Mismatch and Distrust: Institution, Interaction, and Increasing Doctor-Patient Tension in China

Abstract

On March 23, 2012, a medical resident in Harbin, north China, was stabbed to death by an angry young patient. This was, unfortunately, not an isolated incident. The statistics released by the Ministry of Health in China indicates that violent incidents resulted from medical disputes increased by 70 percent from 2006 to 2010. A survey conducted among patients in 30 hospitals in east China in early 2013 reveals that only 10 percent of the respondents said they trusted doctors. How do we explain patients’ escalating dissatisfaction with doctors’ services and the increasing tension between doctors and patients? In this paper, I argue that there are multiple factors that contribute to the poor doctor-patient relation, and among which mismatch and distrust are the paramount factors. Mismatch refers to two levels of discrepancy. First, it refers to the discrepancy between what the public expects from “public hospitals” and what the public experiences in these hospitals. This discrepancy is constituted by state policies and institutional factors, particularly the financing issues of the healthcare system. Second, mismatch also refers to the discrepancy between doctors’ expectation and patients’ expectation. While doctors are longing for a dominance model of doctor-patient interaction as it is in Hong Kong, patients are expecting a bargaining model. Their discrepancy is produced by doctors’ increased exposure to the medical world in Hong Kong in conjunction with the general public’s increased awareness of their rights in a society with conspicuous social inequalities. The two levels of mismatch result in increasing distrust between doctors and patients that shapes their interaction. A vicious circle is produced by the mutual distrust between doctors and patients in their interaction. To mitigate the problem, I suggest that changes have to take place at the institutional level, in particular the first level of mismatch should be eradicated.