ABSTRACT
Introduction The morning of October 25, 2013 started the same as any other. As a part of his daily routine, Dr. Wang Yunjie left home early, at about 7:00 a.m., and headed toward the hospital where he had worked for decades. Earlier in the morning, Lian Enqin – a villager from the Pu’ao Village of the town of Ruoheng, just over ten miles away – stepped out of his home and got on a bus leaving for the same hospital. Lian was carrying his bag as usual, but this time he also brought along a sharp knife and a hammer. At 8:00 a.m., Dr. Wang walked into his consulting room, where more than ten patients, including Lian, had been waiting. Several minutes later, a quarrel could be heard coming from inside. Dr. Wang staggered out of the room screaming, pursued by Lian, who was holding a blood-stained knife. At 8:27 a.m., Dr. Wang passed away. One week later, local medical workers held a strike and protested in the streets. This seemingly bizarre incident took place in Wenling, Zhejiang Province. As a matter of fact, this incident was far from unique – there were 13 other violent attacks on doctors across China in the two months of October and November 2013 alone. For those working in China’s health care system, those were two long, dark months. On the same day as the Wenling tragedy, similar loud noises could be heard in the in-patient department of Section Y in Hospital X in Guangzhou,1 where a patient refused to receive medical care and quarreled with the nurses. From the patient’s perspective, the nurses were about to hurt him by giving him useless medicine. He had spent a small fortune on the treatment, but his condition did not improve. Clearly, a deteriorating doctor-patient relationship harms both doctors and patients. If a patient does not trust his or her doctor, it will be more difficult for the doctor to accurately assess the patient’s condition, and the patient will be more likely to distrust the diagnosis and proposed treatment and hence fail to comply with the medical advice. In extreme cases such as the ones mentioned above, distrust could lead to resentment, aggression, and violence against medical workers. In fact, cultivating an amiable and mutually respectful doctorpatient relationship is an important part of improving the quality of health care and promoting public health reform. Nevertheless, contemporary Chinese society has been experiencing a severe trust crisis in terms of the doctor-patient
relationship. Such a crisis has led to serious consequences, including violence against doctors and other health care workers. The data released by the Chinese Consumers’ Association showed that the average number of medical complaints was 2.64 per month in 1996; 10.17 in 1997; 11.75 in 1998; and 22.25 in 1999. In three years, the number rose ten-fold. In 2000, the Chinese Medical Association conducted a study in 326 hospitals in China and found that 98 percent of them had been involved in medical disputes. Many of these disputes received widespread media coverage. In addition, statistics showed that there were 1,567 cases in which patients caused disruption in 71 level-3 and level-2 hospitals2 in Beijing during 1998-2001 alone. Among them, there were 502 cases in which medical workers were physically assaulted, and 90 people suffered from long-term disability as a result (Song et al. 2003). Since 2000, the incidence of violence against medical workers has been increasing at around 11 percent annually (Zhu and Xu 2013). Between 2008 and 2012, the average number of assaults annually against doctors went up from 20.6 to 27.3 per hospital. A 2013 large-scale national survey carried out by China Youth Daily showed that two-thirds of respondents did not trust “doctors’ professional diagnosis and treatment,” citing reasons including lack of public health services; negative media reports; and lack of trust between doctors and patients (Xinhua, November 12, 2013). This chapter explores the crisis of trust between doctors and patients in contemporary urban China by examining the current doctor-patient relationship and social policies in the city of Guangzhou. Based on extensive ethnographic fieldwork, this study intends to provide a comprehensive analysis of the origins of this loss of trust from individual, institutional, historical, and social perspectives. During July to October 2013, we conducted a three-month field investigation in the outpatient department at a major level-3 hospital (henceforth known as “Hospital X”) in Guangzhou, China.3 We interviewed a total of 20 patients and family members; 15 doctors; and 10 nurses. Each interview lasted approximately 1-2.5 hours. We recorded all the interviews following the approval of the interviewees and the consent forms signed by them. Subsequently, the recording was transcribed and the transcribed files were encoded using Atlas. This chapter also discusses some recent reform measures and reaches the conclusion that it is imperative to re-establish a mechanism for increasing overall trust between doctors and patients in China.
