Does the Impact of COVID-19 Improve the Doctor-Patient Relationship in China?

Dear Editor:

Since the outbreak of the coronavirus disease 2019 (COVID-19), the doctor-patient relationship has become a debated topic in China. According to Baidu, a popular Chinese search engine, 1,440,000 search results can be found correlating the keywords “COVID-19” and “doctor-patient relationship” as of 00:06 on May 11, 2020, indicating a growth in the level of interest regarding this topic.

Since the implementation of the reform and opening up of China in the late 1970s, there has been an increase in incidents of doctors who suffered from physical injury, emotional distress, harassment and killings in China. Although most of Chinese medical and health services have been improved in recent years, the incidence of doctor-patient conflicts has not decreased and the relationship between doctors and patients has continually deteriorated. According to the White Paper on the Practice of Chinese Doctors, published by the Chinese Medical Doctors Association in 2018, 66% of doctors experienced conflicts with patients, and more than 30% were treated violently. Amongst the 295 medical cases reported by Chinese media in the last decade (excluding Hong Kong, Macao and Taiwan), 362 medical workers were injured, 99 were attacked with weapons and 24 doctors lost their lives.

According to a media report, many Chinese medical workers believe that the doctor-patient relationship has been improved significantly due to better patient compliance, an increase of trust and respect, and outstanding medical staff during the period of COVID-19 outbreak in China. Dr. Yan Kang, the director of the Department of Intensive Care Medicine, West China Hospital in Sichuan University, China, said, “There is less tension between doctors and patients during major public emergencies, and patients and their families show more trust in doctors.” He had the experience of participating in the fight against SARS and medical work related to the 2008 Wenchuan earthquake, so he was sent to support Hubei Province from West China Hospital as the leader of the third group medical team. Meanwhile, in an article published recently in the China Youth Daily that supports the idea about the improvement of the doctor-patient relationship, a nurse who works in the intensive care quarantine zone for COVID-19 said, “Some patients who were in serious physical condition can be moody, but they showed great respect to medical workers. They turned their heads away from the nurses while coughing,” which is indicative of a clear move toward a more positive relationship.

Recently a survey from a forum of DXY, a well-known Chinese medical website showed that 13.94% of people believe that the COVID-19 situation could improve the doctor-patient relationship in China, while 61.57% did not believe it and the rest remained neutral, this being contradictory to the above observations and further going against the grain of the Chinese Government's positive publicity about the role of medical workers, the devotion of the medical staff in combating the epidemic and patients’ desire for effective treatment. This led to an issue of a notice jointly delivered by the National Health Commission and other units on February 8, 2020 aimed at ensuring the safety and good order of medical staff during the prevention and control of the COVID-19 epidemic, calling for a severe crackdown on medical-related illegal and criminal acts.

As a matter of fact, the root causes of the Chinese doctor-patient relationship can be analyzed from the following 3 aspects. The first one relates to societal reasons, for example, insufficient investment from the government, an unsound health insurance system, negative media hype, and traditional interpersonal relationships that allow for unfair treatment (including outpatient and hospitalization priority) as a start. The second one relates to the level of medical care provided, which is involved in hospital management systems, treatment procedures, doctor-patient communication, health service consciousness of medical staff and the skillset of doctors and nurses. The third one relates to considerations from patients, such as the lack of complaint management channels and enforceable patients’ rights system, miscommunication, unrealistically high expectations of curative effects of treatments and even inappropriate behaviors from the patients themselves. Regardless of the aspects mentioned above, a report authored by David Blumenthal and William Hsiao shows a similar opinion that while China's health care system has been evolving rapidly, its short history has already offered some lessons. Here, the authors focus on China's experience on health reform, which shows that it may be easier to reform the health insurance system than the medical supply system, and as per the analysis above the role of basic health care cannot be ignored in creating an effective health system.¹

Undoubtedly, it is difficult for China to improve the current situation about the doctor-patient relationship in a short term. However, it is essential to understand the fundamental causes of the disharmony and relevant aspects in which targeted reform measures can be applicable. It is clear that a harmonious relationship between doctors and patients is based on mutual trust, respect and cooperation. The Chinese government should seriously analyze the advantages and disadvantages brought by the current health care reform. It should not rely too much on health care privatization and the associated effects of increased health care competition but build an institution for sharing medical risks so as to improve the doctor-patient relationship effectively in China. In addition, a proper mechanism should be established to guide media publicity and raise the public awareness. Focusing more attention on doctors’ medical professionalism and reinforcing the quality education of health care for all citizens can facilitate an overall more effective doctor – patient relationship.

In summary, it is hoped that the conflicts between doctors and patients can be effectively resolved and prevented through a new round of medical system reform with the reference to the positive achievement in the fight against the COVID-19 epidemic and with the goal of creating a healthier and more harmonious doctor-patient relationship.