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From local press: The root cause of illegal medical practice
By Zhang Haitong (China Daily)
Updated: 2009-11-06 13:49

Media reports that medical students practiced illegally at Peking University First Hospital have immediately caused a public outcry. But the key issue is the conflict between the current exams regime for medical licenses and the medical training system.

Medical graduates must pass national exams before they obtain a license to practice medicine. However, graduates with a bachelor's degree must first work one year in a medical institution. The exams take the graduate several months to complete.

In other words, in order to obtain a license a graduate would have to work up to two years in a hospital. It's not practical for a hospital to provide supervisors to these paid interns on a one-on-one basis throughout that period.

Besides, if interns are not allowed to treat patients independently, then it will be impossible for them to obtain the necessary clinical abilities and experience. This leads to the widespread violations of Chinese medical law by these interns.

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Second, the process of obtaining a medical license has also proved a major problem for medical schools that offer express programs leading to a master's or doctoral degree. Many of these students don't possess a bachelor's degree and will not hold a license during their residency, a stage of graduate medical training.

When disputes arise, their participation in the medical treatment will be very likely to be regarded as "hard evidence" that a patient's interest is being harmed. However, if hospitals don't allow them to be involved in surgeries or emergency operations, it would be hard to ensure the quality of these graduate students.

Of course, although such flaws in the medical exams may be the root cause of illegal practice by interns and residents, there would be major problems in the management of a hospital, if doctors in an emergency operation were all interns without the supervision of licensed physicians.

This is because such practice goes against the fundamental hospital management principles and breaks the law. If this were the case at Peking University First Hospital, it would be difficult to exonerate it from responsibility for the death of the patient.

In a nutshell, we need to strengthen the management of the hospitals and clarify the responsibilities for supervising doctors and interns and residents. But we should also improve the regime of medical exams and help those qualified interns and residents to obtain professional qualifications.

Zhang Haitong

(The article was first published in Beijing Youth Daily on Nov 5)