Rebuilding patient–physician trust in China

Tucker, Joseph D.; Wong, B. C.; Nie, Jing‐Bao; Kleinman, Arthur

doi:10.1016/s0140-6736(16)31362-9

Cited by 84 publications

(68 citation statements)

References 4 publications

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“…Primary prevention could focus on the structural and social issues that underlie medical violence in China 21. For example, improving patient-hospital staff communication may be a key strategy to bolster trust in medical providers and reduce misunderstandings about required medical treatments 26.…”

Section: Secondary and Tertiary Interventions Among Hcws In Chinamentioning

confidence: 99%

Prevalence of medical workplace violence and the shortage of secondary and tertiary interventions among healthcare workers in China

Hall¹,

Xiong

Chang

et al. 2018

J Epidemiol Community Health

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Medical workplace violence (MWV) is a key occupational hazard facing medical professionals worldwide. MWV involves incident where medical staff are abused, threatened and assaulted. MWV affects the health and well-being of medical staff exposed, causes significant erosion of patient-physician trust and leads to poorer health outcomes for patients. In China, the prevalence of MWV appears to be rising. Laws were enacted to keep medical staff safe, but clear surveillance and enforcement is needed to improve the condition. In the current essay, we conducted a systematic literature review to identify secondary and tertiary prevention programmes designed to ameliorate psychological suffering following MWV. This review identified only 10 published studies. A critical gap in the intervention literature exists with regard to addressing the public health burden of MWV.

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Section: Secondary and Tertiary Interventions Among Hcws In Chinamentioning

confidence: 99%

Prevalence of medical workplace violence and the shortage of secondary and tertiary interventions among healthcare workers in China

Hall¹,

Xiong

Chang

et al. 2018

J Epidemiol Community Health

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“…8 This erosion of trust is not a problem that is unique to the medical profession in India; evidence shows that it is a growing concern, globally, 12,13 and the Indian situation has parallels in many low- and middle-income country (LMIC) health systems. 14-16 A critical analysis of India’s response to the situation it faces can provide useful insight not only for India, but also to policy-makers in other LMIC contexts; this is the purpose of this paper. …”

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confidence: 99%

“…17 Relationships of trust involve one party, the trustor, harbouring positive expectations regarding the competence of the other party, the trustee (competence trust), and also the trustor, harbouring an expectation that the trustee will work in his/her best interest (intentional trust). 16 It has been argued that a more earned and conditional or critical trust is an appropriate basis for the doctor-patient relationship. 16 This is considered appropriate because of both, the costs and dangers of blind trust wherein there is a risk of corruption, exploitation, or domination particularly for those with a lack of resources, as well as due to the imperatives related to patient autonomy preferences.…”

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confidence: 99%

“…16 It has been argued that a more earned and conditional or critical trust is an appropriate basis for the doctor-patient relationship. 16 This is considered appropriate because of both, the costs and dangers of blind trust wherein there is a risk of corruption, exploitation, or domination particularly for those with a lack of resources, as well as due to the imperatives related to patient autonomy preferences. 18 Another important way of understanding trust relations in the context of healthcare is to distinguish between interpersonal trust – the trust between individual patient and individual care provider/doctor, and institutional trust, which relates primarily to trust in the medical profession or in the healthcare system.…”

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confidence: 99%

“…19 How systems trust and interpersonal trust relate to each other is, however, quite complex; trust in a particular care provider does not necessarily translate into trust in the medical profession or in the system as a whole, or vice versa. 16 Finally, a key feature of trust as a relational construct is its fragility; while it is difficult to earn trust, it is easy to lose it; trust needs to be continuously earned to maintain it at an optimal level, and to allow the doctor-patient relationships to function well. 20 It is with these understandings of the concept of trust that this paper argues for a more nuanced analysis of the state of affairs in the medical profession and the responses to it, in India.…”

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confidence: 99%

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Erosion of Trust in the Medical Profession in India: Time for Doctors to Act

Kane

Calnan

2016

Int J Health Policy Manag

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In India, over the last decade, a series of stewardship failures in the health system, particularly in the medical profession, have led to a massive erosion of trust in these institutions. In many low- and middle-income countries (LMICs), the situation is similar and has reached crisis proportions; this crisis requires urgent attention. This paper draws on the insights from the recent developments in India, to argue that a purely control-based regulatory response to this crisis in the medical profession, as is being currently envisaged by the Parliament and the Supreme Court of India, runs the risk of undermining the trusting interpersonal relations between doctors and their patients. A more balanced approach which takes into account the differences between system and interpersonal forms of trust and distrust is warranted. Such an approach should on one hand strongly regulate the institutions mandated with the stewardship and qualities of care functions, and simultaneously on the other hand, initiate measures to nurture the trusting interpersonal relations between doctors and patients. The paper concludes by calling for doctors, and those mandated with the stewardship of the profession, to individually and collectively, critically self-reflect upon the state of their profession, its priorities and its future direction.

