I came across an interesting article in the New Yorker last week: “Why Chinese patients are turning against their doctors.” It is a fascinating account of the evolution of the health care system in China, highlighting the major changes that have led to increased patient-doctor homicides.
In a nutshell, in ancient China, traditional medicine reigned king, and people scoffed at the idea of Westernized medicine. This started changing in 1949 with the Communist takeover, when the government began organizing basic vaccination drives and efforts to improve public sanitation. Then in 1965, the Party announced the job of “barefoot doctors,” basically anyone in the villages with a high school education who became the official “doctor.” These “doctors” had no medical training whatsoever, and learned on the go. No wonder these doctors were not well respected at the time. Fast forward to the 2000s, when China announced that it would provide health care insurance for all by 2020, including poor villagers in rural towns. This push led to a huge surge in patients in hospitals located in big cities, increasing already enormous pressure on doctors to see more patients in the same amount of time. The article says,
… a leading radiologist in Shanghai told me he’d heard that the record number of patients seen in a day is three hundred and fourteen. “That was at the Shanghai Children’s Hospital,” he said. “One doctor, 8 a.m. to 6 p.m., ten hours, two minutes per patient.” According to a study conducted in Shaanxi province, the average visit to a doctor’s office lasts seven minutes, and physicians spend only one and a half minutes of that time talking to the patient.
Because of the strained patient-doctor relationship and the increasing burden of health care costs, patients are readily resorting to violence to take out their frustration on medical personnel. The article cites a statistic that in 2012, Chinese hospitals reported an average of twenty-seven attacks a year, per hospital. Nurses, doctors, trainees alike were targeted, by patients with and without mental illnesses.
This article shocked me. In America we recognize the problem of increasing demand on primary care physicians, leading to more physician errors, greater dissatisfaction for physicians and patients alike, greater physician burnout, etc., but the thought of constant danger from my profession never crossed my mind. What are the stats in the U.S.?
An article in Slate cited a stat that, “according to 2005 data from Bureau of Labor Statistics, health care workers are twice as likely as those in other fields to experience an injury from a violent act at work, with nurses being the most common victims.” The same article said, “In a 2005 survey of ER doctors, 75% reported at least one verbal threat in the previous 12 months; 30% indicated that they had been the victims of a physical assault; 12% had been confronted outside of the ER.”
Now that I’ve done a rotation in the ER at my county hospital, I can completely believe it. Patients are often so angry, so frustrated, especially if they are intoxicated on drugs or alcohol or if they are off their psychiatric medications, that we often have to resort to physical restraints and pharmacologic interventions against their will. In areas with high crime rates, I think it makes sense for ERs to have metal detectors at the front door, and for numerous armed security guards to be present.
Reading the New Yorker article and learning the statistics for patient-doctor violence in the U.S. makes me realize that a) I am glad I’m not a doctor in China in the current system they have; and, b) I should have heightened awareness going into a patient’s room even in America: to call for help from security if anything seems off, and to always keep myself between the patient and the door. Attacks can happen at any time, and after so many years of training to help others, it’s best not to take any risks.