More doctors and nurses being assaulted by disgruntled patients and relatives

Assaults, sometimes deadly, by disgruntled patients and their relatives are a growing occupational hazard for medical staff

PUBLISHED : Thursday, 28 November, 2013, 8:48am
UPDATED : Friday, 29 November, 2013, 5:20pm

Wang Tao, a surgeon at a public hospital in Beijing, has kept a metal bar in his office ever since a doctor at a hospital in Wenling, Zhejiang province was stabbed to death last month.

He also makes a habit of sitting facing the door and keeps a careful eye on patients when they reach to take something from their bags.

"It's sad, but I don't want to be slaughtered like a lamb while I am trying to help patients," said Wang, noting that some colleagues have even started carrying knives to protect themselves from violent patients or relatives.

Such is the surreal scenario facing the mainland's five million doctors and nurses every day. While medical staff anywhere can face violence from risky patients - for example, those with psychiatric disorders or dementia - the mainland is seeing a disturbing trend of attacks on doctors and nurses.

According to the Chinese Hospital Association, hospitals across the country see an average of 27 such attacks a year. Seven doctors were killed and 28 injured in 11 attacks last year alone.

Some hospitals have stepped up security for medical staff, even going as far as providing guards with riot equipment such as pepper spray, batons and shields. Two hospitals in Shanghai began taekwondo lessons for doctors after the Wenling attack.

But doctors say these moves are just treating the symptoms while ignoring the disease: growing public mistrust and hostility towards a malfunctioning health care system that leaves them as convenient and vulnerable targets for unhappy patients.

Government funding for public hospitals falls well short of operating costs, doctors say, which in turn places an enormous burden on limited healthcare resources. Public hospitals are typically overcrowded with seemingly endless queues.

When patients reached the end of their tether, they vented their anger on doctors, said Wen Jianmin , the director of orthopaedics at Beijing's Wangjing Hospital.

Even though most patients today have some medical insurance, their bills were still high, said Yan Xiaojun , a surgeon at Shanghai's Tongji Hospital. Patients, especially those from outside the city, pay a lot for treatment and can be quick to blame doctors if they are unhappy with the results.

Doctors say that patients who feel they have not received the level of attention they deserve often forget that doctors are victims of an inadequate system, too.

"My record is treating more than 100 patients in one day," Wen said.

"I finished at about 9pm. Patients flock to big hospitals with better resources."

Yan sympathised with patients who queued for hours just to get a consultation ticket, then spent hours more in waiting rooms for consultations that lasted just a few minutes.

But, he said, with so many patients to treat, a lengthy examination and a clear explanation with each patient were luxuries that doctors could not afford, he said.

"I usually see 50 patients in the morning, and have just a few minutes to see each one," Yan said. "It's not the doctors' fault."

Shanghai has been trying to persuade residents to use family doctors, and big hospitals to team up with lower level facilities, but it is too early to know whether these options are working. Patients still choose the highest-level hospitals, which they think are most reliable, for treatment.

Whatever the reasons, the growing distrust between doctors and their patients is showing side effects. Doctors' low morale hurts patients' welfare as well.

Yan said he had become very careful to avoid risky procedures.

"The wise choice is to avoid risk in complicated cases," Wen said. "I will be very conservative and not take risks even though they might save the patient. It's the difference between risk control to avoid future trouble and saving lives, and patients are suffering the consequences."

The poor image of the profession is affecting recruitment of new doctors, too. Traditionally, only top students or those from medical families applied for medical school, but that has changed, Wen said.

A survey by the Chinese Medical Doctor Association found 78 per cent of it members would not let their children study medicine.

"When we doctors retire, who will fill our shoes?" Wen said.

He called for greater public education to improve public understanding of the problems faced by the medical profession.

"Patients see themselves as customers and as long as they spend money here they should be guaranteed a cure. But, medicine doesn't work that way. It's not grocery shopping," Wen said. Patients needed to adjust their expectations and be realistic about treatments.

"Medicine is limited and we do what we can to help," he said. "You can't blame doctors and attack us if you are not cured. We feel just as bad."

The issue of hospital violence now has the ear of top level officials, with Premier Li Keqiang requesting all government departments to help tackle the problem.

Vice-Premier Liu Yandong , who is in charge of health, also vowed to protect doctors and ordered a one-year crackdown on hospital violence.

Doctors say what is even more urgent was immediate, guaranteed protection by police.

Ling Feng , the director of neurosurgery at Beijing's Xuanwu Hospital and a deputy to the Chinese People's Political Consultative Conference, joined 30 deputies of its medical panel to submit an emergency proposal that hospitals become "public venues" under police control.

Hospitals are not regarded as such, and police usually demand that hospitals settle disputes with patients themselves. Troublemakers are only punished if they injure or kill someone. It is common to see banners, wreaths - and even bodies - at protests staged at hospitals.