Yujia Chen

Doctors are thought to be important and honorable members of society. People rely on doctors to cure their diseases, and doctors gain respect for their contribution to the community. However, in recent days, the doctor-patient relationship has gradually changed.

In 2013, two shocking news stories drew nation-wide attention in China to this topic. The astonishing stories alerted people that the problem is so severe it can no longer be neglected. Li, a 17-year-old boy suffering from both ankylosing spondylitis and tuberculosis, went to Harbin for treatment. Ankylosing spondylitis caused him severe back pain, but the complexity of the disease delayed the correct diagnosis for months and extended his treatment. After years of suffering, he felt desperate. One day, Li killed one intern doctor and seriously injured three other doctors. Ironically, the dead intern was completely irrelevant to Li’s treatment. One year later, another tragedy happened. The perpetrator, Lian, received nose surgery in Wenling, but he was still uncomfortable after the surgery. He returned to many hospitals for examinations. All of the doctors told him that he is healthy and the surgery was a success, but he refused to believe them. He was convinced that the hospitals united together to cover the doctors’ malpractice. Finally, he decided to be the judge. He intended to kill the doctor who treated him, but the doctor wasn’t there, so he stabbed the head of the department instead.

But that’s not the worst part of the story. When the media posted an online questionnaire asking for readers’ reactions to the murder in Harbin, 65 percent of readers chose a smiley face, showing they were happy about the murder. Lian, in an interview after his arrest, told the public “He deserves it”, and showed no regret. It is people’s reactions to the murders that shock us most.

What’s the cause behind the doctor-patient conflict? The reason comes from both sides: misunderstanding from the patients and lack of communication from the doctors.

Patients have stereotyped opinions about doctors and hospitals. First, they believe doctors make earning money their priority. Doctors would ask for “pocket money” and threaten to delay the treatment if a patient doesn’t pay. Then, patients believe that any illness must have an effective therapy. These notions are vividly shown in Lian. He is paranoid and believes both of them. There must be an effective therapy for his nose, so he blamed any side effects on the inability and irresponsibility of the doctor. When other doctors tried to convince him differently, he believed everybody was cheating him.

However, doctors themselves are not completely innocent, especially in a case like Li’s. Li is poor and he put all of his hopes in the doctors. The doctors were always busy and didn’t like talking to him. Sometimes they even gave him conflicting instructions. Li was not treated seriously. Generally speaking, Chinese doctors pay much more attention to patients’ diagnosis but pay relatively little attention to a patient’s mental state.

Doctors need to understand their responsibility for better communication, but there is an objective obstacle: there are too many patients. In China, one doctor takes care of 950 patients on average. By comparison, a doctor in the U.S. takes care of 390 patients. Although increasing the supply of doctors seems to be an easy solution, it is not enough.

In fact, there is a structural problem in the Chinese medical system – centralized medical care. In China, Class 3 hospitals employ the most experienced doctors and own state-of-the-art equipment. Community hospitals, on the other hand, are much smaller, less crowded, and much more convenient. They are supposed to deal with non-severe illnesses. However, according to a survey, 68.3% of respondents don’t trust community hospitals, and 51% prefer to go to Class 3 hospitals regardless of the seriousness of the illness. Given the huge population in China, it is a great burden on top-notch hospitals to treat so many patients. Beijing University Third Hospital, for example, accepts 13,000 patients per day, which means at most 10 minutes for each patient to see a doctor, and each doctor needs to see more than 50 patients in a day. No wonder there is not enough time for communication.

Rebuilding trust is important here. We should tackle this problem from all perspectives. From the patients’ side, we should provide more effective public education, so that people would have reasonable expectations from the doctors. From the doctors’ side, doctors themselves should take responsibility and do whatever they can to care for their patients emotionally. Finally, from the perspective of the medical system, we need to unburden the big hospitals. One possible solution is to provide more support to the community hospital and to promote its credibility so that people are willing to go there. These solutions will help to repair the doctor patient relationship in China, but there is still a long way to go.