The social practice of medical guanxi (personal connections) and patient-physician trust in China: an anthropological and ethical study.

In China's healthcare sector, a popular and socio-culturally distinctive phenomenon known as guanxi jiuyi (medical guanxi), whereby patients draw on their guanxi (personal connections) with physicians when seeking healthcare, is thriving. Integrating anthropological investigation with normative inquiry, this paper examines medical guanxi through the lens of patient-physician trust and mistrust. The first-hand empirical data acquired - on the lived experiences and perspectives of both patients and physicians - is based on six months' fieldwork carried out in a county hospital in Guangdong, southern China, which included in-depth interviews with 20 patients and 20 medical professionals. Patients who emphasized the positive effects of guanxi on patient-physician trust believed that it facilitates access to experienced medical specialists, enhances clinical communication, and reduces the financial and medical risks of over diagnosis and overtreatment by physicians. At the same time, these findings reveal patients' strong sense of mistrust, not only towards individual health professionals but also to the medical profession and China's commercialized healthcare industry. While some health professionals in the study responded favourably to medical guanxi, most were opposed to it on the grounds that it undermines professional standards and equitable healthcare. We found that the practice of medical guanxi is not morally justifiable, chiefly because it reinforces the present high levels of patient-physician mistrust and erodes trust between patients and the medical profession as a whole. In China, both the medical profession and the state need to promote patient-physician trust based on medical professionalism and institutional norms, rather than on guanxi or individual relationships.