Toward doctor-patient rapport

Accelerating the healthcare reform to ease tensions between doctors and patients deserves more attention of the annual sessions of the National People's Congress and the Chinese People's Political Consultative Conference.

Even on the opening day of the NPC, a Guangzhou doctor was pilloried on the street by more than 100 relatives of a patient who died at the hospital the same day. Despite the reason of patient death was unknown yet, such humiliation was unacceptable for most people. Before the Guangzhou case, another two recent incidents exemplify the strain that has developed between doctors and patients or patient parties. The first was the murder of a doctor by a patient in Heilongjiang province. And the second was the physical assault on medical workers of a Nanjing hospital by the parents of a girl because the hospital management had allotted a bed to a male patient in the female ward she occupied.

Violence in hospitals has escalated rapidly in recent years. According to the Chinese Society for Hospital Management, on average a hospital deals with 27 cases of violence (including murder) every year, and the targets are mainly doctors. And there is evidence to suggest that people in general no longer view the medical profession with respect. Once widely respected, doctors are now suspected of violating medical ethics. What are the reasons behind this irony? What can be done to rebuild the harmonious relationship between doctors and patients?

After the foundation of the People's Republic of China, its healthcare system was structured to resemble the Soviet system. All hospitals were virtually public. Governments funded the hospitals and their operational costs were taken care of by heavy subsidies. Patients' fees were nominal to ensure everyone got proper medical treatment. Health workers in hospitals were State employees, receiving fixed salaries. Revered as the "angels in white", doctors and nurses were respected by one and all.

The reform and opening-up, however, dismantled this "mini welfare state". Because of the decline in its revenues, the government, starting from 1980, had to substantially limit its funding to the healthcare sector, which had accounted for 50-60 percent of hospitals' income in the planned economy. Unable to finance public hospitals, the government allowed them to generate income from patients to ensure their financial survival. That created strong incentives for hospitals to shift from providing cost-effective healthcare to the over-utilization of high-tech diagnostic tests and expensive medicines.

Motivated to generate as much profit as possible, most hospitals have now tied physicians' incomes to the revenue they generate, adding a further perverse incentive for making profit while ignoring patient care. The abuse of profitable medical tests and the over-prescribing of drugs, especially antibiotics, have become common in hospitals. Receiving half their income from selling drugs, hospitals are run as profit-making entities. As a result, medical ethics have largely evaporated and mistrust toward the medical profession has become widespread, which has been exacerbated by the disclosure of medical accidents and scandals in the past years.

A survey conducted by China Youth Daily shows that nearly 70 percent of patients are suspicious of doctors' diagnoses and treatments. Another recent nationwide survey shows that merely 26 percent of physicians feel their patients trust them, and 70.9 percent would choose another occupation given the opportunity. More surprisingly, 76.7 of the doctors do not want their children to attend medical school.