Intended for healthcare professionals


Violence against doctors in China

BMJ 2012; 345 doi: (Published 07 September 2012) Cite this as: BMJ 2012;345:e5730

Re: Violence against doctors in China

Recent years has witnessed continuously escalating doctor-patient conflicts, manifested by increasingly exposed bribery in medical industry, hired medical hooligans and doctors being attacked even murdered. The national health and family planning commission issued a policy that each 20 beds should be equipped with a security [1]. Could this effectively resolve conflicts between doctors and patients from the basis?

We analyzed the doctor-patient relationship based on the Maslow’s hierarchy of needs. Maslow used the terms Physiological, Safety, Belongingness and Love, Esteem, Self-Actualization and Self-Transcendence to describe the pattern that human motivations generally move through [2]. Everyone has these five basic needs and needs of different people may vary in levels. In each period, one need dominates while others are in a subordinate position.

When a patient is in disease status, physiological needs to regain health in the lowest level will dominate. However, medicine is not a panacea and cannot always meet the patients’ urgent needs. Nowadays, with a tense doctor-patient relationship, the instinct to protect their interests after treatment failure is particularly prominent. With one-sided reports and exposed medical scandals by the media, patients begin to question the impartiality of the judiciary and medical institutions and impose pressure on hospitals in an irrational or even violent manner for compensation. When the lowest level of needs of patients could not be met, the ethics obviously become fragile. It is easy to put the blame on their direct medical practitioners and even take an extreme way to revenge.

Since the hospital was managed in a market-oriented manner, the technical and labor value of medical workers has not been reflected due to long-term lack of government investment in the healthcare industry. The work ethics of medical workers who ought to pursuit esteem, self-actualization and self-transcendence begin to fade away. The onus proof conversion by law drives doctors to instinctively enhance self-protection awareness. With low incomes, high pressure and incomplete medical liability insurance system, as well as frequent violent events and ineffective legal protection, medical workers increasingly turn to security needs in the low level. Security needs gradually become dominant. From this perspective, tense doctor-patient relationships and zero tolerance towards violence by medical staff could be explained [3].

However, the pursuit process of the five levels of needs is not absolute and can be converted and utilized. On one hand, China should gradually improve the health insurance system and reduce costs of patients. Through positive media reports and strengthening the doctor-patient communication to make the patients correctly understand the limitations of medicine, and doctors should promote the transition from passive treatment to active pursuit of health mode. The government should improve the legal system to protect the legitimate interests of patients, enabling them to regain confidence in the impartiality of medical institutions and judicial expertise. On the other hand, China should increase the income of medical workers, complete the medical liability insurance system, and crack down on vicious medical trouble-makers through administrative legislation to ensure medical staff more security. While ensuring the security needs, doctors should focus on cultivating medical humanities of medical staff and truly respect the patient needs in a patient-centered manner to achieve a higher level of social values.

It is imperative to rebuild doctor-patient confidence and ease the contradiction between doctors and patients. There is a long way to go for the medical reform in China.

Author’s contributions
Nian-Cun Qiu,Xiao-Ke Li,Qin Zhang and Cheng-Xiang Shan wrote the paper. Nian-cun Qiu had the original idea for the paper. All authors reviewed and approved the final draft of the paper.

1.Cong Dai, Min Jiang, Ming-jun Sun. Violence against doctors in China on the rise.BMJ. (accessed Dec 18, 2013).
2.Taormina R J, Taormina R J R J, Jennifer H. GAO J H. Maslow and the Motivation Hierarchy: Measuring Satisfaction of the Needs [J]. The American Journal of Psychology, 2013, 126(2): 155-177.
3.Yang T, Zhang H, Shen F, et al. Appeal from Chinese doctors to end violence [J]. The Lancet, 2013, 382(9906): 1703-1704.

Competing interests: No competing interests

18 December 2013
Nian-Cun Qiu
Xiao-Ke Li,Qin Zhang,Cheng-Xiang Shan
Changzheng Hospital, Second Military Medical University
No.415, Fengyang Road, Huangpu District, Shanghai 200003, China.