Doctor-patient relationship in China
In China, doctors and nurses have increasingly become the targets of attack by vengeful and disgruntled patients.
On October 25, 2013, a patient in Wenling, Zhejiang province, walked into the local People’s Hospital with a knife and stabbed three doctors. One died and two were wounded.
In 2012, a patient killed a 28-year-old intern and wounded three others at the Harbin Medical College with a fruit knife, and in the same year, a tuberculosis patient killed a 33-year-old female doctor by stabbing her 28 times in the city of Hengyang. In 2011, a 38-year-old patient killed a 67-year-old doctor by stabbing him 46 times. In 2001, a farmer from Sichuan was dissatisfied with his treatment so he bombed the hospital, killing 5 and wounding 35 people.
According to Xinhua news reports, patient-doctor conflicts caused the deaths of 7 doctors in 2012. In 2008, patient-doctor conflicts totaled an annual average of 20.6 incidents per hospital. In 2012, the average was 27.3 incidents per hospital per year.
Chinese sociologists and psychologists have been analyzing the causes of such violence against doctors. They suggest that the patients cannot tolerate their suffering anymore so they resort to violence against doctors. This misdirected anger of the patients can be triggered by the bad attitude of the doctors towards the patients, long waits for front desk registration to see a doctor, being told to return later, and the patient’s personal troubles at home, etc.
The patient’s retaliatory attacks are not specifically directed at his own doctor. The rampaging patient usually attacks randomly, even stabbing nurses in hallways.
The deputy director of the Guangdong Department of Health Liao Xinpo cited statistics showing that in mainland China, the percentage of misdiagnosis is 27.89%. The data was compiled by Ji Xiaolong, head of the department of biomedicine in oncology at the General People’s Police Hospital. He gathered 548,400 reports from 200 medical journals and found 152,934 cases of misdiagnosis. The annual percentage of misdiagnosis fluctuates between 24.5% and 32.8%.
Psychologically, the patients believe that their misfortune and suffering are the doctors’ fault. Their logic is: My misfortune is because of my illness. My illness is because the doctor has problems treating me. The doctor is at fault.
In mainland China, access to medical services is difficult for many people, and medical care is too expensive for most people. The bureaucratic attitude and behavior of hospital staff are also recognized as factors in causing patient frustration and anger.
Recently, a Shanghai hospital offered martial arts classes for doctors and medical staff. One critical comment about the program was that even if all the doctors learn to become “Bruce Lee”, they will not solve the problem of patients killing doctors.
The only solution that the sociologists and psychologists could come up with is an education program for patients to make them realize that doctors are not perfect and not omnipotent, and that doctors should not be blamed for their ills.
On November 1, 2013, the Changsha Evening News reported that a survey of the doctor-patient relations among 30 hospitals in eastern China showed that only 10% of patients trust their doctors.
Another November-December internet survey of doctors showed that 78% of them do not want their children to enter the medical profession.
Eighty percent of the nation’s “medical resources” are concentrated in medium and large cities, and of this, 30% are concentrated in the hands of large hospitals.
Among all cases of confrontation between doctors and patients, over 70% are due to misunderstanding between them while 20% are due to technical mishaps.
A 2007 survey of 12 hospitals in the Changsha area showed that in doctor/patient conflicts, 49.07% were the fault of the doctor/hospital, and 50.93% were the fault of the patients.
Causes of such conflicts include cases in which patients had to wait two to three hours for a visit with a doctor for 3 to 5 minutes, misdiagnosis, mistreatment, malpractice, exorbitant medical fees, and bad attitude of medical personnel.
In 1980, the State Council abolished the medical clinic system, and medical clinics of rural farm village cooperatives were dissolved. The State Council also allowed individual doctors to open up and operate private clinics. However, hospitals were still run by government entities.
In 1989, the State Council allowed the various levels of government hospitals to operate independently and to bear their own costs. These hospitals began to operate by maximizing their profits, and in 1992, hospitals began raising prices on medicines administered and dispensed by the hospital pharmacies.
There is one case in which the doctor demanded the patient buy the medical utensil for the patient’s own operation.
Also beginning in 1992, hospitals began their expansion, new construction and securing large construction and expansion loans. The government now provides a subsidy of 10% the hospital’s total revenue, and small and medium sized hospitals have found it difficult to continue to operate.
In 1993, vice minister of health Yin Dagui came out opposing the “marketization” of medical service and the “profit making” of hospitals.
Since then, the people have been complaining about the difficulty to see a doctor, the high cost of medical care, the high prices of medications, and the lack of medical services in rural areas.