In the face of escalating physical violence, outspoken Chinese doctors take grievances online
Microblogging medics on the mainland vent their feelings about the frequent violence of patients' families towards members of the profession
Dr Ning Fanggang goes to work every day with a heavy heart. The medical doctor says his profession saves lives, and deserves dignity, respect and gratitude in today's China. Instead, doctors and other health care workers are increasingly being attacked and seriously injured by the very people they are trying to help.
"I am exhausted and heart-broken in the last few days," Ning, the 38-year-old chief surgeon at the burn surgery and reconstruction department of Beijing Jishuitan Hospital, wrote on his Weibo microblog in February. He's tracked by 120,000 readers, and is one of the most widely followed doctors on the site.
Ning felt compelled to write after a middle-aged couple, both local government officials, assaulted nurses and doctors at a Nanjing hospital on February 25. The woman hit a nurse repeatedly with an umbrella, leaving the care worker with spinal injuries and possible lower extremity paralysis, state media reported. The attackers were angry that the hospital, which was short of beds, had temporarily put a male patient in critical condition in the same ward as their 24-year-old daughter.
Earlier this month Nanjing police arrested the wife, who faces a criminal charge. The husband has been suspended from his position and faces administrative punishment. The hospital said the nurse recently moved her legs and lifted them briefly.
Violence against doctors is one aspect of the myriad problems plaguing the mainland's medical profession, Ning says.
"Chinese doctors have no dignity to speak of," he says.
The enormous medical care system - which in 2012 comprised almost 13,400 public hospitals and 9,800 private hospitals - suffers from underinvestment, Ning says. To keep this huge yet poorly funded machine running, its 2.47 million licensed doctors, especially those working in public hospitals, endure high workloads for meagre pay, he says.
Weibo, the largest online social network in China, has become a forum for outspoken doctors. They share their frustrations with the medical system and urge the government to allow private health care practitioners to operate and give a more caring and personal service.
They're followed by a public that's increasingly frustrated with medicine. For decades, doctors were viewed as authorities who ruled patients' lives, working at hospitals that made money from sickness. When the doctors write online, they become trusted insiders, showing a side of the medical system that most patients haven't been privy to.
Ning vents about the violence in hospitals and about social injustice. He explains that doctors' lives are often in danger as the government and law enforcement fail to protect them from unruly patients.
Some 96 per cent of medical staff received verbal assaults and threats in the workplace in 2012, and 63.7 per cent of them suffered physical violence or injuries, according to a report released by the Chinese Hospital Association in January.
Seven doctors were killed and 28 injured in 11 of the worst attacks last year, the association says. Most involved cases in which disgruntled patients or their families attacked doctors.
Patients lash out, Ning says, when they pay for help that they don't receive. "I feel helpless. If a society is ruled by law, it should leave no choice for doctors but to be advocates," he says.
Putting a smile on faces
Ning's anger is shared by cardiovascular surgeon Dr Zhang Qiang, known as "Dr Smile" to his 140,000 Weibo followers.
Zhang is one of many doctors who have left public hospitals to create private clinics. Such moves, he says, will compel hospitals to work to regain the public's trust.
Zhang quit in 2012 after working for more than two decades in large hospitals in Shanghai. Now he splits his time between two private clinics - the World Path Clinic in Shanghai and United Family Healthcare in Beijing.
"The main reason behind such attacks is the distrust and dissatisfaction of the public towards hospitals," Zhang says.
Zhang performs minimally invasive surgery to treat varicose veins and venous thrombosis, a type of blood clot. Working at a clinic, he says, has allowed him to build a team of seven people, and to work at his own pace. Last year he says he completed about 300 operations. A year of work at a public hospital would involve about 1,000 operations, he says.
"Instead, I can give more attention and care to my patients now," he says.
