“I came to understand how a different health system manages the cancers I want to spend my career treating. I’m leaving with a longer list of questions than I arrived with and a newfound openness to different solutions.”
By: Yash Deshmukh, MED ‘26
Arriving in Chongqing just before New Year's Eve, I was immediately struck by its scale. The city is a sprawling megalopolis of 30 million people perched on limestone cliffs at the confluence of the Yangtze and Jialing rivers. Morning report would draw nearly 30 residents, students, nurses, and family members into a single room, with family members chiming in on clinical updates and helping transport patients to imaging when needed. I spent my first two weeks on the hepatobiliary surgery service, and my final two weeks on the inpatient oncology service.
Rethinking the OR
The surgical cases on Hepato-Pancreato-Biliary were immediately humbling. In the US, I'd come to associate liver surgery with large incisions, significant blood loss, and lengthy recoveries. At CQMU, complex hepatectomies were routinely performed laparoscopically, with patients recovering alongside cholecystectomy patients and ambulating far earlier than I'd expected. This was largely because many of the liver cancer patients here are younger, a result of the high chronic hepatitis B burden due to iatrogenic spread from the 1970s to the late 1990s via infected syringes. I also scrubbed in on a cholangiocarcinoma resection and several liver transplants, all of which are massive, incredibly complex surgeries with many logistical challenges. The integration of technology into the OR felt intentional rather than a blanket solution. Laparoscopic technology enabled faster recoveries and less invasive approaches. However, gowns, drapes, and tools were mostly reused rather than disposed of.
The Ethics of Access
The workload the surgeons managed was bewildering, with some attendings managing a busy inpatient service in the morning and then seeing more than 40 patients in a half-day clinic. This volume meant prioritizing efficiency, with patient autonomy and medical decision-making often coming later. However, patients were more appreciative of the quick and timely access to care over the seemingly curt provision of it. My preexisting notion of ethical care was challenged—was it more ethical to see more patients in a day, even if you could only spend five minutes discussing their care?
Switching to the oncology service in weeks three and four introduced a whole new set of things I didn't know I didn't know. Oncologists at CQMU complete training in both medical and radiation modalities, which is split in the US. Watching a single attending manage a patient's systemic therapy and their radiation planning with equal fluency made me appreciate how patients were not forced to contend with care silos and miscommunication. Lung cancer dominated the service, particularly the volume of small-cell cases with extensive metastatic disease. Several patients had spread to the brain, spine, and adrenal glands by the time we met them, evidence of the public health challenge that widespread tobacco use continues to pose in China. The tumor board was one of the more memorable experiences of the rotation. The deliberation over a patient with a large retroperitoneal sarcoma drew in surgeons, oncologists, and nurses, and what struck me was how much of the discussion centered on who the patient was rather than just what the cancer was, including his family support, his personality, and his frailty. It was a reminder that, though the focus may be on efficiency, the patient's humanity remained central to their care.
Personal Insights
Two things have stayed with me in ways I'm still working through. The first is the practice of disclosing new cancer diagnoses to family members before, or sometimes without, telling the patient directly. I understand the relational and protective logic behind it, yet I also can't fully reconcile it with how I've learned to prioritize patient autonomy. The second is the way technology is harnessed across society to support and prioritize people's lives—from the integrated electronic medical record (EMR) that allowed physicians to access imaging, labs, and notes from any provider, to lab results that are available within hours instead of days, to the ubiquitous and efficient metro system. It made me appreciate how technology should be directed to helping people rather than an end in itself—something especially relevant as AI use continues to proliferate.
The hardest moment of the rotation was watching a patient transition to comfort care after his family ran out of funds for his hospitalization. I've read about financial toxicity and seen it shape outcomes at home, but seeing it function as a direct and proximate cause of death was something else entirely. The Chinese public payer system does things the American system doesn't, subsidizing expensive medications and maintaining an EMR infrastructure that actually shares data across hospital systems in real time. And yet none of that was enough for this patient. I don't have a clean way to end that observation.
I left Chongqing uncertain how to categorize what I'd learned. Some of it was clinical, some of it was systemic, but most of what I'm still sitting with is trickier to name. The way a 40-patient clinic somehow felt personalized, the late-night team dinners after grueling cases, and the way cities embraced modernity while preserving traditional knowledge and legacies. I came to understand how a different health system manages the cancers I want to spend my career treating. I'm leaving with a longer list of questions than I arrived with and a newfound openness to different solutions.