offers ideas in primary care, standardization, continuity, and patient communication; China offers rapid specialist access, high-volume clinical expertise, fast diagnostic pathways, and digitalization.

The value of the program lies less in deciding which model is better than in identifying practices that can cross borders while recognizing differences in population, resources, and culture.

For Xu, the liver biopsy he observed offered an illustration of what might be learned. The technique itself was familiar. What stayed with him was everything surrounding it: a trainee learning under close supervision, a senior doctor providing support, and a patient who understood what was happening and placed her trust in the team.

It was not necessarily a model to copy unchanged, but something to take home, think about, and learn from.

wangmingjie@mail.chinadailyuk.com