Systemic Shortfalls in Medical System Behind Violence Toward Doctors

The Civil Aviation General Hospital in Beijing (source: Gabriel Li)

In this solemn corner of the Civil Aviation General Hospital in Beijing where everything proceeds as usual, chrysanthemum flowers pile up to form a small mountain, covering over the portrait of the deceased. Guards walk by, occasionally watering the flowers with a spray. Amongst the chaotic and busy atmosphere of the emergency clinic, this corner of condolences belongs to a more tranquil side of the world.

flowers are piled up to form a small mountain, expressing condolences for the deceased (source: Gabriel Li)

The deceased is named Yang Wen, a 51-year-old associate chief physician specialized in hypertension-related diseases. On Christmas Eve, a day meant for love and peace, she was on her night shift as usual, waiting her son to come back home from America for Christmas. Her killer approached from behind and cut her throat with a 20-centimeter knife. It wasn’t a clean cut, she struggled for 13 hours before her death.

According to colleagues of the deceased, the murderer was a son of a 95 year-old patient diagnosed with a cerebral embolism. Unsatisfied with the medical treatment of his mother, he incessantly swore to medical staff at the hospital, “If my mother dies, none of you should continue to live!” No one thought he would put his words into practice.

Every tragedy has a collective social significance. Yinao, the Chinese word for disputes between medical care providers and patients, is not a new phenomenon, and can take various forms. Some patient’s families go to extremes, bringing coffins and photos of the deceased and burning paper money in front of hospitals. In fact, in 2018, the Chinese Medical Doctors Association released a “White Paper on the Practice of Chinese Physicians” that shows in China, 66% of physicians have experienced doctor-patient conflicts, 51% have encountered verbal violence, and 30 percent have actually been treated violently by patients.

In 2012 in China’s Northeastern city of Harbin, a handsome young doctor was killed in the Rheumatology Department due to a misunderstanding with a patient. The 18 year-old perpetrator believed that the doctor seemed reluctant to cure his disease.

According to Mr Hua, a specialist of doctor-patient relations working at a public hospital in China’s northeast city of Dalian, there are mainly five reasons for doctor-patient disputes.

The first is disputes brought by medical malpractice.

The second is patients making trouble for no real cause.

The third is patients having too high expectations of health professionals and medicine’s ability to cure all ailments. Patients don’t believe the doctors have tried their best and insist that a disease can be cured once and for all. For instance, a patient has thyreoiditis, and the complications for the surgery makes the patient’s voice hoarse. But the patient doesn’t understand that and believe it is the doctor’s fault.

The fourth is that a doctor has an attitude issue, and lacks efficient communication with the patient.

Finally, some doctors indeed engage in malpractice, demanding extra fees from patients or prescriptions for unnecessary and expensive drugs to pad their pockets. Right now, patients have a higher awareness of protecting their rights, which inflames the conflicts.

“First of all, if we encounter something like this, we should try to resolve it ourselves inside the hospital. If we failed to reach an agreement, then there is a National Mediation Committee for Medical Disputes. If the committee fails, then a lawsuit becomes inevitable,” Hua says.

According to data from the Ministry of Justice, as of September 2018, there are altogether 3,565 medical mediation committees and 2,885 people’s mediation centers established nationwide, covering over 80% of county-level administrative regions in the country. Since 2010, a total of 548,000 medical disputes have been mediated across the country, of which 33,000 were mediated in the first half of 2018. More than 60% of medical disputes are handled by such mediation methods each year, with a success rate of over 85%.

Though medical mediation centers are widespread, the frequency of disputes stays high. It is reported that before the murder happened, Yang was actually threatened several times by the killer.

Noting the repeated threats, Hua said that the killer clearly was carrying a huge grudge that could establish his motive. “There must have been tons of harbingers,” Hua said.

Dr Cheng, who has worked seven years at the Cardiology Department of the Second Hospital of China Medical University, one of the most established hospitals in Northeast China, said,

“Almost every doctor I know has encountered verbal violence. And there is no solution. Words like ‘I wanna kill you’ are not considered a real threat anymore. It’s not real evidence. Even if we report it to the police, the police won’t even take it.”

Hua said the Civil Aviation General Hospital should have had a blacklist system, rejecting quarrelsome patients. He thinks the hospital failed Yang by not responding earlier to the repeated threats against her. “The administrative office should shoulder the responsibility of facilitating communications instead of letting doctors carry the burden.”

Moreover, according to previous media reports, the killer’s rage broke out when his mother couldn’t be transferred from the emergency department to the inpatient department, where most expenditures could be refunded through medical insurance.

Cheng said the problem stems from government inaction on a national level. He said the government needs to invest more money in public hospitals, fueling the medical insurance fund. Right now, there is a medical insurance cap for each hospital. “If inpatients spend more than the medical insurance cap, the financial burden will fall onto the shoulders of the doctor,” Cheng explained.

At the moment, all public hospitals in China are financially self-sustaining entities. The government only subsidizes around 10 percent of their total expenditures every year. In that sense, admitting inpatients will high levels of medical insurance might incur losses for the hospitals.

Doctors suffer constant humiliation

The root cause of the disputes lie in the information asymmetry between the doctor and patients, as well as the twisted positioning of the whole industry. “Now in hospitals many patients see us as servants. Last time, I took some of my students to treat a patient. The family member of the patient talked to me like I was a waiter, telling me to ‘Go get some water.’ Even now I can’t forget the look on his face,” Cheng recalled angrily.

“The whole society advocates the high moral practice of medical staff. Doctors are angels. So angels should bear the hurt and humiliation when offended right? We studied medicine for almost a decade, earned doctorate degrees, and published several essays only to become waiters?”

Another serious issue is the lack of medical resources. According to data from 2017, the number of medical practitioners has reach 3.39 million, and every population of one thousand people has 2.44 medical practitioners on average, which is up to international standards. However, true quality resources are far less accessible. This has given birth to the business of scalpers at major hospitals. After waiting in long lines while in agony and failing to get fair treatment, patients and families tend to ventilate their anger at people nearby wearing white coats.

Cheng said, “Some patients complain that they spend money to register, and I only talk to them for five minutes. They say I don’t have ethics. But in fact, if I talk to them for 20 minutes, the wait lines will get even longer. There is a definite shortage of medical resources here. Many doctors are seeking to change their careers now. Fewer people are choosing to study medicine at school, and this situation is getting worse.” Being one of the most established hospitals in the region, her hospital covers patients from three provinces in the Northeast, as well as Inner Mongolia and nearby counties and townships.

Dr Wang, who is 25 and works at one of Beijing’s most renowned hospitals, Peking Union Medical College Hospital, felt deep remorse after hearing the news of the murder online. “I kept recalling when I first applied for medicine while in college. Both of my parents disapproved, but back then I was happy about my persistence. After the news of the murder broke out, my friends all sent me WeChat messages, expressing concern about my choice of career.”