When medical schools no longer attract the brightest minds, when doctors become the target of attacks, and when weapons of self-defence become necessary in hospitals, something is clearly amiss. Worryingly, the symptoms are spreading on the mainland, so much so that they are further jeopardising the already ailing health care system in the world's most populous nation. The need for major surgery is evident. Stories of medical staff protecting themselves with knives or metal bars in the wake of a fatal stabbing in a Beijing hospital may sound incredible. But it underlines the sorry situation facing the five million medics on the mainland. According to the Chinese Hospital Association, hospitals across the country suffer an average of 27 attacks a year. Seven doctors were killed and 28 injured last year. Separately, 78 per cent of the association's members said they would not let their children study medicine. The figures are not necessarily correlated, but the message is clear. The profession is not as prestigious as it used to be, and mistrust and hostility are growing. Hospital attacks are a disturbing trend that stems from systemic flaws - limited public resources, heavy workloads and inadequate insurance coverage. They all add to the burden as demand for better medical care grows. As this paper reported, patients flood to the major cities for better treatment. But the rigid system only allows medics to be registered at one hospital, forcing them to work elsewhere outside official hours in the name of consultants. Understandably, service quality deteriorates as caseloads mount. This is further marred by corrupt and unethical practices such as overcharging and kickbacks for drug prescriptions. When justice cannot be pursued by legitimate means, aggrieved patients seek revenge through violence. That in turns deters medics from performing risky but necessary operations for fear of retribution. The system is hardly sustainable without reform. Hopes rose after officials at the Communist Party's third plenum pledged to lift more of the restrictions on medical practitioners, and to crack down on hospital violence. This is a necessary, albeit belated, step to stabilise morale and restore security. Giving adequate funding to hospitals is the way to avoid exploitation. Priority should also be given to developing a more active private medical sector. Given the advances that the country has made, patients deserve better.