Medical Community Weekly (WeChat Group) No.2: 'No Protest Goes Unrewarded – If You Can Profit, Why Not Cause Trouble?'

Location: National Primary Healthcare Management and Operations Exchange Group

Participant: Li Wuwei

Topic: Doctor-Patient Relations in China ★ 11 Factors Trapping Chinese DoctorsRestrictions—Adapted from The New York Times ★

1) Insufficient government investment in healthcare. Unreasonable system design has led to severe attrition of medical and nursing staff, with doctors working under excessive long-term workloads, making it increasingly difficult to meet patient needs and resulting in a rising number of doctor-patient disputes.

2) Positioning healthcare as a consumer good. This misleads patients and their families into believing that financial expenditure guarantees favorable outcomes, thereby giving rise to disputes when expectations are not met.

3) A lack of reverence for the guardians of life. This is related to traditional culture; throughout Chinese history, physicians have never belonged to the upper class.

4) The out-of-pocket share of medical expenses for individuals is excessively high. As the saying goes, “even brothers keep clear accounts”; when economic interests are at stake, harmonious and amicable negotiations have never been the norm.

5) The cost of engaging in medical disturbances is too low, even zero. “Minor disturbances yield minor gains; major disturbances yield major gains; no disturbance yields no gain.” “Since disturbing does not go unrewarded, who would not engage in it if profit can be made?”

6) Bureaucratization of hospital administration. Hospital leaders are government officials rather than professional managers; they are accountable only to their superiors, not to doctors and nurses. They often prioritize appeasement and conflict avoidance, ultimately leaving frontline staff to bear the brunt of the consequences.

7) Physicians are not freelancers; they are subject to strict administrative constraints and cannot rely solely on their clinical expertise for professional survival. Non-clinical research activities, such as publishing academic papers, consume a significant amount of physicians’ energy, thereby hindering the improvement of medical care standards.

8) Medical industry associations fail to live up to their names; not only do they struggle to safeguard the rights and interests of healthcare workers, but they often become obstacles to individual medical staff seeking to protect their rights. This is also a drawback of the administrative orientation of these industry associations.

9) Unfair law enforcement. In medical disputes, patients are naturally perceived as the “weaker party,” garnering sympathy or even indulgence. However, everyone is equal before the law; how can there be a distinction between the “weak” and the “strong”? Worse still, the “reversal of the burden of proof” places every physician in a position of presumed guilt.

10) Lack of preventive and early-warning mechanisms for violence against medical personnel. Rather than merely calling for severe crackdowns, it is better to prevent such incidents before they occur. Even if the perpetrator were subjected to the most extreme punishment, could it bring back the life of the murdered physician?

11) The media’s long-standing vilification and defamation of the healthcare industry have seriously distorted the facts. Not only has this entrenched the misguided perception among the public that “access to medical care is difficult and expensive,” but it has also successfully attributed these issues to physicians’ moral decay and profit-driven motives, leaving doctors with no effective means to defend themselves.

Location:【Dayi Cloud Valley+】

Participant: Lucy

Topic: A professor currently pursuing advanced studies at the Mayo Clinic in the United States shares his differing perspectives on medical practice in the two countries.

It was only after coming to Mayo that I realized how fortunate it is to seek medical care in China. Reflecting on my previous work life back home, I truly feel blessed to be at Mayo now!

Medical consultations for Chinese residents...

1) Seek care from the best physicians.

2) Achieve the fastest possible speed (do not waste your own time, and do not make yourself wait for the doctor).

3) Spend the least amount of money; exceeding one’s mental budget by even a single cent is an unforgivable sin.

4) The professor must be highly professional and explain the medical condition with such clarity that even an elderly woman from a rural area can understand it.

5) Dissatisfaction can lead to violence against medical staff, and this even garners support from public opinion.

In the U.S., MayoHere...

1) The best doctors are inaccessible to the general public, as the multi-tiered triage system means that 99% of illnesses have already been addressed by lower-level providers, or patients can no longer afford the out-of-pocket costs even after insurance coverage;

2) For routine emergency cases, the typical wait time is 5–6 hours. As long as it’s not life-threatening, want faster service? Sorry, but this is the pace we operate at!

3) An ultrasound costs several thousand dollars, and an appendectomy runs over ten thousand dollars. Money? Here, no one is in a position to negotiate with doctors—no negotiations at all!

4) Have an expert explain? Sorry, it’s usually the resident physicians who handle these matters. They will only provide you with the conclusion, and any explanation will be kept to a minimum.

