Abstract
The medical sector in China has witnessed increasing disputes between doctors and patients over the past several years. Various factors contribute to the increase in medically-related disputes: a rising consciousness of patient rights, the deepening misunderstanding between patients and doctors, inflammatory media reporting, the commercialised health care that infringe on people’s moral economy, and the absence of a formal institution for dealing with medical disputes. In medical disputes, patients (and their relatives) and doctors (and hospitals) compete in a struggle for power over the control of their interests and safety, and over their moral definitions of justice and rights. When patients are mistreated or die, the moral sentiments of the public who shares many unhappy healthcare experiences are on the side of the patients and their relatives. However, when health professionals are attacked or killed, they become the weak ones, who cannot protect themselves from violence. They begin to win over public sentiment, gradually accumulating moral capital, which justifies them in fighting back. Yet, the configuration of power between disputing patients and health professionals is shaped by the power of the government.
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Notes
- 1.
Chinese reports and articles gave different increase rates nationally. The rates also varied from place to place. Due to the sensitive issue of disputes and the tendency of the local government to conceal disputes, it would be difficult to find out the accurate data. The rate 22.9% is the result of a survey conducted by the Chinese Hospital Management Association, which is comparatively more official than other reports. The number is also quoted by some Chinese journal articles and media reports (all did not mention when the survey took place, but the data itself only emerged after 2012).
- 2.
Yinao can also refer to the people who use violence in medical dispute. Narrowly, it refers to the special groups of gangs employed by the patients’ families to argue for more compensation. The word nao can be used as both a noun and a verb.
- 3.
Under the new healthcare reform, medical institutions at the community level are built up by the state with the hope to take the gatekeeper role, but the effects of these institutions are still limited.
- 4.
My research of more than 10 local hospitals at the county and township level finds rapid increases of patient number in all these hospitals since the new healthcare reform. The People’s Hospital, the biggest hospital in Riverside County, had 500 inpatient beds, but the actual inpatient number ranged from 800 to over 1000 per day in 2011. In 2010, the hospital’s annual outpatient number was over 490,000, more than 1300 outpatient visits per day. The TCM Hospital had around 450 beds, but the daily inpatient number usually surpassed 1000. Public hospitals add extra beds in wards and corridors. The overcrowded arrangements have many problems: exhausted health professionals, patient complaints, possible medical mistakes and accidents, etc.
- 5.
Pei (2010: 29) suggests that ordinary resisters in China are likely to employ simple and direct forms of defiance; their weapon of choice is street demonstrations, blocking major railways and highways, strikes, and even violent attacks on government building. Jing (2010) also writes about the violent contestations and actions, as well as the use of funeral stuffs in Chinese protests. He points out that the transfer of funeral symbolism to social protests is an important feature of China’s political culture. In some recent protests, people also employ funeral symbols to demonstrate their demands, such as the white cloth scroll with black and red petition words on top taken by people in the famous Wukan protest in 2011.
- 6.
Also see various survey results and innumerable media reports (for instance, People’s Net 2014) about doctors’ unwillingness to let their children study medicine. The rising tensions and conflicts between patients and doctors are one of the contributing factors.
- 7.
In 2002, ‘Some Provisions of the Supreme People’s Court on Evidence in Civil Procedures’ released by the Supreme People’s Court (http://www.court.gov.cn/bsfw/sszn/xgft/201004/t20100426_4533.htm, retrieved 14 January, 2013) and the ‘Ordinance on the Handling of Medical Malpractice’ released by the State Council (http://www.gov.cn/banshi/2005-08/02/content_19167.htm, retrieved 14 January, 2013) both regulate that the medical institution shall take the responsibility to prove there is no medical fault and no causation between medical practice and harmful consequence in a tort case, in contrary to other civil lawsuits that require the party who litigates to provide evidence. Patients without professional medical knowledge are regarded as the disadvantaged party who are difficult to get medical evidences, thus the burden of proof rests on the medical institutions and health professionals.
- 8.
The original words this doctor use is ‘yike haozishi dahuai yiguo tang’ (a rat’s dropping spoils a whole cauldron of soup).
- 9.
Such as the pengci people who pretended to be hit by a passing car and demanded compensation from the driver for injuries not actually received, or the Good Samaritans that help others have been extorted by the very person being helped (see Yan 2009).
- 10.
See reports such as Sina 2009.
- 11.
These clauses are: patients need to pay medical fees according to regulation; nobody is allowed to check, ask, change or destroy clinic record without the permission of the hospital; patients are not allowed to occupy a hospital bed (after being discharged from the hospital) and refuse to leave; the corpse is not allowed to be put in places other than the morgue of the hospital, any feudal funeral activity is not allowed in the hospital; forbidding to use ‘medical accident’ as an excuse to nao in the hospital without reason; forbidding to make trouble, damage or sabotage in the hospital, forbidding to attack or condemn health professionals, and so on.
