DOCTORS and nurses — “the angels in white” — may need more than their thin, white coats these days, perhaps adding some armor and helmets, as well as self-defense skills.

Recent events demonstrate that their jobs require them not only to defend people against disease, but also to protect themselves from possible violence from angry patients.

A nurse at Zhongshan Hospital in Guangzhou, capital city of southern China’s Guangdong Province, was hit in the chest with a heavy notebook at the reception desk last Sunday when she hesitated to answer a man’s request for first-aid treatment.

She was busy answering other patients when the man jumped the queue, stating that his son was seriously ill. The nurse’s failure to answer him immediately enraged the man, who grabbed a heavy notebook and slapped it into the nurse’s chest, making her bend over and cry. The man later apologized.

Last Monday, a nurse at Hangzhou Children’s Hospital in Zhejiang Province was beaten with a broom as she and other nurses failed to successfully insert an injection needle into a 5-month-old baby’s vein after five tries.

The mother grabbed a broom, cursed and beat the nurse. The nurse was diagnosed with soft tissue contusions on the arms, shanks and back, as well as a scalp hematoma, resulting in headaches and dizziness. The mother was detained and willing to apologize.

In Sichuan Province, a doctor at Mianzhu People’s Hospital was punched and kicked in March because he urged a patient to get a CT scan when the patient had symptoms that included vomiting, aphasia and dizziness, along with a history of high blood pressure and diabetes. When the CT result showed no bleeding in the brain, family members took that to prove the doctor was wrong, and they attacked him.

The list goes on and on.

More than 60 acts of “medical violence” (attacks on doctors, nurses and other medical staff) were reported by media in 2013 alone. But the prevalence apparently is much greater. An investigation by the Chinese Hospital Association and Chinese Hospital Management Association in 2013 showed that about 27 medical violence incidents occurred in each hospital in China annually. About 96 percent of doctors in hospitals have suffered verbal abuse, and 60 percent have endured physical attacks.

Some 6,000 to 7,000 medical disputes a year surface in Shanghai, according to the Shanghai Health and Family Planning Committee. Doctors, who used to be highly respected, now face a big escalation of violence from patients and their families.

In addition to threats, medical personnel are commonly the objects of beatings and abductions. Hospital property is being smashed, banners are being pulled down and, in extreme cases, arsons and explosions target the facilities.

Disputes about treatments and outcomes, cost and service are among the most common triggers for such violence. Attending doctors are the most frequent victims but there have been cases targeting hospital nurses and other medical staff.

“Any doctor working in hospitals nowadays has experienced or at least witnessed such violence in their work, and it is just so common to witness seven or eight such cases happening in one hospital within a year,” says David Ge, a 37-year-old orthopedic surgeon in a local second-class hospital, who has seen several cases.

The gap between patients’ high expectation for a good treatment and the end result is one of the most frequent causes for disputes and violence, Ge says.

“Even though we have told the patients in advance that they may not recover as though they never had the problem at all, some of them still suspect the doctors and treatments are unqualified when their recovery fails to match their expectation,” says Ge. “Curses and violence just happen until they get what they want — financial compensation or prolonged permission to stay in the hospital for further treatment.”

Compromise

An attempt to persuade a patient is usually the best way to deal with such cases for most doctors and hospitals. Some patients can be convinced and show understanding, while others refuse to compromise even if the expert medical opinion proves the doctor right.

“Some patients just keep thinking that since they have paid, they should have been cured. It must be the doctor’s fault if otherwise,” says Ge.  “But getting treatment is not as simple as purchasing goods.”

However, seeking peace and stability, most hospital will offer compensation to close the issue as soon as possible, according to Ge.

Joanna Lu, a 58-year-old retired police officer, says the police will offer help in acts of medical violence, but with a major aim of keeping it to a minimum. “In most cases we suggest the hospital offer some compensation for a win-win result.”

Laura Wan, a 56-year-old retired worker, says that while she does not condone attacks on doctors, she can understand the perpetrators’ motives sometimes. Wan suffered numbness in her lower limbs five years ago and went to a well-known spinal doctor who suggested surgery to remove a protrusion growing on her spine after checking the X-ray result.

When she asked whether there were any more conservative treatments than surgery, the doctor replied gruffly, “Then you tell me what to do.”

She underwent surgery but the numbness did not go away. It turned out that her numbness was caused by nerve dystrophy rather than the protrusion.

She didn’t make accusations against the doctor because it would have put the friend who helped her get to the doctor in an awkward position. “But I thought the doctor’s arbitrary decision should be blamed,” says Wan.

Limited medical resources, overworked doctors and high medical charges are among the most frequently mentioned reasons for the increasing number of medical disputes and violence in recent years. Patients complain about doctors’ carelessness, while doctors state that they are too tired to handle so many patients every day.

However, decreasing trust in doctors that prevails in China today is a major social root of the problem, according to Professor Zhang Haidong, with the Sociology and Political Science School of Shanghai University.

Limited medical resources do rob time for the proper communication between doctors and patients that may lead to misunderstanding, he acknowledges. But when the public hears about special fast channels for celebrities and rich people using “guanxi” (connections), they feel left out.

Further, news of medical accidents involving poor skills, along with cases of poor ethics, spread online and have played a crucial role in cracking the reputation of doctors, says Zhang.

“We should definitely say no to medical violence, yet I cannot agree with the numbness in some medical staff who use the excuse of overwhelming numbers of patients,” he says. “I think doctors and hospitals should also think about why they failed to win prevalent sympathy even though they are the victims.”

“To tackle the problem, education on medical ethics among the practitioners is just as urgent as investment in providing more medical resources.”

Shanghai is planning a system to have an objective third party explain about treatment choices, costs and related insurance to patients, in an attempt to release doctors from the economic issue and ease tensions.

But the new system won’t help solve the problem, though it may relieve the patient-doctor tension temporarily, according to Gao Xi, a committee member of the Chinese Medical History Association.

She says the current medical system has provided a reasonable variety from first-class hospital to community clinic for different needs. Yet some patients’ belief in imported drugs and first-class hospitals directly led to the high cost and short-landed medical resources, which sometimes ended in medical disputes.

“To ease the tension, I think both patients and doctors should reflect on what they have done,” says Gao.

See crackdown on crimes against medical staff on A8