The Lancet publishes findings of Harvard-sponsored initiative to strengthen patient-physician trust in China

An initiative co-launched by Arthur Kleinman and sponsored by the Harvard China Fund and the China Medical Board highlights a multidisciplinary approach to mistrust between patients and physicians in China.

In China, news of patients and their families attacking doctors and vandalizing hospitals is now commonplace. In May 2016, a patient stabbed his dentist to death in Guangzhou, demanding compensation for a procedure performed over two decades ago.[1] Less than two weeks later, an ear, nose, and throat doctor in Hunan province died after a patient’s family beat him, accusing him of not being vigorous enough in treating patients.[2]  According to a survey published by the Chinese Medical Doctors Association last year, over 13% of doctors reported being physically assaulted.[3] 

To address the violence and mistrust characterizing the patient-physician relationship in China, Professor of Anthropology (FAS) and Global Health and Social Medicine (HMS) Arthur Kleinman, Joseph D. Tucker (UNC – Chapel Hill), Jing-Bao Nie (University of Otago), Wei Zhu (Fudan University) and Bonnie Wong (Stanford University) organized a two-day conference at the Harvard Center Shanghai in October 2015. Public health officials, philosophers, lawyers, medical doctors, private sector leaders, and medical ethicists gathered to share their research, expertise, and develop actionable solutions for improving patient-physician trust in China. The Lancet has recently published a correspondence (URL here) on the findings of this multidisciplinary team and their coauthored white paper that aims to resolve issues contributing to a tense patient-physician relationship in China.  

The white paper (link here) underscores that strengthening patient-physician trust requires both immediate reforms in the health care system in addition to educational, legal, and ethical reforms. Multidisciplinary solutions proposed by the conference team include reforming physician salaries to incentivize better care, requiring medical humanities as a core component of clinical training, and ensuring safety during medical disputes while limiting preventive hospital security personnel. These suggestions align with China’s ongoing health care reform, which include initiatives for the pricing of medical services[4] and a yearlong crackdown to address violent conflicts at hospitals.[5]

The team emphasizes that conflicts between patients and physicians represent an opportunity for positive change. Professor Kleinman highlighted this point within the context of China’s growing middle class, noting that the middle class worldwide distinguishes itself with high expectations about standards and quality: “I think there is something positive about distrust—it means there is a higher expectation, people don’t expect to be treated in a rude, crude, incompetent fashion... they expect competence and caring.”

The Lancet white paper is part of a larger initiative organized by Joseph Tucker with support from the Harvard China Fund and the China Medical Board. The initiative began with a qualitative research study[6] on patient-physician trust and continues to promote research and innovative solutions to address this issue. One of the team collaborators Dr. Cheng Yu, a former visiting scholar at Harvard-Yenching Institute and current Sun Yat-sen University professor, recently launched a new Center for Medical Humanities in Guangzhou. The next step for the initiative involves using a participatory campaign to crowdsource messaging to rebuild patient-physician trust. The team is also working on a thematic issue on rebuilding patient-physician trust with a major international bioethics journal.

[1] “Retired Dentist Dies after Stabbing by Ex-patient,” South China Morning Post, May 7, 2016, accessed July 30, 2016, http://www.scmp.com/news/china/article/1942185/retired-dentist-dies-after-being-stabbed-ex-patient.

[2] Buckley, Chris, “A Danger for Doctors in China: Patient’s Angry Relatives,” The New York Times, May 18, accessed July 30, 2016, http://www.nytimes.com/2016/05/19/world/asia/china-attacks-doctors-hospitals.html?_r=0.  

[3] China Medical Doctor Association, “White Paper on the State of the Medical Profession in China,” May 28, 2015, accessed July 30, 2016, http://www.cmda.net/xiehuixiangmu/falvshiwubu/tongzhigonggao/2015-05-28/14587.html.

[4] The Central Government of the People’s Republic of China, “Notice on the Publication of Advancing Medical Price Reform,” July 6, 2016, accessed July 30, 2016, http://www.gov.cn/xinwen/2016-07/06/content_5088788.htm.

[5] National Health and Family Planning Commission, “Program to Crackdown on Illegal Crimes Interfering with Medicine,” July 8, 2016, accessed July 30, 2016, http://www.nhfpc.gov.cn/yzygj/s3589/201607/36d5fdfa42b1499d88503c25ac879ad1.shtml.

[6] Tucker JD, Cheng Y, Wong B, et al. Patient-physician mistrust and violence against physicians in Guangdong Province, China: a qualitative study. BMJ Open 2015; 5(10): e008221.