Beijing's  Xuanwu Hospital
Beijing's Xuanwu Hospital
Yan Yong

SHANGHAI — Recently, two Shanghai hospitals have held special training courses for their doctors. One invited a Taekwondo coach to teach the physicians self-defense skills, while the other featured a local police expert in crisis negotiation to brief them about violence prevention.

The Chinese public of course understands what this is all about. Just two weeks ago, a patient in the coastal city of Wenling killed a doctor and wounded two others. In the last few years, similar incidents have occurred far too frequently across China, prompting the National Health and Family Planning Commission and the Ministry of Public Security to order every hospital to dispatch full-time security agents, at the rate of one agent for every 20 hospital beds.

But whether it’s about self-defense or about putting in place security staff, this is a stopgap policy in the face of the increasingly acute doctor-patient conflict. When patients turn their feelings of powerlessness into violence, doctors are paying with their lives and the whole of society suffers in China’s very different manifestation of the country's healthcare crisis.

What this dramatic clash reflects is the contradiction between the demand for healthcare services and the inefficiency of medical resources, and shortness of supply of quality care.

According to the 2012 China Health Statistical Yearbook data, outpatient visits in 2011 increased 53.1% compared with 2005, while the number of hospitalizations increased 112.9%. Meanwhile the number of practicing physicians grew by only 24.9%.

What this means is that doctors are exhausted. A doctor in a major public hospital ends up seeing up to 60 patients in half a day. But the patients are not any better off, having to queue up a whole morning in a clogged space just to be given a consultation of less than five minutes.

Bedside skills

In 1997, China introduced a major medical care reform. Unfortunately, not only were the boundaries not made clear between the government and the market, it actually triggered the public hospitals’ impulse to pursue profits. Doctors bear directly the task of generating income and benefit from the hospitals’ economic success, while the patients’ medical expenses soar.

While the anger toward the system deepens, the conflict is shouldered by the doctors. In addition, Chinese medical schools today almost entirely lack any humanistic education and doctors often are unwilling or unable to communicate with patients.

It is urgent that China reform its medical system, and find ways to expand the supply of proper medical resources if the doctor-patient conflict is to be resolved. The reforms should include the liberalization of the medical market, promotion of multi-access medical care so that healthcare resources can be shared evenly. The public hospitals should not have the monopoly of the doctors’ resources and physicians should be allowed to practice freely so as to promote an environment of orderly competition and fix the long distorted healthcare pricing system.

But the medical reform not only must address the question of financial security but also the quality of the health care services. The former is about who pays — how the government, the commercial insurance and the patient are to share out the cost. The latter is about the medical treatment, i.e. the doctors. Obviously, this implies attracting and mobilizing more resources for healthcare facilities and personnel.

Doctors in China are unhappy. The Physicians’ Association conducted four surveys regarding practitioners in 2002, 2004, 2009 and 2011. The last survey showed that 48.51% respondents are not satisfied with their working environment, and the higher their rank, the deeper the dissatisfaction. Only 6.8% of interviewed doctors said they would want their children to become doctors.

The survey also showed that 55.7% of doctors believe that “the public have prejudice against doctors.” After the Wenling incident, Chinese doctors voiced their concern collectively for the first time. This has in turn aroused public concern and empathy. To rebuild China’s doctor-patient trust, the medical system needs major changes.

Doctors and patients are not natural enemies, and indeed share the same foe: illness. But only if there’s trust between the two can our healthcare system lower its financial and human costs.

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