Editor's note: The following article, which was edited and translated from several articles that appear on jkb.com.cn, caixin.com and Global Times, covers the tragic doctor-patient dispute that occurred last month in Harbin, and discusses the popular sentiment against doctors and medical treatment in China. The article addresses the various causes of these increasingly common violent doctor-patient disputes, and reports on a potential healthcare reform that may help prevent them in the future.

On March 23, a 17-year-old patient named Li Mengnan was diagnosed with tuberculosis and spinal problems at First Affiliated Hospital of Harbin Medical University in China's Heilongjiang Province. After being diagnosed, Li left the hospital feeling that his doctor had deliberately refused to treat his illness. Later that day, furious with the way he was treated, Li returned to the hospital, this time with a knife in hand, where he proceeded to barge into an office and attack several medical practitioners before trying to end his own life. A critically wounded medical intern named Wang Hao later died and three other hospital staff suffered injuries.

Even more unsettling, after this incident was reported by popular microblogging website Tencent (QQ), over 65 percent of the readers (4,018) said that they were "happy" about the attack, while 879 readers were "angry"; meanwhile another 410 readers were "sad" and 258 readers were "sympathetic". Similar discussions related to problems with medical treatment services appeared on several other blogs as well. While for many Chinese there is no sympathy lost for these doctors, who are demonised for victimising these vengeful patients and their families, it is easy to overlook that in a way the doctors too are victims of the current medical system, which is seriously flawed and in need of reform.

How common are these incidents?

In recent years, disputes between doctors and patients in China have been increasingly common, resulting in frequent bouts of "verbal violence", physical altercates and even severe injuries and death in the most extreme cases. Last September, after learning that the throat cancer he had been treated for had returned, Wang Baoming, a 54-year-old cancer patient at Beijing Tongren Hospital stabbed his physician, Xu Wen, to death with a knife. In January 2011, the family members of a patient who died after being refused a pill prescription– because he could not afford his medical bills – stabbed 10 doctors at Xinhua Hospital in Shanghai.

On March 24th, a compendium of recent cases of doctor-patient conflicts that occurred in Mainland China was posted on academic website "Lilac Garden" (丁香园). The 125 cases included in the post were compiled from various news media reports from 2000-2009. According to the report's incomplete statistics, in 2011, there were 11 doctor-patient conflict cases that resulted in death, and in 2012, there have already been three such cases thus far. And these reports are just the tip of the iceberg. According to a Xinhua report, in 2006 there were 9,831 violent incidents that occurred in hospitals, resulting in 5,519 injured medical staff and property damage exceeding two hundred million Yuan. According to China Daily, in 2010 there were over 17,000 violent incidents that occurred in hospitals. No wonder that in February, the Dongguan Municipal Government Office passed a bill to equip local hospitals with police batons, tear gas and stab-proof vests for emergency situations.

What are the causes of these violent doctor-patient disputes?

According to Jiang Lifang, a Professor at the Sun Yat-sen University School of Medicine, it is mainly due to lack of patient trust in the quality of the medical treatment. Another doctor told reporters that people don't really understand what is happening at hospitals these days. They have excessively high expectations of medical technology and whenever something goes wrong they immediately assume that it's due to medical malpractice.

As far as many patients are concerned, the doctor's negative attitude, blunt language, coupled with "hidden rules" (潜规则) – such as the doctor's expectation of receiving a "red envelope" for their services and pushing expensive drugs on patients– have all caused patients to have an inherent distrust of doctors and medical treatments. In addition, some healthcare services are indeed flawed, the proficiency for some medical treatments are quite low and some operations are not standardised, which also often lead to severe consequences. Finally, there are also problems with doctor-patient communications, as well as doctors who don't respect the patient's right to know the facts of their case or their right to choose, all of which are important causes for these increasingly common doctor-patient conflicts.

There are other institutional factors in play as well. In China, doctors commonly work long hours for relatively low pay– supplemented by "red envelopes"– and their salaries are cut when they don't meet the quota of selling profitable prescriptions to patients. Moreover, due to the overloaded nature of the Chinese medical system– which must deal with the world's largest aging population –an average doctor will see more than 100 patients during a single five hour shift, which no doubt influences their perceivably "unfriendly" attitude and the long wait times endured by suffering patients. In addition, although medical treatments are quite inexpensive compared to other countries, they are still exceedingly expensive for much of China's population, and often times a large portion of a patient's charges are not covered by the national healthcare system.

Resolving the flaws of the healthcare system

This most recent tragedy at the First Affiliated Hospital of Harbin Medical University can only reaffirm that China's healthcare system is in dire need of reform. According to media reports last month, the State Council recently issued a new document on healthcare reform detailing a clear-cut roadmap for the remainder of the 12th Five-Year Plan (2011-2015). The document, which mandates that the government will help pay for hospital equipment and medical research expenses, is a strong first step toward relieving some of the financial burden placed on hospitals to handle their own financial expenses. Assuming that the government financial support is used as intended, it will allow hospitals to stop viewing their patients merely as customers and start refocusing on patient welfare and the quality of service. Once that happens, expect the number of violent doctor-patient disputes to decrease.

Source: jkb.com.cn; globaltimes.cn; caixin
 

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Keywords: China medical malpractice China violent doctor-patient cases China healthcare system reform what’s wrong with China’s healthcare