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Fudan University

Introduction to

Clinical Medicine

The Practice of Medicine

Dr. Chouwen ZHU

Director, Foreign Affairs Office, Fudan University

Associate Professor,

Zhong Shan Hospital, affiliated to Fudan University

Evidence-Based Medicine Centre, Fudan University

Sept 05, 2011

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Self-introduction

Associate Professor

(Gastroenterologist, Clinical Epidemiologist)

1984-1992 MD, Peking Union Medical College

1991 UCSF, School of Medicine (exchange student)

1992-Present Internal Medicine, Zhong Shan Hospital

1994-1996 Graduate School, Chulalongkorn University

MSc, Clinical Epidemiology

1999 Senior Scholar, Rochester University, NY

1999-2003 Deputy Director, Medical Affairs Office,

Zhong Shan Hospital

2003-2011 Deputy Director, Foreign Affairs Office, Fudan U

2008-2011Jan Director, Medical Center Office, Fudan U

2011Mar - Director, Foreign Affairs Office, Fudan U

cwzhu@fudan.edu.cn

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Fudan University Founder - Dr. MA Xiangbo

Dr. Sun Yat-Sen

1st President of

Republic of China,

Director of Fudan

Board

Fudan University, 1905~

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Shanghai Medical University

Found in 1927 by Dr. Fuqing Yan

Dr. Fuqing YAN,

a Yale MD and PhD in Public Health

The first modern

medical college

established by

Chinese scholars

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Fudan University Shanghai Medical University Merged in April 2000 a new national key research university

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Handan Campus (main)

Fenglin Campus (med)

Zhangjiang Campus

New Jiangwan Campus Campus Location

EXPO

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Please do be proud of your

medical background!

Medicine

Science & Art

scientific knowledge, technical skill,

evidence, experience, intuition,

social concerning, human understanding,

judgment, decision-making…

Very unique profession !

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Fudan University

Please do be proud of your

medical background!

Medicine

Care the human beings and their suffering

(“Quality of Life 生命质量”), not only the

“cases” or “diseases”

Ideal “Patient-Physician Relationship”

Thorough knowledge of patient,

Mutual trust,

The ability of communication

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Difference between Learning Medicine & Practicing Medicine

While learning,

Know the diseases first, then find the relevant

abnormalities

While practicing,

Explore the abnormalities first, then deduce the

conclusion with reasons and make solutions

Internal Medicine

The first essential step for such transition

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Principles of Patient Care

Evidence-Based Medicine 循证医学

"the conscientious, explicit and judicious use of

current best evidence in making decisions about

the care of individual patients." (David Sackett)

有意识地、明确地、审慎地利用现有最好的研究证据制定关于个体病人的诊治方案。

Practice Guidelines

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Principles of Patient Care

Medical Decision-Making

Current Best

Evidence

Current Available Resources

Patient & Social

Concerns expertise/

facilities/

…

value/

expense/

…

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Types of Evidence-based Information

Cohort Studies

Case Control Studies

Case Series

Case Reports

Ideas, Editorials, Opinion

Full-Text Journal Articles

Randomised Controlled

Double Blind Studies

Systematic Reviews and

Meta-analyses

Source: Medical Research Library of Brooklyn

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• MEDLINE

• Cochrane Library

• EBM Reviews

• Clinical Evidence

• Guidelines Clearing House

Online Evidence Bank

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BMJ: 临床决策（诊疗系统）

----Search based on “Disease 疾病”

----Search based on “Symptoms 症状”

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Principles of Patient Care

Some special features Language communication

Internet

Ageing

Death, Dying or Incurable

Informed Consent

Medical errors or malpractice

Clinical economics Cost-Effectiveness analysis

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Know something beyond the clinical

medicine

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Some China’s Characteristics

Decision generally made by patient’s

relatives, not the patient him/herself

Heavy personal burden

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NHE Trend in China

0

1000

2000

3000

4000

5000

6000

7000

78 80 82 84 86 88 90 92 94 96 98 oo o2

Personal

Governm

Society

658.4 bln

100 mln

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National Health Expenditure in country

groups, 2000(%)

Health Expdt of

GDP

Personal Burden

Gov or society’s burden

CHINA 中国 5.13 59.0 41.0

developed 8.5 27.0 73.0

transitional 5.3 30.0 70.0

Most undeveloped 4.4 40.7 59.3

Other developing 5.6 42.8 57.2

World average 5.7 38.2 61.8

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中国卫生筹资结构变化 Structure of health financing

资料来源：卫生部卫生经济研究所, 2008

36.24

25.0622.8420.8419.7519.4317.9717.0416.3816.0415.8415.4715.9315.6916.9617.0417.9318.0720.35

42.57

39.2239.6739.3438.0936.62

35.6332.3230.7829.1128.3125.5524.126.5927.1629.3229.8732.62

34.49

21.19

35.7337.539.8142.1743.9546.450.6452.8454.8555.8558.9859.9757.7255.8753.6452.2149.3145.16

0

10

20

30

40

50

60

70

80

90

100

80 … 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07

个人

社会

政府

individual

Govern’t

Social

/employer

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Some China’s Characteristics

Regional difference

Accessibility

Health statue indicators

Quality

Reimbursement

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Number of beds and physicians

per 1000 inhabitants

Bed

Shanghai 5.7 vs. Guizhou 1.47

Rural Shanghai 3.55 vs. Rural Guizhou 0.44

Physicians

Beijing 4.13 vs. Guizhou 0.97

Rural Shanghai 3.24 vs. Rural Guizhou 0.64

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Main health status indicators

Life expectancy:

71.4 years in 2000 (male 69.6, female 73.3)

(78.14 in Shanghai, 64 in Guizhou)

Infant mortality rate:

19.0‰ in 2005

(Shanghai 4‰ vs poor rural 64‰)

Maternal mortality rate:

47.7 per 100,000 in 2005

(Shanghai 10.8 vs poor rural 95.4)

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Life expectancy at birth by Gross Domestic Product

(GDP) per capita of 30 Chinese Provinces in 2000

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Goal of Healthcare System Reform:

Healthy and Wealthy for the Whole Nation 目标：全民族健康素质，全民小康社会

Ideology :

Scientific Concept of Development

Human-oriented harmonious society with

sustainable development

Aims:

Efficiency, Effectiveness, Fairness, Accessibility

理念:科学发展观;全面，协调，可持续发展; 以人为本，和谐社会

目的：效率、效果、公平、可及

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Five reform programs from 2009 to 2011

Accelerate the establishment of the basic medical

security system.

Set up, preliminarily, the national essential

medicines system.

Improve the grass-roots (community) health care

services system.

Press gradually ahead with the equalization of

basic public health services.

Push forward pilot projects for public hospital

reform.

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Special Assignment

Review and Presentations

After the serial courses for “one system”

Pulmonary, cardiovascular and digestive diseases

By students

Select one certain session in “one system”

10-minute talk

8 students in one presentation course

Evaluation

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Comments?

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