Restoring Doctor-Patient Trust to Curb Violence Against Doctors.

Violence against doctors is a global concern. Specifically, Chinese medical workers face severe violence on a large scale. According to a survey by the Chinese Hospital Association (CHA), on average, 27 violent incidents involving doctors occur in each Chinese hospital every year. Violence against doctors occurs for many reasons, and the most common is the loss of trust between the doctor and the patient, which worsens the doctor-patient relationship. We found that the loss of doctor-patient trust is attributed to changes in the doctor-patient relationship to a seller-buyer interaction. Patients have high expectations of medical technology, while effective communication between doctors and patients is lacking. Restoring doctor-patient trust could help reduce and reduce violence against doctors. The Chinese government should take effective measures to improve the doctor-patient relationship based on medical reform. Medical institutions and social networks should provide medical knowledge to common people and guide patients to establish reasonable expectations for treatment. Health departments should train physicians and patients in communication skills to improve the efficiency of communication between physicians and patients and restore patients' trust in physicians.

Introduction

Violence against doctors is a global concern, and violent incidents against doctors are frequently reported in media worldwide. Chinese media have reported many incidents of killing and injuring doctors over the past few years. According to the reports of China’s highest judicial body, Chinese medical workers risk being injured, maimed, and even killed by patients or their family members.1 Although the Chinese government has started addressing and solving such problems, violence against doctors is still difficult to abolish.

In January 2020, a violent incident occurred at the Beijing Chao-Yang Hospital ophthalmology clinic, where three medical personnel were attacked. The chief physician Tao Yong was seriously injured and required two weeks to escape danger.2 After the media reported the incident, a heated discussion erupted among the public. Additionally, assaults against physicians are still increasing, and violence against doctors is widespread and increasing in hospitals.3 Based on the White Book on the Medical Practice of Chinese Doctors published by the Chinese Hospital Association in 2018, 66% of the doctors had experienced medical conflicts.4 There are 11 million medical workers in mainland China, and the rate of violence against physicians is 42%~83%.5

The law does not provide full protection for medical personnel. Nine sets of laws and three sets of administrative regulations in China provide legal protection to medical personnel and keep them safe. However, simply relying on the law as a deterrent cannot prevent all incidents of violence against doctors. At least 362 Chinese doctors have been injured, disabled, or even killed in the past 10 years.6

Violence against healthcare workers is on the rise. The number of such incidents has increased steadily, and the intensity of violence has gradually escalated from verbal and internet violence to physical harm and even murder.7 The Lancet has also reported on the scale, frequency, and severity of violence against Chinese medical workers.8

There are many reasons for this problem, but a key cause of such incidents is the lack of doctor-patient trust, which leads to tension between doctors and patients, thus causing violent conflicts. Therefore, taking effective measures to restore the trust between doctors and patients is required to minimize violence against doctors.

Discussion

The Lack of Doctor-patient Trust is Attributed to the Change in the Doctor-patient Relationship to a Seller-buyer Interaction, High Expectations of the Patients from Medical Technology, as well as the Lack of Effective Communication Between Doctors and Patients and Social Networks have Not Played a Positive Role in Improving Doctor-patient Relations.

The Change in the Doctor-Patient Relationship to a Seller-Buyer Interaction

The relationship between medical staff and patients has been reduced to a seller-buyer interaction. Patients and their family members hope to buy treatment. Many patients in the hospital think that they are consumers;9 thus, a medical dispute often arises when treatment does not meet their needs or expectations.10 China’s medical reform has also promoted changes in the doctor-patient relationship to a seller-buyer interaction. Patients need to pay for medical services, and doctors earn money from patients.11 Studies have shown that Chinese residents must bear 40.3% of hospitalization expenses in 2019.12 When patients have to pay for the medical services directly, a medical dispute is more likely to arise.13

Excessive Expectations of Patients from Medical Technology

The lack of doctor-patient trust might also be due to excessive expectations of patients from medical technology. With the rapid development of modern medical technology, patients are under the impression that modern medicine is omnipotent. Due to the lack of medical knowledge, patients and their family members might not understand that there are only a few diseases that modern medicine can cure. When the expectations of patients and their family members are not met, their relationship with doctors is adversely affected.10 Patients lose their trust in doctors and get angry with them. Studies have shown that 80% of the cases of violence against doctors are caused by patients’ dissatisfaction with the treatment provided.14 For example, in December 2019, an emergency medicine specialist at the Civil Aviation General Hospital was killed by a patient who felt dissatisfied with the treatment.15

Lack of Effective Communication Between Doctors and Patients

Lack of effective communication between doctors and patients might also lead to the loss of doctor-patient trust. An investigation of medical disputes occurring from 2014 to 2018 showed that the lack of effective doctor-patient communication is the major cause (76.9%) of these cases.16 Some doctors do not have the time or patience to listen to their patients, nor do they explain the patients’ conditions. The lack of effective doctor-patient communication causes a loss of trust.17 This might be due to a lack of training of Chinese doctors in doctor-patient communication, general communication skills, and the absence of concern toward patients.18 It might also be related to the unbalanced medical service system of China19 and an imperfect diagnosis and treatment system.20 Patients seek treatment in top hospitals, where the doctors often do not have enough time to communicate with the patients.21

