Communication in the Chinese doctor–patient–family relationship: a qualitative study of expectations and experiences in a breast surgery setting

Abstract

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.

Exploring the growth patterns of medical demand for eye care: a longitudinal hospital-level study over 10 years in China

“…From 2011 to 2012, the revisit interval to ZOC decreased dramatically. In GZ City, the revisit interval decreased from 26 [9, 71] days (2008-2011) to approximately 21 [7,58] days (2012-2017) (Wilcoxon ranksum test P<2.2e−16) (Figure 4A). In other cities in GD Province, the revisit interval decreased from 28 [9,71] days (2008)(2009)(2010)(2011) to 17 [7,47] days (2012-2017) (Wilcoxon rank-sum test P<2.2e−16) (Figure 4A).…”

“…In GZ City, the revisit interval decreased from 26 [9, 71] days (2008-2011) to approximately 21 [7,58] days (2012-2017) (Wilcoxon ranksum test P<2.2e−16) (Figure 4A). In other cities in GD Province, the revisit interval decreased from 28 [9,71] days (2008)(2009)(2010)(2011) to 17 [7,47] days (2012-2017) (Wilcoxon rank-sum test P<2.2e−16) (Figure 4A). Comparing the results among other provinces in China, the revisit interval in GD Province decreased from 26 [9,71] days (2008)(2009)(2010)(2011) to approximately 20 [7,55] days (2012-2017) (Wilcoxon rank-sum test: P<2.2e−16) (Figure 4B), while in other provinces, the revisit interval decreased from 21 [7,63] days (2008)(2009)(2010)(2011) to approximately 13 [4,35] days (2012-2017) (Wilcoxon rank-sum test: P<2.2e−16) (Figure 4B).…”

“…These increases also inflict heavier burdens on the eye care system (5,6). Increasing outpatient visits reduce each patient's meeting time with doctors and cause doctor overload, resulting in insufficient medical communication (7). Previous studies have revealed that uneven medical demand distributions, such as the weekend effect (8)(9)(10) and the July effect (11,12), are related to unsatisfactory medical outcomes.…”

“…Non-local patients from other cities other than Guangzhou in GD Province visited ZOC more frequently than local patients in GZ City each year after 2010 (Wilcoxon rank-sum test: *, P<0.05; **, P<0.01). In GZ City, the revisit intervals decreased from 26[9, 71] days(2008)(2009)(2010)(2011) to approximately 21[7, 58] days (2012-2017) (Wilcoxon rank-sum test: P<2.2e−16). In other cities of GD Province, the revisit intervals decreased from 28[9, 71] days (2008-2011) to 17[7, 47] days (2012-2017) (Wilcoxon ranksum test P<2.2e−16).…”

“…In GZ City, the revisit intervals decreased from 26[9, 71] days(2008)(2009)(2010)(2011) to approximately 21[7, 58] days (2012-2017) (Wilcoxon rank-sum test: P<2.2e−16). In other cities of GD Province, the revisit intervals decreased from 28[9, 71] days (2008-2011) to 17[7, 47] days (2012-2017) (Wilcoxon ranksum test P<2.2e−16). The revisit intervals decreased sharply between 2010 and 2012.…”