DOCTOR Wang Yunjie died in the hospital where he had worked for 23 years, the latest victim in a spate of violent attacks on medical workers.

    The 49-year-old died Oct. 25 after being attacked by a patient who was unhappy with the result of an operation Wang had performed on his nose. The patient stabbed Wang with a 30-centimeter knife, causing severe chest injuries. Two other doctors were also badly injured in the attack in Wenling, Zhejiang Province.

    Attacks on medical workers occur every two weeks on average, according to the China Hospital Association. There have been six serious attacks in the last two weeks alone.

    The association said 27.3 percent of hospital doctors were assaulted in 2012, a rise from 20 percent in 2008. Seven doctors died as a result of attacks by patients or their relatives last year.

    Workers in the ear, nose and throat department where Wang worked called a strike in response to their colleague’s killing. The incident also triggered nationwide protests by medical professionals, who called for greater protection and increased security.

    Patient trust eroded

    “I couldn’t stop crying when I read about the case on the Internet,” said Jiang Li, a 28-year-old who has a close relative working in the same hospital as Wang. “I couldn’t breathe until I saw the name; thank God, it was not my relative,” she said.

    Details of Wang’s career are still available on Haodf, China’s biggest Internet platform for the medical profession, which provides information about hospitals and physicians and acts as a forum for comments from patients. A patient’s message is still posted on the page thanking Wang for surgery he had performed.

    According to Jiang, Wang had a good professional reputation, but she said the relationship between physicians and patients has deteriorated because of the poor behavior of a few doctors.

    “Some doctors earned extra money by prescribing expensive drugs to treat simple ailments or by asking patients to undertake unnecessary health checks. That sort of behavior eroded patient trust,” she said.

    Resentment over high medical costs and poor service has resulted in a fractious relationship between patients and doctors at many hospitals in China.

    Statistics published by the National Health and Family Planning Commission in 2012 show that the number of licensed physicians in China rose by 17.5 percent between 2006 and 2011. In 2011, there were about 2.5 million licensed physicians around the country. At the same time, however, the number of patients visiting hospitals rose by more than 60 percent — a total of 63 billion by 2011, while the inpatient rate soared by more than 90 percent.

    China’s medical professionals are expected to deal with more than 6 billion patient visits every year, but the low wages — doctors in rural areas earn around 3,000 yuan a month, while those in urban areas can make 8,000 to 9,000 — coupled with the heavy workload has led many to turn to other ways of making money, such as prescribing unnecessary drugs and treatment and, on occasion, accepting bribes from patients desperate for medical attention.

    “Most of the violent incidents have occurred in level-three hospitals (the highest level in China), where most of the cases involve serious conditions with a higher risk factor,” said Deng Liqiang, director of the law department at the Chinese Medical Doctor Association. “But violence should never be used to solve problems. There are always risks and uncertainties in medical science, and patients should be aware of that.”

    Nearly 80 percent of China’s hospitals have experienced violence that has damaged the mental or physical health of the doctors concerned, according to a report released by the Chinese Hospital Association earlier this year. The report revealed that more than half of the doctors surveyed in 316 hospitals said working conditions were poor and nearly 40 percent of them had considered quitting the medical profession and looking for alternative employment.

    To smooth the hospital-patient relationship, some cities have established their own regional medical mediation commissions. Since it was established in 2011, the commission in Beijing has dealt with approximately 2,000 disputes, of which 50 percent were the result of negligence or carelessness by medical staff.

    Doctors have also taken action to reduce the number of disputes. “To avoid problems, we take a photo of every child when they check in at our hospital,” said Gao Man, a 33-year-old nurse at the Capital Institute of Pediatrics in Beijing.

    Gao said parents sometimes complain that their child has contracted roseola, a viral infection that causes skin rashes, or lost weight when hospitalized, and blame the medical staff for treating them inappropriately. “But we don’t know whether the child contracted roseola before or after they’ve been with us,” she said.

    “Relations between patients and doctors are pretty rocky. Once a problem occurs, it’s hard to make an objective judgment based on so-called trust, so it’s better to have a photo as evidence.”

    Gao said that initially the parents took photos of their children before admission to the hospital, but the hospital also took up the practice and stored the photos as proof of the child’s condition when they were admitted. “The photos help to keep us safe from disputes and lawsuits,” added Gao.

    Internet guidelines

    The rising number of cases of violence in hospitals has prompted some unofficial Internet sites to provide guidance for doctors. The guidelines involve 31 points, the last of which is usually: “Remind yourself that the patient sitting in front of you might take you to court.”

    “If this sort of violence continues, doctors won’t fully devote themselves to saving lives. We are not respected or protected, so who will save us while we are saving others?” asked Yu Keyi, a physician at the Peking Union Medical College Hospital in Beijing.

    The National Health and Family Planning Commission recently announced plans to provide better security at hospitals.

    Last year, the commission and the Ministry of Public Security released a joint announcement in which they pledged to guarantee the safety of hospital workers. However, the current situation has failed to satisfy the physicians.

    “What we have right now is just a few security guards armed with nightsticks. Some of them are older than 50 and would be ineffective if a serious incident occurred. Also, clinical rooms are rarely fitted with alarm bells,” said Yu, who worked in Saint Louis in the United States for six months late last year.

    Yu said he was impressed by the guards at U.S. hospitals, and by the plans formulated to ensure the safety of medical staff. “There is detailed guidance on how to deal with hospital violence. Classification of incidents is color-coded, so people are aware of the nature of any incidents and are able to impose a measure of control even at the inception. Security checks are also mandatory,” he said.

    Yu said the guards and security checks are a practical response to the threat posed by violent patients and can help to alleviate problems. “We doctors should stick to the ethics of our profession. If we are good doctors first and foremost, we will gain respect,” he said. “However, I also think we urgently need a specific law to guarantee our safety.”

    Core values

    Liu Xiaojing, 33, worked as a registered nurse in Singapore, for 18 months from the start of 2010. She said that in Singapore both the patients and hospitals have a highly developed understanding of the law.

    “Once a medical-negligence case is filed, both parties seek a solution through legal channels rather than by fighting. The hospitals all have dedicated lawyers and the patients can get help from the local community,” she said.

    Dissatisfied patients can register complaints and provide hospital authorities with feedback when they are discharged. “But I didn’t hear anyone using bad language or acting violently in the hospital, unlike in China, where this has become almost commonplace,” she said. “When we were hired, we were also given training sessions about the hospital’s core values, which emphasized the service attitude we should adhere to.”

    China’s hospitals are not listed as public security protection areas, which means that violent offenders in hospitals can’t even be charged with causing a public disturbance. Experts are now calling for the public security bureau to include hospitals in the list of public security protection areas and have urged laws to provide medical professionals with improved levels of protection.

    (SD-Agencies)