Hard work, low pay, little appreciation
Hours after holding his newborn son the first time, emergency room doctor Gao Weibo left his wife, who was still recovering from a morning Caesarean section, and returned to his crowded ward in Peking University People's Hospital.
From 6pm to 8am he and another doctor received about 90 patients, while also attending to dozens of others left over from the day shift. Gao works 14 hours a day for 21 consecutive days, public holidays included, with seven-day breaks in between. He did not ask for leave when his son was born and worked through his entire three-week schedule before joining his family for a week.
By comparison, doctors in Hong Kong work 65.6 hours a week, or almost 11 hours a shift for a six-day week, leading to complaints of overwork and plans by the city's Hospital Authority to recruit doctors from overseas to ease their local counterparts' workload.
'There are too many patients and too few doctors,' Gao said, in an interview in the hospital's admissions ward, before a long night's work.
During last month's National Day 'golden week' holiday, the number of patients shot up 50 per cent and he was so busy that he could not find the time to get a drink of water. On the fourth day, after he came down with a fever, Gao diagnosed and treated himself, administering an intravenous drip and antibiotics so that he could get back to work.
Many mainland doctors, especially those in top hospitals, are overwhelmed by the heavy workloads and long hours as patients from across the country tend to shun lower-level local hospitals and flock to those in the big cities. Some queue overnight for days or pay thousands of yuan to see top specialists.
And patients often turn on the doctors, incensed by media reports of hospital overcharging and malpractice.
Doctors frequently find themselves the victims of verbal abuse and even violent attacks. Nowadays, it seems, they are no longer regarded as heroes, the 'white-coat angels' who braved danger to save lives during the severe acute respiratory syndrome epidemic in 2003 and the Sichuan earthquake in 2008.
Fewer than a fifth of doctors surveyed by the Chinese Medical Doctor Association in August said they were satisfied with their working conditions. More than half think patients are biased against them and almost three quarters said medical disputes, heavy workloads and patients' high expectations were their main sources of stress.
At least 11 attacks on doctors this year - two of them fatal - have sent doctors' morale to a new low. They say they work hard for long hours and are paid little, but are still under-appreciated. Unless they get some trust and understanding, they say, patients' interests will eventually be jeopardised.
'Trust is a rare virtue in this society and the distrust between doctors and patients is one good example,' said Professor Zhang Xuewu, from Peking University People's Hospital's department of rheumatology and immunology.
Zhang once met a patient who recorded every conversation with doctors and photocopied every page of his hospital chart, and then sued the doctors.
'Without trust doctors will use only conservative treatment, with fewer risks. The priority will be to ensure the safety of doctors and treatment, not what's the best for the patient. Patients are losers in this, too,' Zhang said.
Li Zhan, an obstetrician-gynaecologist in his second year as a specialist at Beijing's Chaoyang Hospital, said the greatest career risk he faced was not surgery that went wrong but hostile patients.
His department is often engaged in disputes with patients, who blame doctors for such things as newborn asphyxia or bleeding after the removal of a contraceptive device.
'Patients have this expectation that if they give birth in a hospital they should be fine and the babies should be fine,' Li said. 'They don't know there might be loss of blood, asphyxia or other risks. When reality kicks in and falls short of expectations, they blame doctors for that.
'We try our best but the result might not be satisfactory. We feel such a great sense of failure when patients blame us for sparing efforts or doing something bad on purpose.'
He had just seen a woman patient who arrived in the emergency room complaining of acute abdominal pain. Li advised her to have more check-ups but she insisted that she just needed a painkiller and left.
Many patients suspect that doctors prescribe check-ups to boost their incomes and not because they are necessary. There have been widespread reports about hospitals prescribing unnecessary tests and drugs and the incomes of mainland doctors are linked to what they prescribe. Government funding accounts for just a small fraction of public hospital income and they are left to their own devices to find the means to pay doctors and buy equipment.
Crowded hospitals make complaints from both doctors and patients harder to resolve.
Patients complain about the length of time they have to wait to secure an appointment, followed by long periods in waiting rooms, to spend only a short time with doctors. Sometimes their questions are not answered.