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Effectiveness of a Quality Improvement Intervention on Reperfusion Treatment for Patients With Acute Ischemic Stroke

Wang

Zong

et al. 2023

JAMA Netw Open

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ImportanceReperfusion therapy is the most effective treatment for acute ischemic stroke but remains underused in China.ObjectiveTo evaluate the effect of a problem-oriented, culturally adapted, targeted quality improvement intervention on reperfusion therapy for patients with acute ischemic stroke in China.Design, Setting, and ParticipantsIn this stepped-wedge cluster randomized clinical trial, patients from 16 secondary and 33 tertiary hospitals in China with acute ischemic stroke within 6 hours of symptom onset were consecutively recruited between July 1, 2018, and June 30, 2020.InterventionsHospitals were randomly assigned to 1 of 3 sequences to receive the targeted quality improvement intervention (n = 5689), in which workflow reconstruction was promoted to reduce in-hospital reperfusion treatment delays, or usual care (n = 6443), in which conventional stroke care was left to the discretion of the stroke team.Main Outcomes and MeasuresThe primary outcome was the reperfusion therapy rate, a composite outcome of intravenous recombinant tissue plasminogen activator (IV rtPA) or endovascular thrombectomy (EVT) for eligible patients who arrived within 3.5 or 4.5 hours of symptom onset. Secondary outcomes were the IV rtPA administration rate among eligible patients who arrived within 3.5 hours of symptom onset, the EVT rate among eligible participants who arrived within 4.5 hours of symptom onset, the proportion of patients with door-to-needle time within 60 minutes, the proportion of patients with door-to-puncture time within 90 minutes, in-hospital mortality, and 3-month disability as measured by a modified Rankin Scale score greater than 2.ResultsAll 12 132 eligible patients (mean [SD] age, 66 [12.1] years; 7759 male [64.0%]) completed the trial. The reperfusion rate was 53.5% (3046 of 5689) for the eligible patients in the intervention period and 43.9% (2830 of 6443) in the control period. No significant improvement in primary outcomes was found for the intervention after adjusting for cluster, period, and imbalanced baseline covariates (adjusted risk difference [ARD], 5.5%; 95% CI, −8.0% to 19.0%; adjusted odds ratio [AOR], 1.26; 95% CI, 0.72-2.21) or for the secondary outcomes. However, significant improvements were found in secondary hospitals for reperfusion therapy (1081 of 1870 patients [57.8%] vs 945 of 2022 patients [42.9%]; ARD, 19.0%; 95% CI, 6.4%-31.6%; AOR, 2.24; 95% CI, 1.29-3.88), IV rtPA administration (1062 of 1826 patients [58.2%] vs 916 of 2170 patients [42.2%]; ARD, 20.3%; 95% CI, 7.4%-33.1%; AOR, 2.37; 95% CI, 1.34-4.19), and EVT (51 of 231 patients [22.1%] vs 37 of 259 patients [14.3%]; ARD, 13.6%; 95% CI, 1.0%-26.3%; AOR, 3.03; 95% CI, 1.11-8.25) in subgroup analyses.Conclusions and RelevanceIn this stepped-wedge cluster randomized clinical trial of patients with acute ischemic stroke in China, the use of a targeted quality improvement intervention compared with usual care did not improve the reperfusion therapy rate. However, the intervention may be effective in secondary hospitals.Trial RegistrationClinicalTrials.gov Identifier: NCT03578107

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Rebuilding patient–physician trust in China

Abstract: Health system reforms, violence against doctors and job satisfaction in the medical profession: a cross-sectional survey in Zhejiang Province, Eastern China. BMJ Open 2014; 4: e006431. 3Chen XY. Clinical bioethics in China: the challenge of entering a market economy.

Cited by 84 publications

References 4 publications

Prevalence of medical workplace violence and the shortage of secondary and tertiary interventions among healthcare workers in China

Prevalence of medical workplace violence and the shortage of secondary and tertiary interventions among healthcare workers in China

Erosion of Trust in the Medical Profession in India: Time for Doctors to Act

Effectiveness of a Quality Improvement Intervention on Reperfusion Treatment for Patients With Acute Ischemic Stroke

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