The Hippocratic Dilemmas: Guanxi and Professional Work in Hospital Care in China

Abstract

Patients mobilising guanxi (interpersonal relations) to gain access to hospital care is prevalent in post-Mao China. Yet few studies have centred on how medical professionals deal with guanxi patients. Based on ethnographic research and applying an analytical frame of Chinese guanxi developed by Fei Xiaotong (1992 [1948]) and Cheris Shun-ching Chan (2009), this article examines the dilemmas that Chinese physicians face in weighing professional standards versus guanxi. We divide the patients into three general categories: patients without any guanxi, patients with weak to moderate ties with physicians, and patients with strong ties with physicians. We find that physicians face few dilemmas when they interact with patients without guanxi. They largely adhere to their professional code of practice and generally display dominance over the patients. When interacting with patients with weak to moderate ties, however, physicians are caught in a dilemma between fulfilling renqing (interpersonal obligation) and adhering to a professional code of practice. They manage this dilemma through dramaturgical strategies such as information-sharing, emotional work, and face-giving. When interacting with patients with whom they have strong ties, however, affection and the sense of asymmetric obligation may take precedence over professional codes. Physicians deal with this dilemma through a different set of strategies, such as information-control, emotional avoidance, and altruistic care. Our analysis reveals the impacts of guanxi on medical professionals and the moral dilemmas they face in a guanxi-dominant societal context. It offers direction for possible policy reforms to mitigate the problem.