Doctors say that because of the crowds waiting to see them, they cannot afford to spend enough time consulting patients.
'If I see only 10 patients one morning, I can afford to give them only 20 minutes each and explain everything, said Li, who sees between 25 and 35 patients in a morning. 'But now, with 60 patients a day I have just the minimum time to brief them. If I spend too much time with one patient the queuing patients will have a problem.'
Adding to the hospital's problems is its proximity to a street filled with bars. On summer nights groups of injured drunks fill its emergency wards.
Gao said every shift saw patients engaged in disputes with medical staff. Just minutes earlier he had to calm an angry bus driver who had pulled out his drip after an argument with a lower-level doctor who advised that he needed further tests to check his endocrine levels for the cause of his palpitations.
'When we can spend time talking to patients and apologising even when we don't need to they will listen to you and calm down,' Gao said. 'Sometimes we are threatened. We run when they start to talk rough. If they run faster, then we are beaten up. Doctors who have experienced attacks know the stress and fear. '
Veteran doctors such as Zhang remember a time when the profession enjoyed some respect from patients.
'It is so sad. I had no idea that knowledge was not going to be respected and doctors would encounter such fear,' said Zhang, who graduated from medical school in 1988.
Ten years later, when Li started to go to medical school, he said being a 'doctor was still a promising job and only the top students could go to medical school'.
But it did not take him long to realise that it was not the most lucrative profession.
'I graduated from a very good high school in Beijing and now I am paid the lowest among my high school peers,' Li said. 'It's not that I don't work hard enough.'
The 31-year-old arrives at work in the dark and leaves when it is dark again. He also takes on unpaid shifts on weekends and public holidays and has little time to spend with his young son.
He Xin, a colleague of Li's and the mother of a toddler, came up with a joke - shared ruefully by her colleagues - that the children of doctors are like the 'leftover' children of migrant workers, who stay behind in rural areas when their parents go to the cities to look for work.
He is working as the chief of residents this year, meaning that she and another doctor must work alternate night shifts for 12 months.
Inevitably, the unusual working hours and heavy workload take their toll on family life.
'I'm so tired when I get home that I don't want to talk,' Gao said. 'I don't even want to move.'
Gao doesn't see much of his wife, a nurse at Peking Union Medical College Hospital, who works eight night shifts a month.
Divorce and broken relationships are not uncommon in Gao's department.
Doctors' pay for such physically demanding and highly challenging work was set by the National Development and Reform Commission years ago and is nothing to write home about. In many cases, the hand using a scalpel in surgery earns less than one using scissors to cut hair. For each night shift in Li's hospital, doctors are paid 50 yuan (HK$61) to 80 yuan. For each surgery - even the removal of tumours - doctors are paid 10 to 20 yuan.
In public hospitals, the consultation fee for a doctor is five yuan, rising to seven yuan if the doctor is an assistant professor and 14 yuan if they are a full professor.
Gao has been a doctor for 11 years and earns about 1,500 yuan a month after tax and social welfare payments. He gets another 6,000 yuan or so for completing a certain workload.
Zhang, a professor, makes around 10,000 yuan.
'Doctors are the most responsible group in society,' Li said. 'We do the job out of a sense of mission, not as a career. If you see it as a career you will be hurt and upset. Those who have survived residency and haven't quit will stay.'
But not all doctors have Li's resolve. A fifth of his classmates at medical school have pursued other careers and five others have stopped doing clinical work, not only because of the low pay. A family cannot afford to have two doctors, Li said. Other working couples can pick up their children after school, but never doctors.
Gao loves his career for giving him the opportunity to save lives. He transferred from the haematology department to the emergency room just to get more hands-on experience. But his wife is considering quitting her job as a nurse because of the hardship and he would not encourage his son to pursue medicine. More than 75 per cent of doctors surveyed by the Chinese Medical Doctor Association share that sentiment.
'It is a very difficult job,' Gao said on the day his son was born. 'You never stop the learning process. To get promotion you have to sit difficult exams all the time and deal with the pressure of publishing research findings, which is almost impossible because of the heavy workload. This is a job of high risks.
'I want my son to have an easier life. He can be a doctor, but only if he loves saving people's lives.'