Chinese doctors under threat: who will repair the broken windows?
This is a guest post by Yina Xiao, a Researcher here at Bocconi University, about an under-reported (suppressed?) challenge currently facing the medical profession in China…
Last Friday, April 13th, a serial killer attacked the chief of the E.N.T. department in Peking University’s 2nd affiliated hospital (Renming Hospital) and a resident working in the emergency department of the No. 711 hospital (for reports in Mandarin, see here and here). Both of the doctors were stabbed in the neck and, following surgery, are now back to the Intensive Care Unit for further treatment. These terrible attacks follow the murder of one doctor less than a month ago (on March 23rd) and injury to three further medical personnel by a patient at the No. 1 teaching hospital of the Harbin Medical University in northeast China’s Heilongjiang Province. The patient believed that the doctor was unwilling to take care of him.
According to rough estimates, between 2000 and 2010 more than 10,000 medical staff were injured annually, with 11 medical personnel killed by their patients. This increasing violence towards doctors in China’s hospitals has significantly affected the working environment of medical staff, turning hospitals into battlegrounds. The Lancet reported in 2010 that: “being a doctor has become a dangerous job in China”. Little, it seems, has been done since that report to make the lives of medical personnel less dangerous.
These increasingly frequent and violent incidents remind me of the broken windows theory. The theory goes that when there is a building with a few broken windows, if the windows are not repaired, people will tend to break more. If we imagine the hospital environment, the security of medical personnel, and the further interests of the patient as a building, then the violent attacks are the smashed windows. Without repairmen from the outside, inevitably violent events such as these will increase. Despite such terrible attacks, the authorities have not implemented any further protection for medical personnel. At the same time, the media continue to demonize the image of doctors as the ‘greedy evil’.
However, what worries me more are the reasons beneath the violence. After economic reforms in 1980, the so-called “public hospitals” now receive such limited ﬁnancial support from the government that those hospitals must generate income to cover costs. With modest salaries, even by Chinese standards, many doctors struggle to make ends meet in an economically booming China. One consequence has been over prescription of drugs and an increase in unnecessary examinations, and increasing incidence of doctors receiving ﬁnancial kickbacks from drug companies.
On the patient’s side, with inadequate coverage of medical insurance, the poor cannot afford treatment for illness without risking bringing their whole family into poverty. Social pressure – raised by problems such as the serious housing issue in China or the economic inequality gap between a poor older generation and a much more affluent second generation - is creating flashpoints. The physician-patient relationship is becoming one of the most evident examples nowadays in China.
The pressure has already pushed the doctors and patients to the edge, and windows are being broken. Who is supposed to repair these broken windows? Clearly the newly implemented medical reform has been a total failure in this regard.
Last Saturday (14th April) was Beijing University’s open day. The number of visits to one of the best medical schools in Beijing decreased by over 40% compare to last year. To illustrate this, compare the following two photographs:
The first picture is the bustling Peking University reception area (busy, right?); the second (below) is the reception to Peking University’s Health Science Center (spot the difference).
Under the current pressures (both physical and psychological) now facing medical staff in China, one has to wonder – will there be any more doctors in the future?