In 2013, the State Council released guidelines to overhaul the health care industry, to include more aspects of a market-based system. It estimates that a thriving health care market worth more than 8 trillion yuan (HK$10 trillion) could become a major economic growth engine by 2020. The goal is to make health care more affordable, the government says, while boosting the incomes of hospitals and doctors. Private hospitals and clinics are viewed as an important part of the blueprint. But there are challenges ahead. Once doctors choose to work in private clinics, they must create and publicise their reputation themselves.
Zhang says social media such as Weibo acts as a business card for doctors at private clinics. He says that many of his Weibo followers have become his patients. "They read my Weibo and know who I am. They trust me," he says. "I don't print 'cardiovascular surgeon' on my business card any more. I am Dr Smile."
Sense of humour
A third medical doctor who is popular with Weibo users is Dr Yu Ying, who calls herself "Superwoman in the ER". She has 2.7 million Weibo followers.
Yu mixes satire and humour in her posts to comment on social issues, including many cases of patient violence against doctors. Being outspoken, even sarcastic, has won her a wide reputation beyond that of a doctor.
But those same comments have caused her some trouble, too. Yu was an attending physician at the emergency department of Peking Union Medical College Hospital until last year, where she says that her bosses repeatedly advised her not to post about social issues on Weibo. "I want to speak. I am who I am," she says.
After working in the public hospital system for more than 15 years, Yu quit her job last year. First, she opened an e-shop to sell women and children's products through Taobao, China's largest e-commerce platform. At its peak, her monthly revenue reached 700,000 yuan (HK$890,000), almost twice her annual salary at the hospital.
The profits, she says, will feed her bigger dream to open a first-class private hospital with an epidemiology research centre.
"The current medical system has limited patients' rights to know and choose their treatments," she says. "Doctors are unmotivated. Patients are unhappy. Violence continues."
Yu says that developing community and private clinics will ease tensions between doctors and patients because a competitive market would require clinics to improve on the service offered by hospitals.
"The public is seeking direct communication with doctors. That's how I post on my Weibo," she says. "To be direct and fun."
Chinese doctors blog about patient violence:
Dr Ning Fanggang, chief surgeon at the burns surgery and reconstruction department, Beijing Jishuitan Hospital:
The major problems in Chinese society exist because the growing awareness of civil rights runs up against outdated laws.
The main cause of violence against Chinese doctors is the failure of the rule of law to maintain social stability.
When the police dare not prosecute perpetrators and governments repeatedly force hospitals to yield to the perpetrators, the environment for Chinese doctors inevitably gets worse.
The challenge of the Chinese doctor-patient relationship comes from patients expecting doctors to have unlimited high technical and moral standards. In contrast, the doctor's return is pathetically low.
The unequal responsibilities and rights make doctors miserable. To improve the doctor-patient relationship, patients should have a better understanding of the limitation of medical conditions and the abilities of doctors.
Dr Zhang Qiang, cardiovascular surgeon at private clinics in Shanghai and Beijing, known online as "Dr Smile":
The challenge to the Chinese medical system is that the public demand for health care is lagging behind.
Meanwhile, health care can't meet the needs of various people. People in good financial conditions cannot buy good services. Thus, the public distrust towards the medical system grows and they are dissatisfied.
All these problems are related to the openness of this market.
Dr Yu Ying, former attending physician at the emergency department of Peking Union Medical College Hospital:
Our medical treatments are not the best in the world. No matter how good our service is, customers will continue to demand better treatment. Demands motivate us to make progress.
However, while we can admit our medical treatment is not the best, that does not justify the use of violence.
Most hospital disturbances come with compensation.
In the old days, patients made scenes by displaying wreaths and memorial tablets. It would cost them money.
These days they just strike with their fists, then hospitals bow and pay them compensation.
Patients make money so easily. Of course, they will continue disturbances!
For individuals to open clinics in China, it requires that they follow administrative examinations and orders instead of establishing a medical records-sharing system that has been adopted by most other countries.
An earlier version of this story said Dr Yu Ying used to work at Beijing United Family Hospital. It should be "Peking Union Medical College Hospital".