Doctoring in China Can Be Dangerous
The doctor won’t be able to see you now. Or ever again. He has been murdered!
What are the causes of increasing violence against doctors in China? Chinese medicine has a long, illustrious history and doctors have traditionally been well-respected. However, since the 2010s, Western medical journals, including “The British Medical Journal” and the “Lancet” have reported about the surge in patient violence against physicians (1, 2). Why is this happening now? One explanation is that in the 1980s much of medical care was privatized and large discrepancies in health care delivery appeared along with astronomical fees. Patients and their families, facing unprecedented costs and inability to pay became desperate. Some turned to violence. (3) In addition, the medical system forces doctors to see up to 100 patients a day, incentivizes ordering many medications and tests and leaves little or no time for building trust or developing rapport. The following student essay excerpts illustrate the problems.
My students Flying (her “English” name) and Petter (correct spelling of his “English” name) are both majoring clinical medicine. (That’s an actual undergraduate major in China.) Flying looked for root causes of violence against doctors in China, while Petter took a more optimistic tack and explained why he wanted to be a doctor in spite of the dangers.
In one of Wendy’s classes she asked her students to write a rant about a social problem and then write a poem reflecting on that issue. Wendy’s students, Yvonne and Helen, both addressed violence against doctors. For Yvonne, the issue is particularly close to her heart; her father is a doctor.
Here are excerpts from Yvonne’s essay entitled, “My rant – the statement about my angry” She makes her point with several recent high-profile tragedies.
“On December 24, 2019, an emergency physician named Yang Wen in Beijing was fatally stabbed by a patient’s son. On January 20, 2020, an ophthalmologist in Beijing named Tao Yong was stabbed by his patient and almost died. Due to the severe injury of his hands, he is never able to operate another eye surgery for any patients.”
During the COVID-19 pandemic Yvonne worried about her father.
“When the pandemic broke out, me and my mother were extremely worried about his safety, because not only did he need to fight against the virus, but also the patients who were in the excitable mood state. All I wish is his safe returning from work every day.”
She is angry about a system that has allowed such a severe lack of trust to develop between doctors and patients. She recognizes the stress that illness brings, but feels that more should be done to bring high quality, personalized care to everyone.
Flying, examined several factors that could contribute to violence against doctors, including China’s large population, the influence of the media, lack of trust between doctors and patients and the lack of government leadership.
“China's large population puts great pressure on the work of Chinese doctors. There are more than 1.4 billion people in China, yet there are far too few doctors to serve them. In this way, every doctor will need to see more patients. Nowadays, it is the norm for a chief physician to see fifty patients in four hours, from eight in the morning to twelve at noon.”
“To some extent, the media publicity has put more pressure on doctors. The media should be impartial and realistic, but for a variety of reasons, many times the relevant reports are biased. Medicine is a professional subject, and many things are difficult for the layman to understand. Sometimes, the media will release some one-sided reports and write their article and make their announcement based on just one study or their understanding of the study. This will cause the public to not understand the issue and it is not conducive to people really knowing the truth of the matter. Sometimes, these reports lead to misunderstandings about doctors and justify attacks on the doctor community. Sometimes the coverage of doctors is too unrealistic. Doctors are made into gods, as if their selflessness were taken for granted. However, in fact, we are doctors, not gods, just ordinary human beings who work hard to help people. The media gives too much attention and pressure to the working environment of doctors. The occurrence and development of we-media has exacerbated this phenomenon.”
Flying discusses the same sensational attacks mentioned by Yvonne.
“The acrimonious doctor-patient relationship is the worst part of the working environment for doctors in China. …It is unthinkable that less than a month after the outbreak, there were two cases of malignant injury to doctors. One of the doctors lost his life, the other eye doctor lost the ability to operate with his hand. It seems to be a vicious circle. The poor doctor-patient relationship has led to a decline in the number of doctors, and the shortage the shortage of doctors leads to people's dissatisfaction with doctors, forming a bad doctor-patient relationship.”
Flying would like to see the government get even more involved in reforming health care delivery, in spite of its past failures.
“The absence of government is also a factor in a bad work environment for doctors in China. The Chinese government has been reforming China's medical system since 1985, but the first round of health-care reform was declared a failure in 2009. After that, a new round of medical system reform was carried out. It will take years to see what happens. I hope it works.”
Petter has decided to become a doctor anyway, in spite of the dangers. In his essay, he outlines the potential hazards, but also the rewards of the profession. He is optimistic that improvements in the health care system could enhance patient care and physician safety and satisfaction.
Petter says that initially his parents were pleased with his decision to study clinical medicine. However, given the recent violent reports, their opinion changed, as he describes.
“They didn’t seem as pleased with my major as they used to be after several incidents happened where doctors were injured recently. My parents became worried and sounded negative about my major’s prospects.”
He continues with the idea that the satisfaction from helping others will be worth it in the end.
“The sense of achievement brought by this occupation fascinate me a great deal, and I believe that the busy work and tense doctor-patient relationship will not be real obstructions.”
He also feels that there is need for reorganization of medical care and looks to the government for solutions.
“The occupation itself should not be blamed, for the real problems are in management systems of the hospital and the medicine system. It is one of reasons why our government is promoting the medical care reform. It is same in those events that doctors are injured by patients or their families. In order to avoid such events forever, we should face with those problems in hospital systems and help to solve them instead of escaping from them. Those tragedies shouldn’t be reasons that prevent us from becoming a doctor, but should be the motivation for us to choose this profession. Only though the continuous efforts of more talented and responsible doctors will the medicine system become better. It will ultimately benefit everyone in the society, not just doctors.”
