Chinese Change: Medical Malaise

Shanghai is finally taking more action to combat the growing problem of attacks on health care workers, urging hospitals to take better measures to improve security to prevent such clashes. The campaign is certainly a good first step, though much more needs to be done to tackle a growing problem that looks quite bizarre to a westerner who never heard of such attacks before coming to China.

Obviously there are many reasons for this problem, which in extreme cases has even seen doctors killed by angry patients who believed they or their relatives received inferior health. While lack of civility is partly to blame, health care professionals themselves are bear some responsibility for this strange and unacceptable behavior that has no place in modern society.

The real culprit is China’s medical system itself, which puts far too much emphasis on profits and awards lowly status to doctors who often work long hours for low pay. Many of these issues have emerged as the country transforms from an old socialist system where everyone got free medical care through their state-owned work units, to one where most people have to pay for their own care.

Barely a week goes by these days without a new report on the latest attack on a doctor or hospital staff by angry patients. Such stories are plentiful partly for technical reasons, since most hospitals have extensive closed-circuit monitoring systems that provide graphic and sometimes chilling records of such attacks.

Stories showing frustrated patients destroying medical equipment and beating hospital employees have become common fare on the TV news. One particularly chilling incident last year saw an upset patient stab his doctor to death and injure two others in the Zhejiang city of Wenling.

Another disturbing case happened just last week here in Shanghai after a woman suspicious that something was wrong with her pregnancy went to a Pudong hospital for an examination. Doctors later removed the fetus, which was stillborn. The next day, more than 50 members of the woman’s family returned to the hospital demanding an explanation, and started a melee that saw several people seriously injured.

The shameful practice has even spread to foreigners, and I was shocked to read about another case last year where an Italian man attacked a doctor in Zhejiang after he thought he wasn’t getting preferential treatment.

Responding to the growing tide of discontent and attacks, Shanghai’s public security bureau has embarked on a round of unannounced visits to major hospitals in recent weeks to see what they are doing to improve security. It should come as no surprise that many hospitals are taking on an almost fortress-style approach, hiring retired military personnel to maintain security and also installing extensive monitoring systems.

While this kind of response is certainly understandable and could help to reduce the problem in the short term, a more systemic approach is needed to really tackle and eradicate this problem over the longer run. The two biggest problems lie in commercial pressures, and the general lack of respect by many Chinese towards health care workers.

In a bid to make as much money as possible, many hospitals have become assembly lines where doctors try to see as many patients as possible in the shortest time. That means doctors spend very little time with each patient, with the result that their diagnoses are often inaccurate. While that may be inconvenient for a patient with a skin rash or stomach ache, it could be deadly for patients with more serious problems that go undetected.

This kind of problem exists far less in the US because doctors generally charge higher rates for their services, and also because many work in their own private clinics that have much lower operating costs than big hospitals. My doctor visits in the US typically last 15 minutes each, including lengthy discussion of my complaint and often a brief examination by the doctor.

By comparison, I’m lucky if my visits with doctors in China last for more than 3 minutes each. Such visits usually consist of 1 or 2 questions about my complaint and then the writing of a prescription for medicine. Sometimes there’s also a quick medical examination, but just as often the doctor never even takes time to examine me. Some corrupt doctors do offer better service in exchange for bribes, further fueling resentment from less affluent patients and also undermining their image.

Then there’s the problem of lowly status for doctors in China. Many of the Chinese doctors I talk to complain of a general lack of respect for their profession, and few would encourage their children to choose medical careers. Many also complain of long hours, and some even say they regret their career decision. With that kind of lowly status, it’s not surprising that some people feel less inhibited about attacking these medical workers when they feel they’ve been treated unfairly.

By comparison, doctors in the US have a much higher status, and careers in medicine carry a high level of prestige. Salaries are also far higher than the national average. Getting admitted to a medical school is quite competitive, and many parents encourage their children to pursue such careers.

China’s medical system is clearly going through some major growing pains, as it attempts to transform into an efficient, commercial-oriented system that provides good care for everyone. But it’s falling well short of that goal right now, often leading to frustration and cynicism from patients and society as a whole.

Perhaps the new security and better education among average Chinese will help to curtain the problem of attacks on medical workers in the short term. But until the country addresses the bigger problems of unreasonable commercial pressures and lack of social status, the kind of resentment and frustration that leads to such attacks is likely to continue.