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Patients can’t trust doctors’ advice if we hide our financial connections with drug companies

BMJ 2014; 348 doi: (Published 15 January 2014) Cite this as: BMJ 2014;348:g167

Re: Patients can’t trust doctors’ advice if we hide our financial connections with drug companies

Recent years witnessed the deteriorating relationship between doctors and patients [1]. The medical costs and prices are soaring. Some doctors’ gray income and bribery are exposed to the public, leading to the loss of public trust in medical institutions. Some medical disputes, even homicide cases and incidence of violence demonstrate the indifference of the patients, which cause bigger blow to the enthusiasm of the medical staff [2]. The doctor-patient relationship is on the hazard in China. We should reflect the root causes of crisis of trust between doctors and patients.

First, people were provided with free medical service in the past, while they have to pay for the medical service, thus individuals have to bear an increasing proportion of medical expenses. The patients hope to reduce the burden of healthcare costs while enjoying more and better medical services. The doctors have to protect their own economic interests and consider the patients’ economic interests and affordability. In addition, they have to cater to the requirements of the patients in drugs, avoid medical disputes, conduct reasonable medical examination, make rational prescription and act in line with health insurance and public health regulations. Therefore, patients will naturally blame their negative psychology following interest damage to the medical workers.

Second, following the Medical Malpractice Management Regulation that tends to enhance precaution consciousness of crisis of doctor-patient relationship, the burden of proof in medical disputes is in the patients’ favor, causing huge psychological pressure to doctors, who have to act with extreme caution, as though treading on holy ground. Both doctors and patients have to prevent the emergence of medical disputes. For instance, this Regulation allows patients to copy medical records; medical accident is no longer divided into technique and human element accidents; and the hospitals have to put to proof to testify their innocence. Some family members of patients believe the hospitals pass the buck, so they use recording devices, covertly or secretly, to the record the conversation with doctors, some even require record the surgery.

Third, the development of high-tech equipment allows healthcare workers increasingly rely on medical equipments, reducing the doctor-patient communication and personal checks and relatively alienating patients. Some medical workers lack of medical ethics and sense of responsibility, affecting the image of the entire health care industry.

Fourth, the media usually report some news that is not in favor of the medical industry while ignoring the fact that medical industry is a high-risk industry. This is largely misleading the majority of patients and exacerbating the crisis of confidence between doctors and patients.

Last but not least, in dealing with disputes between doctors and patients, the judicial organs tend to maintain stability. The results are no longer depending on the right and wrong, but on the dispute tension. Patients do not believe impartiality of the medical accident accrediting institutions. They choose to trigger medical trouble, and even hire the so-called professional medical trouble makers to put pressure on the hospital so as to obtain some compensation. The medical workers also strongly question the Medical Malpractice Management Regulation and believe this Regulation has no legal effect, cannot not solve the fundamental violence and protect their personal safety [3]. Public trusts in medical institutions and the judiciary organs are on the decline.

How to regain a sense of trust between doctors and patients and create a harmonious doctor-patient relationship remains a thorny issue. Therefore, we call on the Chinese government accelerate health care reform to ease the tension of doctor-patient conflicts fundamentally. Patients should trust and understand the medical staff, and the doctors should regain their faith in medical services--- Hippocratic Oath!

Author’s contributions
Nian-Cun Qiu, Xiao-Ke Li, Miao-E Liu and Ming-Qiu 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. Wen L. Patients can't trust doctors' advice if we hide our financial connections with drug companies. BMJ.2014 Jan 15;348:g167. doi: 10.1136/bmj.g167.
2. Nian-Cun Qiu, Xiao-Ke Li, Qin Zhang, et al. Maslow's theory: a New Insight into Deteriorating Doctor-patient Relationship in China. BMJ.
3. Yang T, Zhang H, Shen F, et al. Appeal from Chinese doctors to end violence [J]. The Lancet, 2013, 382(9906): 1703-1704.

Nian-Cun Qiu1, Xiao-Ke Li1, Miao-E Liu2, Ming-Qiu1
1 Department of General Surgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
2 Department of Obstetrics and Gynecology, Women’s Hospital, School of Medicine Zhejiang University, Zhejiang 310000, China

Competing interests: No competing interests

19 January 2014
Nian-Cun Qiu
Xiao-Ke Li, Miao-E Liu, Ming-Qiu*
Department of General Surgery, Changzheng Hospital, Second Military Medical University
No.415, Fengyang Road, Huangpu District, Shanghai 200003, China.