He ends on an upbeat tone:
“In conclusion, I don’t worry about the disadvantages and dangers of being a doctor. I believe it is my duty to contribute my efforts to make it better. Obviously, no job is perfect and 100-percent safe. The only one thing that we can do is keeping our enthusiasm to do the job well and try to change it for the better. Eventually, I explained all of the reasons why I want to stick in the way to be a doctor to my parents and then they became relieved and totally supported me.”
Our students are appropriately concerned about violence against doctors. They have thoughtfully considered the problem and are looking for solutions. China has been proactive and a recently, June 1st, 2020, a law went into effect protecting doctors. The law “bans any organization or individual from threatening or harming the personal safety or dignity of medical workers, stipulating that their personal safety and dignity shall not be infringed on and that their legitimate rights and interests are protected by law.” (4)
Violence against doctors is not limited to China. Recently in the United States there have been threats against Dr. Anthony Fauci, a brilliant researcher, administrator and physician who has been in the spotlight while leading America through the COVID-19 pandemic. I have great affection and respect for Dr. Fauci. I read his chapters in “Harrison’s” textbook of Internal Medicine as a student and resident and have heard him speak at American College of Physician meetings. In the 1980s he was a voice of calm and reason during the tumultuous early days of HIV/AIDS. At that time, he routinely met with lawmakers from both sides of the isle, gay activists, and scientists and worked to find solutions to HIV. The death threats against him today remind me of the persecution of other scientists like Galileo. Real leaders accept personal risks when they work to bring humanity forward out of ignorance and into enlightenment. Certainly, patients are scared and vulnerable. They may suffer from denial and feel tremendous anger. What amazes me now is that we have moved to a place where people are calling for and committing premeditated violence against doctors. I join with the students and agree that we must look for ways to provide good health care for all and do it in a way that is both effective and safe, for patients as well as doctors.
***Poems***
“On the afternoon of Jan 20, Tao Yong, one of the best ophthalmologists in China, suffered a vicious attack. A man who was unsatisfied about the therapeutic effect took a cleaver to the seventh floor of Beijing Chaoyang Hospital and struck Tao on the back of the head and neck, and fractured Tao's left hand and caused nerve damage. “To be honest, I become timid now. I have spent numerous time and energy to save someone. But when people are cured, they want to kill you. Why?” said Tao after left ICU.
The afternoon of Jan 20
Finish a surgery,
I back to the office to put reports in order.
Work for hours with high-intensity,
I am exhausted now.
“Dr. Tao, a patient wants to talk with you,”
the nurse says out the door.
I stepped out of office,
and see a familiar face.
All of a sudden,
screams run out,
as well as scarlet liquid.
Lying on the floor,
I think
I can relax now.
Wendy’s student, Yvonne, wrote a poem about her concern for the well-being of her doctor father.
"Back in February, one day at about four o’ clock early in the morning, I woke up because of a nightmare and could not fall asleep because I opened up the WeChat moments and saw many posts about the pandemic. I went downstairs to seek my parents for help. I usually did this when I was little, getting up early and climbing into their bed. They were having light sleep, so when I woke them up, they were not surprised to find me in their bed. My father asked me if there was anything that bothered me. I told him all my worries. He was moved. We had a deep talk. I have never had such a long conversation with my father about his work before. And this poem is about one of the stories he told me during that talk."
No Emergency
A cold rainy night,
sitting in the emergency room,
Lights were on,
bright everywhere,
Room empty,
so no emergency.
I was glad.
But also worried.
Worried about an upcoming emergency
breaking out in the next second.
I said to myself
“This is a hospital.
Anything could happen here.”
I started to reflect on the past month
since I graduated and entered this hospital.
It was a completely new stage of my life,
leaving school and having a job.
It was weird.
It turned out things were easier
back in the medical school.
I had little experience dealing with emergencies that happened at night.
I prayed in my heart that nothing would happen.
I wondered what my wife and daughter were dreaming.
They must have been asleep for a long time.
I worried about this month’s rent.
I hoped we could make ends meet.
Midnight came.
Perhaps this would be
a peaceful night,
one that an emergency room
does not usually have.
When I was in a trance,
a young man suddenly broke in.
I knew things would not be so easy for me.
Unlike other patients who broke into the emergency room at the midnight,
he seemed okay, no bleeding, no obvious injury
But there must be something wrong with him
which I could tell from the look on his face.
I asked him what was the matter
Then he started to speak:
“I have AIDS, give me money or I’ll jump from that building right before your eyes.”
Oh, come on, I am a doctor, not a bank!
I yelled inside of me but I tried to persuade him to leave.
He only got more furious and threatened that he was going to bite me and get me infected.
I was terrified, so I handed in two hundred yuan to him, which was a fifth of my salary.
He took the money,
left quickly,
disappeared without a trace.
References:
1) Violence against doctors in China BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e5730 (Published 07 September 2012)Cite this as: BMJ 2012;345:e5730
2) Violence against doctors: Why China? Why now? What next? The Lancet March 22, 2014DOI:https://doi.org/10.1016/S0140-6736(14)60501-8
3) Shukun Yao,1,* Qing Zeng,1,* Mingqiang Peng,1,* Shiyan Ren,corresponding author2 Gang Chen,1 and Jiangjun Wang1 J Stop violence against medical workers in China Thorac Dis. 2014 Jun; 6(6): E141–E145. doi: 10.3978/j.issn.2072-1439.2014.06.10
4) China 14:19, 28-Dec-2019 China adopts new law to stop violence against medical workers CGTN
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