Bitter Dose for Doctors

Doctor-patient relations are rapidly deteriorating in China. Medical staff are under fire after a series of scandals in recent years, including instances of bribery and corruption, refusing to help dying patients, all compounded by spiraling medical fees. China's Vice Health Minister, Wang Longde, commented earlier this year that China's doctor-patient relations are experiencing a record low. 

A recent survey carried out by the Ministry of Health reveals that around 91 per cent of doctors claim they are under great pressure, about 23 per cent say they are unhappy at work, another 10 per cent believe that doctor-patient relations have become simply akin to 'buyer-seller' relations, and merely 54 per cent agreed that their work should be patient-centered. The survey was carried out amongst 2,400 medical staff in six provinces and municipalities across the country.

Another survey by the Chinese Medical Doctors Association (CMDA), involving 2,000 medical staff from Beijing, Guangdong, Sichuan, Liaoning and Zhejiang, found that more than half the doctors find their work conditions 'awful', with just 5 per cent believing that their work conditions are 'good'. Most complained that it is hard to be a practitioner as they face heavy pressure at work and a lack of understanding from the public.

"I'm sometimes reluctant to tell others I'm a doctor," said Gong Maoqi, 38, who currently works at the Beijing Jishuitan Hospital. "It's as if the people believe doctors are some kind of blackmailers or cheaters with foul consciences!" He said it was not rare for staff in his accident and emergency department to be attacked by receive patients or their relatives.

Indeed, almost 97 per cent of hospitals have reported violent patient rampages, triggered by medical disputes, according to another survey carried out by the CMDA. On average, each hospital reports around 15 such incidents a year, incurring damages of over 300,000 yuan (37,500 U.S. dollars) each. 

"Doctors and patients used to be friends in fighting diseases," said CMDA head Yin Dakui. "Only with the trust and cooperation of patients can doctors pioneer new methods in treatment." Yuan Zhong, assistant head of the Chinese Academy of Medical Sciences, agreed: "The worst fallout of these strained doctor-patient relations is that doctors dare not explore further or attempt to cure unfamiliar diseases, thus affecting the progress of medical science." 

The increasing number of disputes has also resulted in a growing financial burden on patients - the cost of medical services has skyrocketed. A Ministry of Health survey reveals that average clinic and hospitalization fees rose 77 and 116 times respectively during the 1980-2005 period. In the same period, incomes grew only 16 times.

Yuan Zhong said many now doctors take precautionary measures - namely collecting proof and conducting extensive examinations on patients. "If it prevents further dispute, it's not so bad if patients have to spend more on check-ups," he said

"Unlike our foreign peers, many Chinese doctors have high work pressure and low incomes. Also, we aren't protected from medical disputes," said Dr. Dong, who practices in Beijing. "When disputes occur, even the security guards shy away in fear of being hurt, doctors have to pay compensation from their own pockets and they are often held responsible even though they are generally not their fault." 

Government health investment had been insufficient for years, noted Yu Zonghe, former director of the Ministry of Health's Department of Medical Administration. Doctors and hospitals have had to raise medical fees in a bid for survival. "As a result," he said, "patients and doctors have turned into enemies instead of friends."

Indeed, according to WHO figures, China's healthcare system currently ranks 144th out of 191 countries based on its overall performance and 188th on its financial fairness.

According to Ba Denian, former head of the Peking Union Medical College at Tsinghua University, China spends a mere 2.7 per cent of its GDP on health, whilst figures in most Economically More Developed Countries (EMDC's) are above 10 per cent. Ba added that even figures in Newly Industrializing Countries (NIC's) akin to China are higher - 6.1 per cent in India and 7.9 per cent in Brazil.

The imbalance in medical resources distribution is another reason for the deterioration. Yin Dakui pointed out that rural areas are short of medial resources since China's high-quality medical resources are mostly concentrated in big cities. Most people do not trust small, local hospitals even though they have the capacity to attend to many cases, and have started to swarm to large, city-based ones, placing them under ever-increasing stress. 

As a result of this influx of patients from the countryside, the burdens placed on urban medical services have intensified. "Patients complain of the lack of beds and insufficient attention, while doctors are overworked and can't provide high quality services," observed Yin.

The media has come under fire for extensively reporting doctor-patient woes. The recent 'infected tea' case is a case in point. A local reporter tricked 10 hospitals by passing off tea as his urine and, at six of them, he was informed that he had a bladder infection and received a prescription. The report questioned doctors' morality and capacity. Doctors, meanwhile, blamed the testing equipment. 

According to a CMDA survey, more than 80 per cent doctors questioned believed that the media is not balanced in reporting medical disputes. Gong argued, "The media is playing a key role in escalating the distrust - they are sympathizing with the patients, but should give us more of a chance to speak out."

A series of measures have been introduced to revamp the healthcare system, including promoting the cooperative medical system in rural areas, standardizing medicine prices, and injecting more funds into community hospitals. Premier Wen Jiabao pledged in his government work report this March that the cooperative health system - which currently serves half of the countryside - would be expanded to cover 80 per cent of all rural areas.

Despite the government's efforts, China still has a long way to go before the fractured relationship between doctor and patient is healed. "Do you still remember the fight against SARS in 2003?" asked Gong wistfully. "Doctors were highly respected then - I just hope that things can go back to the way they were." 


More by :  Zhan Yan

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