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Violent Doctor-Patient Cases: What’s Wrong with China’s Healthcare System? [Copy link] 中文

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Post time 2012-4-12 13:33:03 |Display all floors
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Editor's note: The following article, which was edited and translated from several articles that appear on, 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.

A female doctor at a well-known hospital in Beijing was stabbed by an unidentified knife-wielding man Friday, the second such incident in the country in a month.This latest case happened at about 10:25 a.m. at the Peking University People's Hospital, when doctor Xing Zhimin with the Otolaryngological Department who was receiving a patient was attacked unexpectedly by a masked man, a spokesman with the hospital said.

Xing was wounded and she was being treated at the hospital, the spokesman said.The assailant had fled. Police are looking into the incident, he added. No further details were provided. This is the second such attack on doctors in China in less than a month.

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.

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Post time 2012-4-14 10:03:24 |Display all floors
It seems these encounters are on the increase in other countries as well.
Life is becoming more stressful all over the world.

Understanding patient violence against health care workers
by Kevin Pho, MD

The following op-ed was published on February 2, 2011 in USA Today.

Last fall, a surgeon at Johns Hopkins Hospital was shot by the distraught son of a patient for whom he was caring.
The man later killed his mother, then himself. A week earlier, a patient in a Long Island, N.Y., hospital beat his
nurse with a leg from a broken chair, causing serious injuries. The following month, a psychiatric technician at
a Napa, Calif., state hospital was fatally attacked on the job.

This snapshot of violence against health care workers reflects a disturbing trend. According to a Bureau of Labor
Statistics analysis published last year, almost 60% of assaults in the workplace occurred in a health care setting.
Nearly three-quarters of these assaults were by patients or residents of a health facility.

No longer havens

Health care settings have been traditionally thought of as “safe havens,” open to anyone as a place to be protected
and cared for. This is a trend worth watching. The Joint Commission, a national accrediting agency, soberly noted
last year that “health care institutions today are confronting steadily increasing rates of crime, including violent
crimes such as assault, rape and homicide.”Violence is most common in psychiatric facilities and emergency
departments, but can also be seen in waiting rooms, long-term care centers and critical care units. Nurses are the
most frequent targets. According to a 2010 survey from the Emergency Nurses Association, more than half of ER nurses
were victims of physical violence and verbal abuse, including being spit on, shoved, or kicked; one in four reported
being assaulted more than 20 times over the past three years. The survey noted that the violence seemed to be
increasing at the same time the number of alcohol-, drug- and psychiatric-related patients was rising.

Clearly, we must do better protecting those charged with healing the sick. Most hospitals have focused attention on
controlling access with security personnel. They’ve also trained staff how to recognize agitated patients,
de-escalate threatening situations and to routinely report such incidents. Some facilities and states have taken
stronger steps. Detroit’s Henry Ford Hospital has installed metal detectors, and Massachusetts recently strengthened
criminal penalties for assaults on health care providers.

Doctor-patient strains

But I wonder whether the rising tide of violence against doctors and nurses is more emblematic of a dysfunctional
health system. Patients are learning that health care is a commodity. I see firsthand the deterioration of the
doctor-patient relationship, as physicians are pressured to see more patients in shorter amounts of time. Patients
are rightly frustrated, and some are lashing out.

Rita Anderson, a former emergency room nurse, successfully spearheaded New York’s 1996 campaign that made it a
felony to assault a nurse. She told CNN, “People are just tired of waiting, or they are just angry that they’re
not getting the care they feel is acceptable. Instead of saying something, their response is hitting, screaming,
spitting, yelling.”

Sometimes the simplest approaches are the most effective. Rather than adding security or installing metal detectors
to prevent hospital violence, doctors and nurses could do a better job of empathizing with patients who are under
stress when they are hospitalized or are angry because they’ve waited hours for medical care. At the same time,
patients must realize that health care professionals are doing the best they can with an overtaxed health care
system and should never resort to violence or abuse.

That shared understanding and cooperation is essential if we hope to restore our health care institutions to the
safe havens they were meant to be.
If capitalism promotes innovation and creativity then why aren't scientists and artists the richest people in a capitalist nation?

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Post time 2012-4-14 10:08:43 |Display all floors
In total , It is a problem of system .And ,the related system contruction is relevant with the development of economy .It is difficult to put an end to this accident ,but we should try our best to reduce the probability of occourence .After all. every life is precious .

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Post time 2012-4-14 13:52:21 |Display all floors
There will always be people who are dissatisfied with the service(s) provided by any medical system, but when the system encourages corrupt behaviours, such as highlighted in the OP, i.e: that a doctor's salary would be reduced if they fail to prescribe a given quota of some expensive drug, and the EXPECTATION of a nice fat envelope, then the problem will continue to get worse.

The expectations that many have of the medical service is often un-realistic, coupled with an ingrained distrust of the practicioners, and your own (or a loved one's) life in the balance, then the resorting to violence is not to be unexpected.

It is not acceptable, nor warranted that persons doing a job should be exposed to such violent behaviours, so the perpetrators should be punished to the full extent of the law.
At the same time, any medical staff taking bribes or acting in a corrupt manner should be punished equally, as they are placing the lives of their patients at risk of death or injury through mal-practice, their colleagues at risk of (misplaced) violent retribution and lastly, BRINGING THE SYSTEM INTO DISREPUTE, when TRUST and COMPASSION are the underpinning principles of medical practice.

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Post time 2012-4-14 18:11:51 |Display all floors
This post was edited by loveyouall at 2012-4-14 18:13

A main reason for such tragic incidents iis behaviour of the doctors.  Many of my friends, have told me about this.  When the patient goes to a hospital for illness, he will usually go to to diagonostics,  after that he wants to know the cause and reason as to why it happened.  But unfortunately many doctors behave very rude if any questions are asked.  Answers like "it happened, why you want to know the reason?"  "Am i the doctor or you are the doctor,  if want to know more , go and study to become a doctor"  Firstly the patients have to wait for a long time and then the feeling of being brushed off makes them feel neglected.

Also many doctors want the patients to do unnecessary tests to let the hospitals make money.  A doctor's profession is a Noble Profession.  People give their lives in the hands of the Doctors.  Doctors also must be courteous towards the patients.   
At the same time, some doctors behave like this because of work overload and handling of so many patients.  Therefore such rude behaviour and irritation although not desirable is displayed.

if you can be happy with what you have, dont wait for more

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Post time 2012-4-14 23:12:24 |Display all floors
Chinese medical system is fostered in the planned economy area, which beagn its reform from 1990s. When our whole society has made a great achievements in many areas, our medical systems nearly keep its origional operation model. Some detailed reasons are as following:
-we have the largest population in the world, and with the economic development, the medical service demand show a situation of diversification. At the same time, our current hospital can not satisfy the demand, so everyone only has  the choice to treat a few of state-owned hospitals.
-Although doctors have the higest qulification of educted degree, and need to keep studying all their vocation career, their salary can not match and value their qulification. Therefore, hidden rules occured in the hospital to make up for the income gap of doctors.
-The sales and marketing model in the pharmaceutical industry in China still largely based on the kickbacks of sales to doctors, not the academic introduction.
-Our pharmaceutical companies are lack of not only the catital, but also the innovation spirit. So the domestic companies are always confronted with the low-end competition of cut-price.
-Our patiets prefer to seeing the doctor at the big hospitals, which are congested with lots of patiets, no matter a severe disease or just a common disease. The basic-level medical institutions have not play its proper role in the medical system, for its poor medical equitment, low medical skills and our stereostyped image of basic level hospitals.

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