5) Looting and vandalism? Well, the ubiquitous security police (armed with live ammunition) will assist you (by detaining you first).

Domestic experts and professors must keep their mobile phones on 24/7, remaining on standby beyond their daily work hours.

“A Mayo physician? I’m off duty; this is my personal time. Sorry, what? You insist that my presence is absolutely necessary? Very well, then please be prepared to pay a substantial consultation fee—note that I said consultation fee!”

Looking back at China, it is truly a blessing to receive medical treatment there!

Location: Shanghai (Traditional Chinese Medicine (TCM)Health Industry Salon

Contributor: Lao Xian

Topic: Doctors treat diseases, while nurses care for people.

During medical school, medical humanities teaches that physicians treat patients who are suffering from diseases. However, the methodology of experimental research in Western medicine focuses on the disease itself. For instance, in our clinical studies, we first establish a baseline, with the objective of targeting the disease. This leads many doctors to adopt a mindset that they are treating the disease rather than the person who is ill. Therefore, it will take several more years for the concept of patient-centered care to be fully embraced and successfully implemented.

Nursing, however, is different. The nursing philosophy centers on caring for patients to facilitate their faster recovery. Consequently, we observe that mobile health initiatives in the United States are increasingly employing nurses rather than physicians to manage patient health and chronic diseases. China’s mobile health sector is also adopting this model; for instance, DXY and Tencent’s Tang Dafu (Sugar Doctor) project both utilize nurses for patient management.

Location: Shanghai ((Traditional Chinese Medicine)Health Industry Salon

Contributor: Lao Xian

Topic: The gap between private and public hospitals is gradually narrowing.

We need to examine the three initial forms of hospitals. The first was established by religious orders, characterized by a strong humanitarian relief ethos; physicians served in a charitable capacity without profit motives. A contemporary example is the Sovereign Military Order of Malta, which originated as a knightly order responsible for medical care during the Crusades. The second form emerged spontaneously among physicians in the United States, where doctors constituted the core entity, and hospital administration merely provided supportive services. The third form refers to hospitals in China before the Reform and Opening-up policy, operating under the socialist system, fully dedicated to serving the people, with organizations assuming all responsibilities. The fourth form comprises private hospitals established after the Reform and Opening-up, funded by capital with profit-seeking objectives; consequently, numerous procedural requirements are implemented to mitigate liability. However, public hospitals in the post-Reform era appear to have adopted profit maximization as their goal, making them scarcely distinguishable from private hospitals in terms of underlying objectives.

“Everyone says private hospitals are bad, but if we look at the essence of public hospitals today, there is actually no clear distinction between the two. Public hospitals simply have more talent and higher social status, but if things continue this way, their reputation will eventually decline as well.”

Hospitals need to avoid liability, leading to an increasing burden of administrative tasks. The excessive expansion of hospitals has not only constrained physicians’ ability to provide emergency care but also hindered the advancement of medical science.

Chinese Society for Health Policy and Management

Participant: Susan Lu

Topic: Causes of Medical Disputes: 1, Patient lacks pathway; 2, consider doctors "too rational."

Recently, there has been a surge in incidents of medical disturbances and violence against healthcare workers, driven by a multitude of factors. In my view, two critical issues cannot be overlooked: first, patients in China lack adequate channels for filing complaints; second, both healthcare providers and patients tend to exhibit bounded rationality. Patients perceive physicians as rational actors,The motivation behind the behavior is to benefit the physicians themselves.a rational choice, and the medical decisions made are alsoto serve the physicians' own interestsas the primary point of departure. This perception of physicians as rational actors (rather than as white-clad angels dedicated to saving lives) has severely harmed our doctors and significantly increased social costs. The medical profession itself lies at the intersection of ethics and rationality, with the relative weight of each varying across countries and time periods. In today’s China, we have an obligation to effect change rather than use our voices to further emphasize the notion that “doctors are rational actors.” Otherwise, incidents of violence against medical personnel will continue to escalate!

Chinese Society for Health Policy and Management

Contributor: Zhu Hengpeng

Topic: Can Moral Preaching Influence Medical Practice?

If moralizing and oaths could solve the problem, health economists and healthcare reformers might as well just call it a day. So-called morality is nothing more than utility maximization under constraints; only ethical norms that align with this criterion gain widespread social acceptance and adherence. While human lives are of equal value, individuals’ opportunity costs of time vary significantly.Most medical care does not involve life-and-death situations, and indeed, most cases do not even hinge on whether a cure is achieved.。

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