FANG LIJIE : Doctor-patient conflicts go beyond medical realm
In recent years, tensions between doctors and patients in China have been on the rise, resulting in a series of attacks against doctors by their former patients. And conflicts between the two groups appear to be escalating.
In China, grievances toward doctors began emerging in the late 1990s, with accusations of profiteering by hospitals and doctors. The conflict escalated into recurring “medical disturbances,” which even deteriorated into assaults on doctors.
To resolve these problems, many argue that most effective measures are reforms to the healthcare system and severe punishments for those who attack doctors. However, is this the only way to establish mutual trust between the two groups? The answer remains uncertain. Therefore, more in-depth analysis is needed on the motives and behaviors of doctors and patients.
Medical professions are characterized by a high level of specialization, leaving common people unable to provide supervision and forcing them to rely on two regulating channels: one is external, which mainly refers to the regulation by the government as well as medical insurance institutions. The other is internal. Doctors can police themselves as an occupational group, which is comparatively more effective and encouraging. The American College of Physicians sets a good example. It is one of the major forces that wield influence on U.S. healthcare policy. Tensions began to arise in the mid-1990s when medical services in China became commercialized, prompting doctors to become more and more motivated by market incentives. However, government regulation has failed to keep pace with the trend.
In addition, a real physicians’ association has failed to take shape in the country, which is to say, doctors are autonomous, unprotected by medical organizations and free from strict occupational restrictions. This may drive some doctors to seek excessive profits by themselves in violation of professional ethics.
In China, patients are also autonomous. At present, there is basically no patients’ association or other specialized social organizations to offer them help. So patients have to put all their trust in the doctors, leading to overly high expectations. In addition to their deficient medical knowledge, patients are undoubtedly at disadvantage.
Moreover, China has not yet established a system of family physicians, and the quality of medical services at the local level remains low, leading to an over-concentration of medical resources in big hospitals, which are usually over-crowded. For those who manage to register and get hospitalized after strenuous efforts, it is difficult for them to get personalized care because of doctors’ excessive workloads. Under such circumstances, medical staff has become the focal point of medical contradictions and the target of patients’ discontent.
Tackling these conflicts should not be confined to the medical realm. It is also an issue of social governance. As members of society, doctors lack a sense of belonging and are not bound by sufficient codes of professional conduct. From the perspective of social relationships, it is hard for doctors and patients to maintain lasting and stable interactions with each other. The feeling of estrangement and resentment between them still remains. In a broader sense, the high management costs and low levels of efficiency in the medical realm are also due to an absence of an effective social mechanism.
Hence, the fundamental solution to ease the tensions between doctors and patients is to establish specialized social organizations for the protection of both parties’ interest and maintain long-term steady interactions between the two.
In fact, the doctor-patient relationship is just one of the social relations in modern society. The logic for resolving this issue could also be applied to other social realms. Other social problems emerging in today’s China can be interpreted through the lens of autonomous entities and social organizations, such as the decline of mutual trust between different segments of society, frequent non-rational violence as well as the safety risks of various services and products.
Fang Lijie is from the Institute of Sociology at Chinese Academy of Social Sciences.
The Chinese version appeared in Chinese Social Sciences Today, No. 631, August 10, 2014
Edited and translated by Bai Le
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