- 12.
The four clauses are: patients’ legal rights in medical institution are protected by the law while patients and their families should also obey medical institution’s regulation; the society should respect health professionals whose works are protected by the law, while health professionals should serve people wholeheartedly, improve service attitude and quality, pay attention to medical ethics, and improve medical skill; health professionals and patients should maintain good relationship with mutual-understanding and mutual-trust, when medical dispute happens, medical institution should share information with patients and their families, while patients and their families should solve medical disputes through the legal channel; medical institution should improve its transparency on fees and charges, is forbidden to charge arbitrarily, should give emergency treatment to serious patients, while patients should pay the medical bill according to regulation.
- 13.
In 2013, after a new series of violent attacks and killings of hospital doctors, the NHFPC and the Ministry of Public Security released a new document—‘Guidance on Strengthening of Hospital’s Safety Preventive System’ (see NHFPC and MOPS 2013), aiming at building ‘safe hospitals’ (pingan yiyuan). The guide includes suggestions such as hospitals should assign one security guard per 20 beds, and security guards should account for no less than 3% of the total medical staff.
- 14.
For instance, despite the People’s Hospital is located just opposite to the police office, the hospital director’s office has still been stationed by two security guards since he was attacked in a medical dispute in 2011. In the TCM Hospital, extra security guards have been recruited, counted to 15 formal guards in early 2012, and a police station plaque was installed outside the guard office at the entrance of the hospital to add more symbolic authority to the office. The county hospitals installed CCTV camera in every corner of hospital buildings. Even private clinics have installed home-camera to record evidence in order to prevent serious loss in cases of dispute.
- 15.
- 16.
Central People’s Government, PRC (2018).
- 17.
This dispute resolution procedure image is drawn by the author based upon the image used in local hospitals.
- 18.
A very influential case occurred in 2012 (Ifeng 2012b), when a patient, from a very influential family in local society, died in a private hospital in Shaanxi, the hospital staff (over 40 health professionals) were pressurised to kneel down in the patient’s mourning hall to make an apology. Besides, the hospital had to compensate the family 3 million Yuan.
- 19.
Such a case happened in 2016 when a patient in Guangzhou followed a doctor to his home and attacked the doctor who died subsequently (see http://www.chinanews.com/sh/2016/05-06/7861463.shtml, retrieved 14 March, 2018).
- 20.
A basic health and health promotion law is drafted and under review (see http://health.people.com.cn/n1/2017/1223/c14739-29724759.html, retrieved 31 March, 2018).
- 21.
‘A new “Ordinances on the Prevention and Resolution of Medical Disputes” is forthcoming’ (xinban yiliao jiufen yufang he chuli tiaoli jijiang chutai) (see http://www.chinanews.com/jk/2015/11-26/7641809.shtml, retrieved 13 March, 2018).
- 22.
For instance, the People’s Mediation Committee of Medical Dispute has been listed in Guangdong province’s Regulation on the Prevention and Resolution of Medical Disputes issued by the provincial government in 2013. The mediation committee is encouraged in the province to solve medical dispute and is set up in most municipals (see http://society.people.com.cn/n/2013/0926/c136657-23048180.html, retrieved 16 March, 2018).
- 23.
‘Opinions on strengthening the work of medical liability insurance’ (Guanyu jiaqiang yiliao zeren baoxian gongzuo de yijian) (see http://www.nhfpc.gov.cn/yzygj/s3589/201407/65d55251804c408581a4e58db41f4bc7.shtml, retrieved 11 March, 2017).
- 24.
‘Notice on further improving the work of medical order maintenance’ (Guanyu jinyibu zuohao weihu yiliao zhixu de tongzhi) (see http://www.nhfpc.gov.cn/yzygj/s3590/201603/946d95d967474f3c840e9e903f564154.shtml, retrieved 10 March, 2017).
- 25.
‘Undercover journalists to disclose inside stories: professional yinao gang extort hospital as well as patients’ family’ (Jizhe wodi jie heimu: zhiye yinao e wan yiyuan qiao jiashu). Sangxiang City Express (see http://news.sohu.com/20140701/n401595199.shtml, retrieved 12 December, 2016).
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Tu, J. (2019). Power Game of Nao: Violent Disputes in the Chinese Medical Sector. In: Health Care Transformation in Contemporary China . Springer, Singapore. https://doi.org/10.1007/978-981-13-0788-1_6
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