Social Networks Have Not Played a Positive Role in Improving Doctor-Patient Relations

To attract readers and obtain economic benefits, news reports pay more attention to the conflict between doctors and patients. Some media have extended the misconduct of a few doctors to the whole group of physicians. Continuous reports not only describe the doctor-patient relationship as a social problem of tension, lack of trust, and decline of doctors’ morality but also raise individual problems in the doctor-patient relationship to universal problems.

Over-reporting doctor-patient relationships on social media will also lead to individual medical disputes turning into extreme media events. An example is China’s “maternal death event in Xiangtan City, Hunan Province” in 2016. In a normal medical event, in the early stage of reporting, words such as “maternal tragic death”, “bizarre death”, and “missing medical staff” filled a large number of media reports, and netizens’ emotions instantly showed a one-sided trend.22 This incident incited netizens to denounce the excessive emotional expression of the medical authorities, and local hospitals and the government were also under greater pressure from the public. Extreme emotional expression, in turn, affects truth investigation and brings long-term disharmony to the doctor-patient relationship.

Conclusions

The key to restoring doctor-patient trust is to improve the doctor-patient relationship and provide medical knowledge to common people to guide patients in establishing reasonable expectations of treatment and improving the efficiency of doctor-patient communication and social media changes reporting strategies and building communication platforms.

Improving the Doctor-Patient Relationship

The Chinese government should take measures to improve the doctor-patient relationship. Disease treatment is not a seller-buyer relationship. To build a harmonious doctor-patient relationship, the government should promote the rational distribution of medical resources, relieve stress among doctors, increase their salaries, reduce patients’ medical expenditures, and advocate humanistic care during treatment. According to official data, China’s total health expenditure accounted for 7.12% of GDP in 2020, which was only US$769 per capita19 and lower than that of many developed and developing countries. Chinese medical workers are not paid highly. So, they work well over 40 h per week to get better pay.23 China needs to invest more in the medical field to motivate medical staff and reduce medical expenses to improve the doctor-patient relationship.

Providing Medical Knowledge to Patients for Guiding Them and Establishing Reasonable Expectations for Treatment

The government should provide basic medical knowledge to patients. Medical and healthcare institutions and the media should also guide patients in developing a reasonable understanding of disease treatment. The whole society should participate in health education activities to increase the understanding of people regarding common diseases, chronic diseases, and major diseases. These measures should be implemented at the earliest. When a patient is suffering from a critical disease, it is even more important to guide them in understanding the disease and the efficacy of modern medical treatment. By helping them establish reasonable treatment expectations, further medical conflicts might be alleviated, and trust in doctors might be restored.

Improving the Efficiency of Doctor-Patient Communication

Effective communication between doctors and patients can help to improve the level of doctor-patient cooperation, ease the tension between doctors and patients further, and restore trust in doctors. About 90% of Chinese medical workers believe that “poor doctor-patient communication” is the main reason for doctor-patient tension and loss of trust.24 Therefore, the government and hospitals should help doctors and patients improve their communication skills. Doctors should learn as much about the patients as possible, show humanistic care, and communicate effectively with them. Patients should have high treatment compliance, follow the doctor’s advice, be open about their conditions, communicate freely with the doctor, and look at the treatment reasonably. Such cooperation can enhance doctor-patient trust.

Social Media Changes Reporting Strategies and Builds Communication Platforms

Social media should increase the number of positive reports on doctor-patient relations. Objective, accurate, and fair news reports will help establish a good doctor-patient relationship. When dealing with the report of doctor-patient relationships, we should establish a long-term and in-depth reporting mechanism. Learning from the New York Times, which is good at using continuous reports to reflect the occurrence, development, outcome, and impact of doctor-patient events, will help to establish a harmonious doctor-patient relationship.

Social networks use the characteristics of high public participation to build a communication platform for doctors and patients. Some studies show that providing an online communication platform for doctors and patients will effectively improve the doctor-patient relationship.25 Through social platforms, patients seek opportunities to communicate with doctors and obtain emotional support, effectively reducing depression and psychological trauma and more conducive to disease recovery.26 At the same time, the interaction of messages between doctors and patients on social networks is not only conducive to the dissemination of medical knowledge to patients and the establishment of reasonable government expectations but also broadens the communication channels between doctors and patients, which has a positive impact on doctor-patient relations.27

Zhejiang Province launched a doctor-patient communication project centered on the diagnosis and treatment experience of patients.28 China has started to promote the construction of Internet hospitals to facilitate online and offline doctor-patient communication.29 These measures might have a positive influence on the health system.