Every day, there are heartbreaking reports of patients and their relatives abusing doctors and nurses in China.
According to the latest official statistics, 59.8 percent of doctors in China have been verbally threatened throughout their careers, while 13.1 percent have been physically assaulted. In contrast with other countries worldwide, the medical profession no longer seems to be as respected a position in China as it was two decades ago.
Due to excessive work and low wages, many doctors in China would leave and work overseas if they had the chance to do so. Meanwhile, the quality of medical students has been declining over past years.
The brain drain is creating a worrying situation for the medical system in China, a nation of 1.4 billion people. Moreover, medicine has developed more slowly compared with the economy and other aspects of the country, partly due to fear of failure in treating patients.
Despite frequent policy changes by the central government, it is universally accepted that hospitals in China are increasingly dangerous places to work.
Apparently, a large proportion of attacks on Chinese doctors are perpetrated by patients or their family members, who are dissatisfied with the care they have received.
According to media reports, the main reason behind these high rates of attack is the corruption of medical personnel.
In reality, the real reason is far beyond common sense, which is already irredeemable.
A very recent incident in the western Chinese city of Chongqing vividly exposed the deep-rooted reasons for riots at hospitals: The parents of a sick child ransacked the facility and attacked doctors for refusing to hospitalize the child after an assessment. The next day, the local medical bureau chief and hospital managers ordered staff to admit the patient and provide preferential care.
However, doctors and nurses did not obey that order as they normally do and instead took to the streets to demand improved safety for medical personnel and that relevant authorities apologize.
Police, who were nowhere to be found when the hospital was attacked, reacted quickly when the doctors and nurses were marching for justice and suppressed the rally in the name of social harmony.
The contradiction between the reactions of the doctors and medical authorities is a signal that some frontline medical personnel realize that they are the victims of the medical system’s failure and that officials should be the ones taking responsibility.
Who do medical bureau officials work for?
Today, many of these officials are neither doctors nor do they have any medical experience. Some of these professional bureaucrats work only for their superiors and not for health workers. When facing an incident, they are inclined to cover it up, which means “harmonizing” the situation, at the expense of doctors. There are hospital heads who would prefer to admit threatening patients and accept their no-fault compensation demands than stand up for their organization.
In China, the yi nao (醫勞) profession was created to illegally claim sky-high compensation, which is dependent more on how far a hospital can be forced than it is about how poorly a doctor performed.
Failure to address yi nao has fostered a poor administrative atmosphere. Doctors fall prey to violence and no help is available from the system when they are in danger.
No wonder they were so angry in Chongqing.
How much financial support is being offered to Chinese hospitals and patients, and where is it going?
Patients that have no medical insurance are the ones most likely to sue a doctor and ask for compensation.
The proportion of health expenditure to GDP in China has only risen from 4.7 percent to 5.6 percent over the past decade, significantly lower than Western societies.
Unfortunately, financial support in China is clustered in large cities and, even worse, a great deal of that money is wasted by the elite in society.
Today, even among people who have medical insurance, reimbursement is so limited that many families are impoverished after just one family member is diagnosed with a terminal disease. Hospitals then become targets for patients’ anger.
Corruption is widespread in China’s medical system, because government-regulated medical labor is extremely cheap and many doctors feel their long education and overwork are unfair, resulting in “red envelope” bribes that are common in many hospitals. As medical bureaus are unable to support hospitals, they acquiesce to doctors, supplementing their income through bought medical prescriptions.
Although corruption is definitely a bad thing and should not be tolerated, it is not the reason for violence against medical personnel, despite what Chinese authorities have said.
According to an analysis of attacks over recent years, most doctors that have been assaulted were clearly innocent.
In one case, a student intern at a hospital in the northwestern Chinese city of Harbin was killed simply because he was wearing a white lab coat.
Medical news is popular in China, as political news seems to be less attractive than in Western societies. Medical news, especially negative reports, can be sensational and tap into the public’s psyche, leading to the media acting in a very dishonorable fashion.
One journalist sent tea for a urine test, reporting that doctors were irresponsible, because the automated analysis machine detected white blood cells. Biased reporting damages social trust and lowers the moral baseline. Unfortunately, many regulators prefer to remain silent on these issues, because they dare not risk the ire of the media.
China’s relatively low quality of medical care is mainly due to overworked personnel. A survey this year found that 52.72 percent of doctors in China work between 40 and 60 hours per week, while 32.69 percent work more than 60 hours per week. Overtime has become a regular thing for them.
There is a vicious cycle in China, where on the one hand, recent medical school graduates are refused employment in the system, while on the other hand the number of doctors in China is insufficient due to limited financial support. Hospital administrators would rather work doctors harder than increase staff and have everyone get a smaller share of the pie.
How much does healthcare cost in China?
Medical fees in China are between one-10th and one-100th of those in the US. The idea behind this twisted low-cost strategy is mainly that it is supposed to reduce the financial burden for patients.
Unfortunately, this policy not only fails to satisfy patients’ needs, because some still cannot afford treatment, but it also frustrates doctors, who are paid less than barbers down the street.
In a system where irritable patients never show gratitude, innocent doctors accept violence in silence and irresponsible media prefer to see the world in chaos, it would be almost impossible to address the deteriorating relationship between doctors and patients without a thorough revolution. Investment is important, but more important is how to implement investments efficiently and fairly.
Depriving frontline doctors in China the right to speak up is shameful and should be stopped immediately. To maintain so-called “harmony” or care for people — that is a question for the officials in charge of China’s medical system.
Jiang Xie is a doctor at the Mayo Clinic in Rochester, Minnesota.
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