Easing Tensions

　　Disputes between medical staff and patients remain at an all-time high， highlighting the need for medical reform

　　A number of recent cases of violence against medical staff have brought the long-standing issue of tension between patients and doctors into the spotlight once more.

　　On March 21， a patient attacked three doctors with a 20-cm-long knife at the Fifth People’s Hospital of Shanghai. The 50-year-old man， who had been diagnosed with lymph cancer， was discharged from the hospital on March 17. His motive is under investigation， according to the police.

　　There have been a slew of similar headline-making incidents in which patients threatened， humiliated or harmed doctors.

　　On March 5， a doctor at the Chaozhou Central Hospital in south China’s Guangdong Province was forced into a public parade by the relatives of a patient whose life he failed to save.

　　Earlier in the month， a couple， who were both government officials， were punished for beating and ultimately paralyzing a nurse at the Nanjing Stomatological Hospital in east China’s Jiangsu Province.

　　Cases of doctors being attacked by patients or their families have increased， worsened and become increasingly intolerable in recent years， said Zhang Fan， an official with the Information Department of the Chinese Medical Doctor Association (CMDA).

　　According to the association’s research， disputes between doctors and patients often involved protests outside hospitals in the past. But in recent years， some disgruntled patients have become violent and have taken to beating up or even killing medical workers.

　　Wang Zhong， Vice President of Tsinghua University Hospital in Beijing， said that the assaults against medical staff make them fearful for their lives， which ultimately has a negative impact on medical services.

　　Rising medical disputes

　　China has about 1，000 top-tier public hospitals and each treats more than 10，000 outpatients daily. In many of these hospitals， patients often wait in long lines for hours before seeing a doctor for just a few minutes.

　　Many patients have also complained about the high costs of medical treatment， reportedly caused by some hospitals’ overemphasis on making profits. “Some doctors exaggerate patients’ illnesses so that they can prescribe medicine indiscriminately， or recommend unnecessary physical checks， which is part of the reason for this discontent among patients，” said Guo Yufen， Deputy Director of the Commission of Health and Family Planning of northwest China’s Gansu Province.

　　A sample survey conducted by the Chinese Hospital Association (CHA) from December 2012 to July 2013 showed that the annual average number of assaults on doctors per hospital increased from 20.6 in 2008 to 27.3 in 2012. The survey polled the staff and patients at 316 hospitals.

　　Meanwhile， about 70，000 medical disputes were reported nationwide in 2013， according to official statistics.

　　Along with rising doctor-patient tensions， medical workers’ reported career satisfaction has reached a new low， researches have found.

　　The survey conducted by the CHA showed that nearly 40 percent of responding doctors said that they had considered leaving the medical profession to search for alternative employment.

　　“If this sort of violence continues， doctors won’t fully devote themselves to saving lives. We are not respected or protected. Who will save us while we are saving others？” asked Yu Keyi， a physician at Peking Union Medical College Hospital in Beijing.

　　In fact， not only are doctors unhappy with their jobs， they are also discouraging their children from following in their footsteps.

　　According to another survey conducted by the CMDA at hospitals across 11 provinces in 2011， 78 percent of the 3，700 doctors it surveyed said that they did not expect their children to take to their profession in the future. Many of the doctors surveyed cited growing tensions between patients and doctors as well as the escalating violence in hospitals across the country in recent years.

　　In 2009， 62.5 percent of the 3，200 doctors the association surveyed expressed the same opinion， according to the CMDA.

　　“We conducted similar surveys around the country in 2002， 2004， 2009 and 2011， and we found that the proportion of doctors who want to see their children become doctors keeps dropping，” said Deng Liqiang， Director of the CMDA’s Legal Department.

　　Furthermore， more than 70 percent of those polled by the CMDA said that “excessive expectations from patients” also added to their work pressure and helped their thoughts about abandoning their careers in medicine.

　　Xing Zhou， Vice President of the Second Affiliated Hospital of Guangzhou Medical University in Guangdong， said that patients’ expectations need to be adjusted. “It is important for the public to have a clear understanding of medical science，” Xing said. “It is impossible to cure all diseases. It is not like other products or services.”

　　“Only one third of diseases can be effectively treated by medical science， and sometimes it’s hard to predict how a disease will develop，” said Deng， who was ever a doctor in central China’s Henan Province. “However， sometimes medical disputes occur when patients and their families feel that the treatment doesn’t meet their expectations.”

　　A rule issued by the Supreme People’s Court in 2001 stated that hospitals must provide evidence proving they are not responsible for injury to patients if a patient sues for allegedly flawed treatment.

　　Though the rule was scrapped in 2010， more and more people have already formed the idea that any dissatisfaction they feel about the treatment has something to do with the hospital， and that they will get compensation as long as they draw attention to their dissatisfaction， according to Deng.

　　Searching for a solution

　　In the wake of the rising spate of vicious attacks against medical workers， a number of security measures， including a permanent police presence， have started being introduced in major hospitals.

　　To deter fatal attacks and disputes that may lead to physical violence， two or three police officers will be stationed at each hospital， said Sun Haibo， an officer with the Public Security Management Bureau of the Ministry of Public Security. He also revealed that police authorities will train security guards in the hospital to offer mediation， to identify situations that could lead to violence， provide immediate help if a situation escalates and help gather evidence.

　　“Hospitals are often scenes of intense emotion as relatives and friends can be overwhelmed with their grief and act out of character. Mediation can be immensely helpful， but the safety of medical personnel is paramount，” Sun said .

　　Hospitals are also required to employ at least three security guards for every 100 patients they receive on a daily basis， but most have failed to meet this requirement.

　　On March 6， 90 members of the National Committee of the Chinese People’s Political Consultative Conference (CPPCC)， the national political advisory body， submitted a proposal on stepping up security to prevent attacks on hospital staff.

　　Ling Feng， Director of the Neurosurgery Department of Beijing’s Xuanwu Hospital and a CPPCC National Committee member， said that the proposal is meant to promote the Central Government to revise relative regulations to redefine hospitals as public places.

　　According to the current regulations， if a person disturbs order in a public place that person could be detained. “Currently， medical institutions are classified as ’inner security’ units and guarded by unarmed security staff hired by hospital management. Only when police guard hospitals can the security of medical workers truly be guaranteed，” Ling said.

　　The proposal also said that the “fundamental solution” to clashes between patients and the medical fraternity is to speed up healthcare reform.

　　“We have to admit that uneven distribution of medical resources is one of the underlying reasons behind rising doctor-patient pensions，” said Guo， the official in Gansu. “Patients flood into big hospitals where quality medical equipment and good doctors converge， which inevitably inflates consultation times and mars doctor-patient communication， creating strained medical relationships.”

　　“If the government wants to improve the situation， it should strengthen community hospitals and divert patients at major hospitals to smaller ones，” CMDA’s Deng said .

　　Another problem is the costliness and time taken by the legal procedures for solving medical disputes， which can last for months or even years， according to Shao Xiaoying， a professor with Fudan University.

　　Gao Chunfang， a member of the CPPCC National Committee， calls for a bigger role of law in preventing medical disputes from happening.

　　A specific regulation to maintain order in medical institutions should be issued， and anyone who disrupts order there should be punished by law， Gao said， adding that government departments should make joint efforts in handling medical disputes. “Authorities should be established to evaluate what’s behind the disputes， while specific courts need to be set up to handle such disputes to ensure justice，” he noted.

　　By Yin Pumin