Background Problems facing the doctor-patient-family relationship in China, including violence against doctors, have received international attention. Possible reasons for tension in the medical relationship include systems-level challenges such as imbalances between provider and patient populations and a biased media. Yet limited empirical work has been done to examine how interpersonal dynamics, particularly communication, between patients, their family members, and providers contribute to satisfaction or tension. The aim of this study was to identify actionable communication factors contributing to tension in the Chinese doctor-patient-family relationship among breast surgeons, surgical patients, and their family members in an urban, tertiary-level teaching hospital in Hunan Province, China. Methods We conducted a qualitative study between June and August, 2015. We recruited a convenience sample of 29 participants, including 11 breast lumpectomy inpatients, nine corresponding family members, and nine breast surgeons. In-depth, semi-structured interviews were conducted perioperatively in Mandarin and English, with patients and family members interviewed before and after surgery when possible. Interviews were transcribed and translated into English. Transcripts were coded and a thematic analysis was applied. Findings We identified three emergent themes. First, trust deteriorated before and during the health-care experience. Second, the health-care-seeking experience for patients and family members was marked by unmet expectations for achieving a basic understanding as well as powerlessness. Third, societal pressures on doctors contributed to a state of learned helplessness. Interpretation Our findings suggest that tension between doctors, patients, and family members is associated with both interpersonal and structural challenges, with communication having an important role. Reforms at all levels are needed to promote empowerment by providing a more patient-centred experience for patients and family members while ensuring the wellbeing and security of providers.

No abstract

ObjectiveTo identify actionable barriers to communication that contribute to tension in the Chinese doctor–patient–family relationship (DPFR) among surgeons, surgical patients and their family members.DesignWe employed qualitative research methods using in-depth, semistructured interviews in Mandarin and English and conducted preoperatively and postoperatively. Interviews were audio recorded, transcribed and translated into English. Data were analysed using thematic analysis.SettingAn urban, tertiary-level teaching hospital in Hunan Province, China.ParticipantsWe recruited a purposive sample of 11 inpatients undergoing the same minor surgery, 9 of their family members and 9 surgeons between June and August 2015.ResultsWe identified three emergent themes. First, trust degradation occurred before and during the healthcare experience. Second, the healthcare-seeking experience for patients and family members was marked by unmet expectations for achieving a basic understanding of the illness as well as powerlessness over their situation. Third, societal pressures on doctors contributed to a state of learned helplessness.ConclusionsOur findings suggest that tension in the DPFR is associated with interpersonal and structural challenges, with communication playing an important role. Reforms at all levels are needed to promote a more patient-centred experience while ensuring the well-being and security of providers.