A doctor's calling turns dangerous as violence stalks hospitals
Thanks to the constant threat of physical attacks or lawsuits from patients or patients' relatives, being a doctor on the mainland is a dangerous job. Those dangers came to the fore in January when, according to Shanghai's municipal health bureau, 10 doctors at the Xinhua Hospital in Yangpu district were injured by 20 relatives of a patient who died after heart surgery.
The relatives forced their way into the cardiothoracic surgery department and assaulted its deputy director. They stabbed him in the chest, missing his heart by less than 2cm, the bureau said. When other doctors tried to stop the attack, nine were injured, five seriously.
Angry relatives of Liu Yonghua, who had died at the hospital three days earlier after being transferred there following heart surgery in Anhui province, accused the hospital of stopping treatment - something it denied doing - because they had defaulted on payment of 26,000 yuan (HK$30,800). Family members said they had sold their houses to pay Liu's medical bills.
The Lancet medical journal published an editorial in August saying that many Chinese doctors were greatly concerned about their personal safety because they were often victims of terrible violence.
'Being a doctor has become a dangerous job in China,' it said.
That comment prompted a flood of responses on dxy.cn, the most popular medical website among mainland doctors. In a survey it conducted, 94 per cent of the 14,577 doctors polled said they witnessed at least one hospital dispute a month, with a third saying they encountered more than three a month, Southern Metropolis News reported.
In another report, by the Chinese Medical Doctor Association several years ago, 74 per cent of doctors said their rights were not protected, nearly half regarded the working environment as adverse and 13 per cent described it as 'extremely bad'.
Chen Shaoxian , a professor in public health at Guangzhou's Sun Yat-sen University, says the government's funding of public hospitals is far from sufficient, leading hospitals and doctors to impose surcharges on examinations and drugs, and sometimes to prescribe excessive medication. 'If they didn't pursue profit, they wouldn't be able to make a living,' Chen says.
On average, mainlanders have to pay nearly half of their health care bills, with the rest covered by the government and the burgeoning insurance sector. And medicine costs have soared because of astronomical mark-ups.
Chen says patients, with the little medical knowledge they have, tend to hold high expectations of hospitals because they charge so much and blame doctors if treatment fails.
'This is a misunderstanding,' he says. 'Patients should be aware that even nowadays, humans know only very little about diseases and our bodies. There are also plenty of uncertainties in medicine.'
A regulation on civil lawsuits issued by the Supreme People's Court in 2002 has caused a 'blowout' of medical disputes, says Zhang Zanning , a public health researcher at the Beijing-based China Transition Institute. The regulation orders doctors facing a patient's lawsuit to produce evidence no malpractice has been involved. Zhang says such a reversal of the onus of proof is unscientific and many medical experts have called for its cancellation.
But patients say they need the regulation because they generally lack medical knowledge and are often unable to afford lawyers.
Chen says a recent survey he conducted found that patients and doctors did not trust each other.
Meanwhile, a tongue-in-cheek internet posting lists 31 principles of self-protection that doctors should follow. Among them are keeping diagnoses for outpatients vague and prescribing as many check-ups as possible, with any refusal recorded and signed by the patient. It also says doctors should not explain the disease explicitly, but only tell the patient the name of the disease and that it is serious.
The No 1 rule, it says, is to always remember your patient could be hauling you to court tomorrow, and that when facing a mob attack, the golden principle is to run away.
Apart from violent attacks, dissatisfied patients and their families often resort to harassment, arranging for dozens of people, mostly hooligans dubbed 'professional hospitals' troublemakers', to rally at hospitals, unfolding placards and shouting their grievances.
'The rationale of patients and their families is to threaten the hospital to seek more compensation, because the legal way - to achieve a compromise with the involvement of the health authorities and arbitration - is time-consuming and ends up paying less,' Chen says.
He says his survey finds more than two-thirds of doctors and nurses do not want their children to follow in their professional footsteps. And that pervasive pessimism means fewer students are applying for medical schools.
At a China Europe Business School forum on China's medical reform last year, one academic warned: 'If the social status and working environment of doctors are not changed, in one to two decades, Chinese people, well heeled by then, will have difficulty finding qualified doctors to look after their diseases.'
