Week in China: Survey from China Youth Daily late last year found that 67% of respondents did not trust doctors’ diagnoses or recommended treatments

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“Trust me, I’m a doctor”

Doctors go on strike to protest beatings received from angry patients

Sep 12, 2014 (WiC 252)

A doctor attacked at the Huimin Hospital in Hubei province

Late last month more than 100 medical workers gathered outside Yulong Hospital in Yunnan province. They were protesting at the number of times they’d been attacked by disgruntled patients or their relatives, reports Yunnan Information News.

This hospital strike wasn’t an isolated incident. Just days earlier a group of 100 doctors had also protested outside the city government’s offices in Yueyang in Hunan province. They were furious about an incident in which a doctor was badly beaten up by the relatives of a patient who had died in their hospital. According to the Beijing News, the medics demanded safer working conditions for healthcare professionals. “The hospital is no longer a safe place. We are full of fear at work,” one doctor complained.

In Beijing the city government even sent riot gear to local hospitals in July. “The growing number of attacks on doctors and hospital personnel in recent years has moved the local government to enhance security at public hospitals,” commented the China Daily.

The statistics make it hard to disagree. A survey by the China Hospital Management Association found that violence against medical personnel rose an average 23% each year between 2002 and 2012.

In a two-week period in February, angry patients paralysed a nurse in Nanjing, cut the throat of a doctor in Hebei, and beat another one to death (with a pipe) in Heilongjiang.

In a New Yorker article titled ‘Under the knife’, Christopher Beam asks why Chinese patients are turning against their doctors. Published at the end of August, the investigative piece came out just two days before the Yunnan doctors went on strike. In an attempt to understand the phenomenon, Beam focuses on the case of Li Mengnan, a migrant worker who was so enraged by his treatment that he went on a stabbing rampage at a hospital in Harbin in 2012. In an incident that got widespread media attention, Li stabbed and killed Wang Hao, a doctor – moreover one who had nothing to do with his case.

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But Li’s guilt was not as clearcut as it initially appeared. Indeed as more information emerged about Li, public sympathy increasingly swung behind the patient-turned-killer. Born in 1994 Li went to Beijing as a migrant worker aged 15, earning about Rmb700 a month. His legs began to hurt, and although he went to a local hospital, he couldn’t afford the tests necessary for a full diagnosis. So he quit the capital and returned to his home town in Inner Mongolia. But the medical facilities there didn’t have the right equipment to figure out what was wrong, so he was taken by his grandfather to a major hospital in Harbin.

This time Li’s condition was diagnosed, except wrongly. He was told he had synovitis (an inflammation of the joints) and prescribed shots. But they only made his condition worse and he was soon walking like an old man, his grandmother told media. So they took the 10-hour train journey back to Harbin, where Li’s condition was finally diagnosed correctly as ankylosing spondylitus, a chronic inflammatory disease also known as ‘bamboo spine’.

Although incurable, the condition can be treated with Remicade, an intravenous drug. The treatment cost Rmb80,000 ($13,051), with Li’s health insurance covering less than half of that. However, using his grandfather’s pension and savings from family friends, Li went ahead. Initially he felt better, but he was then told the treatment needed to stop because he had tuberculosis. (Li’s lawyer later said the hospital knew of his TB before the treatment started, but went ahead because the fee was so lucrative.)

Li then spent four months in a hospital in his home town taking an anti-tuberculosis drug. But when the course finished and he went back to Harbin, the doctors refused to continue with his earlier treatment, saying his TB hadn’t cleared up, and he had to go back to Inner Mongolia.

Feeling exploited and exasperated, Li told his grandfather he could no longer bear it. Later that day he purchased a three-inch knife and walked into the hospital, stabbing the first doctor he saw – Wang Hao – and slashing at others. He then tried to stab himself, although his suicide attempt failed and he was arrested and later tried, getting a life sentence.

As the New Yorker points out, attitudes to Li’s case changed during the trial, particularly as journalists were given full access to cover it.

“The media’s portrait of the killer softened: Li Mengnan wasn’t a lunatic, nor did he have a history of violence. He was a man whom society had failed so completely that he was impelled to lash out. Wang Hao’s death came to symbolise the collapse of doctor-patient relations and a fundamental dysfunction in China’s healthcare system,” opinesthe New Yorker.

Even the dead doctor’s father told the magazine’s Beam: “I blame the healthcare system. Li Mengnan was just a representative of this conflict. Incidents like this have happened many times. How could we just blame Li?”

WiC has reported before on the increasing amounts being spent on medical care in China and the blueprints for major healthcare reforms. These have extended healthcare coverage to 95% of the population and mandated that key drugs be sold at lower, fixed prices. However, systemic problems remain, not just in the way urban hospitals are run but also due to the lack of sophisticated facilities in rural areas. Limited rural health facilities also forces patients into the cities and leads to overcrowding at urban hospitals. This can make it difficult to get an appointment (unless patients are prepared to jump the queue by paying bribes). Stretched finances also mean that many public hospitals tend to over-prescribe expensive (and more profitable) drugs. In some of the most scandalous situations doctors have recommended costly but unnecessary treatments solely because they boost the institution’s income. Add to this that plenty of doctors are compromised by murky financial relationships with the drugs companies.

All of the above is well understood in China, so it was no surprise that a survey from China Youth Daily late last year found that 67% of respondents did not trust doctors’ diagnoses or recommended treatments (a hefty 252,283 respondents took part, making it a pretty representative sample).

The doctors themselves are dissatisfied with the current state of affairs too, reports Healthaffairs.org. A 2011 Chinese Medical Association survey of its members showed fewer than 20% were satisfied with their medical practice environments, while 48% rated them “poor” or “very poor”. Doctors were particularly dissatisfied with their pay. They were also concerned about their working conditions and their workloads.

A leading radiologist told the New Yorker that the record number of patients seen by a single doctor in a single shift at the Shanghai Children’s Hospital is 314. That works out as an average of two minutes per patient, the radiologist said.

Interestingly, the same survey showed that fewer than 10% of respondents blamed doctors, the hospitals or the patients themselves for the grievances that they were reporting. The majority (83%) simply blamed “the system” for tensions between doctors and their patients.

Indeed, with poor pay, little public respect for their profession and the apparent threat to their physical safety, it’s little surprise that the Chinese Medical Association survey also found that just 21% of its members wanted their own children to become doctors.

This lack of enthusiasm for the profession could have serious consequences. One of the interviewees told Beam that a career as a doctor was seen as a respectable profession when she studied medicine. But now “our friends’ children aren’t going into medicine”, she warned. That will mean a shortage of doctors in the years ahead, she forecast.

Meanwhile the attempts at health industry reform go on. In a move to encourage investment in the sector, the Ministry of Commerce announced on August 27 that foreign entities will be able to establish wholly-owned hospitals in seven regions. The trial programme will proceed in the municipalities of Beijing, Shanghai and Tianjin, as well as the provinces of Guangdong, Jiangsu, Fujian and Hainan.

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