Patient–physician mistrust and violence against physicians in Guangdong Province, China: a qualitative study

Abstract

ObjectiveTo better understand the origins, manifestations and current policy responses to patient–physician mistrust in China.DesignQualitative study using in-depth interviews focused on personal experiences of patient–physician mistrust and trust.SettingGuangdong Province, China.ParticipantsOne hundred and sixty patients, patient family members, physicians, nurses and hospital administrators at seven hospitals varying in type, geography and stages of achieving goals of health reform. These interviews included purposive selection of individuals who had experienced both trustful and mistrustful patient–physician relationships.ResultsOne of the most prominent forces driving patient–physician mistrust was a patient perception of injustice within the medical sphere, related to profit mongering, knowledge imbalances and physician conflicts of interest. Individual physicians, departments and hospitals were explicitly incentivised to generate revenue without evaluation of caregiving. Physicians did not receive training in negotiating medical disputes or humanistic principles that underpin caregiving. Patient–physician mistrust precipitated medical disputes leading to the following outcomes: non-resolution with patient resentment towards physicians; violent resolution such as physical and verbal attacks against physicians; and non-violent resolution such as hospital-mediated dispute resolution. Policy responses to violence included increased hospital security forces, which inadvertently fuelled mistrust. Instead of encouraging communication that facilitated resolution, medical disputes sometimes ignited a vicious cycle leading to mob violence. However, patient–physician interactions at one hospital that has implemented a primary care model embodying health reform goals showed improved patient–physician trust.ConclusionsThe blind pursuit of financial profits at a systems level has eroded patient–physician trust in China. Restructuring incentives, reforming medical education and promoting caregiving are pathways towards restoring trust. Assessing and valuing the quality of caregiving is essential for transitioning away from entrenched profit-focused models. Moral, in addition to regulatory and legal, responses are urgently needed to restore trust.

Doctor becomes a patient: a qualitative study of health care work place violence related perception among junior doctors working in a teaching hospital in India

“…Several cross sectional surveys have been conducted in various parts of the world, but surprisingly, qualitative (perception) studies have scarcely been performed. 32,33,[41][42][43] The perception of young doctors has remained almost unexplored hitherto. To our knowledge this is the first qualitative study in India which has explored the perception of young (junior) doctors regarding health care work place violence.…”

“…Mutual trust between patients and health care providers has earlier been described as an implicit fundamental building block of clinical medicine and is believed to be a means of bridging the vulnerability, uncertainty, and unpredictability of healthcare. 41,49 In a qualitative study conducted in Guangdong province of China, a patient commented that hospital salaries cannot come close to matching money from kickbacks and commissions which doctors receive. In addition, patients have to propitiate doctors by means of favors, cash and gift as part of -hongbao".…”

The role of professionalism in clinical practice, medical education, biomedical research and health care administration

“…To read additional information related, here I recommend several literatures published by Annals of Internal Medicine (2002) [1] , New England Journal of Medicine (2015) [2] , BMJ Open (2015) [3] and Mayo Clinic Proceedings (2014) [4] , which are listed as references.…”

Derechos y deberes de los ciudadanos: de los usuarios y de los trabajadores de salud

“…Para los investigadores, implica un llamado para entender esta dinámica entre profesionales de la salud y los pacientes, que muchos perciben en evolución (5) ; para los docentes, conlleva una invocación a formar nuevos profesionales en una cultura de promoción a los derechos y deberes de los usuarios y del personal de salud, todos ciudadanos en salud.…”