Tensions rise between doctors and patients in China

Editor’s Note:

In China, it is sometimes the doctors who call for medical help.

In Beijing last month, an angry patient left a female doctor with 17 stab wounds.

Wang Baoming, a cancer patient, allegedly attacked Dr. Xu Wen with a kitchen knife, wounding her arms, left leg and back. Fortunately, she survived after nine hours in surgery.

Wang is now under arrest. He reportedly attacked the 43-year-old surgeon because he deemed her attempt to remove his laryngeal tumor in 2006 a failure that made his condition worse.

The suspected assailant had complained about it in his blog.

“It was supposed to be a minor operation which can cure my illness once and for all,” he wrote as early as April 2009. “Because of the destructive surgery by Mrs. Xu, within three months the scattered cancer cells spread.”

He was left a disabled man, he wrote, and wanted to take revenge on Xu.

This is not an isolated case, the Chinese media and medical industry sources say.

Caixin, a muck-raking Chinese weekly, said at least eight similar cases have occurred this year.

In August, a patient in Guangdong province, reportedly hacked to death Dr. Liu Zhonglin and injured another doctor who tried to stop the attack. The patient claimed the doctor failed to cure him of facial spasms, state-run Xinhua said.

“This has been going on for a long time,” said an American consultant familiar with China’s medical sector, who requested anonymity.

“Doctors are frequently attacked and the professional morale is very low.”

Chinese doctors are asking for understanding and help. On September 16, the Chinese Medical Doctors Association issued a statement urging the Chinese public to show more respect to doctors.

“The government should attach importance to the rising tensions between doctors and patients, and think about what caused the current situation,” said Deng Liqiang, head of the association’s legal department.

In August, the association released the results of a nationwide survey. Of the 3,704 doctors who responded, 91.9% said their job involves many sacrifices for low pay, the China Daily reported.

Why have doctors become victims of violence?

Some 55.6% of respondents said the society is simply prejudiced against the medical profession, 23.5% of doctors did not properly communicate with their patients and 20.6% said treatment cannot meet patients’ high expectations.

In the early 1980s, as part of Deng Xiaoping’s reform and open-door program, China extended its market reforms to health care. Hospitals were stripped of government subsidies and forced to become financially self-supporting. The assumption was the market would move in and take care of the problems.

Since then, however, China’s health care system has fallen behind the country’s rapid socio-economic growth. Observers say hospitals are now typically underfunded and doctors are under-paid.

“Hospitals here are often understaffed and have to cater to large number of patients,” noted an Asian physician who works in a Beijing hospital.

“I visited a friend one night in the Beijing Children’s Hospital to help interpret for her. The lines were long and there were two doctors on duty at the ER. Since the lines were long, the quality of care leaves much to be desired. The doctors hardly have time to do a thorough check up,” the physician said.

Deregulation of the health care sector has led to accusations of profiteering by hospitals, doctors, drug companies.

In some cases, according to various reports by Chinese media, hospitals have reportedly demanded that patients pay much of their likely bill before treatment. In others, some doctors were said to demand red envelopes - containing cash - before treating patients.

Chinese blogger “Songst557” observed: “We’ve heard it so many times that if a patient does not bribe his doctor, there is high probability that his surgery would not be successful. It’s also a common knowledge that even patients who had given bribes still worry if they gave enough bribes. With such severe anxiety added to their painful illness, even the normally failed surgery would be deemed abnormal.”

Doctors and would-be doctors complain that the burden of proof is one-sidedly put on their side.

“Only China adopts a ‘reverse onus’ principle in dealing with doctor-patient disputes, which assumes that doctors are guilty and are asked for evidence to prove their innocence,” said Chen Xue, a resident at the Peking Medical University Hospital. “This is quite ironic.”

“Of course, overburdened case-loads and relatively low official pay may actually contribute to practitioners unmotivated to show compassion, but there is also a sense of entitlement on the part of patients,” added the American consultant.

China is now considering administrative and legal mechanisms to deal with doctor-patient disputes.

Meanwhile, observers say the situation is demoralizing doctors and doctors-in-training, prompting a kind of brain drain.

“That is partially why some talent are going abroad and some are defecting to become pharmaceutical and device sales people,” said the consultant. “With relatively low salaries and little respect it seems less young people are interested in studying medicine.”

Chen Xue, who is in his final year at Peking University’s medical school, says he will stick to his medical career. “To guarantee our safety,” he said, “we now need to observe carefully to avoid patients who are hard to deal with and if we encounter any disputes, we need to be alert about our own safety.”

Chen says he loves his career and enjoys helping patients.

“That’s why we are willing to take the risk under the current circumstances,” said the 26-year-old Chen.