This Doctor's Job Is No Easy Task; Preventing Doctor-Patient Disputes Matters

Today, watching the news, I saw two police notices.

One was from the Shangcheng District Branch of the Hangzhou Public Security Bureau, reporting that at about 10:55 a.m. on January 22, 2021, the bureau received a call reporting a suspected explosive device deflagration incident on the fifth floor of Building 6 of the First Affiliated Hospital of Zhejiang University School of Medicine, injuring three hospital staff and one patient. Police have taken the suspect into custody.

The other, from the Louxing District Branch of the Loudi Public Security Bureau on January 21, 2021, reported that at about 8:00 a.m. on January 17, 2021, a vicious case occurred in Jiamao Village, Shexingshan Town, Louxing District, Loudi City: the suspect Kang Mouyong stabbed a minor, Zhu Mouhan, with a knife. Investigation found that months earlier the suspect had sought treatment at the clinic run by the victim's father and, dissatisfied that he was not cured, injured the victim to take revenge on the parents.

In recent years, medical workers have faced more and more of these security threats; the environment for practicing medicine in China is quite harsh.

I myself am often threatened and abused, and the behavior of some patients and their families is unreasonable. They see a doctor without registering, ask for consultation without paying, and at the slightest dissatisfaction curse or beat the doctor, all while feeling fully justified, convinced that the doctor lacks medical ethics, never stopping to think that as patients or family members they themselves must also have moral conduct. The great majority of medical and nursing staff swallow their anger and choose to take a step back to prevent things from worsening. Whether in big hospitals or small clinics, medical workers' personal dignity and personal safety are not guaranteed.

Anyone can fall ill—good people and bad, the mild-tempered and the hot-tempered alike; everyone may need to seek care or accompany family members to seek care. I am often slandered with abusive language by low-quality patients or family members; if we choose to fight back, they will pester us endlessly. The cost of cursing or beating a doctor for these people is truly too low. In other countries, beating or cursing a doctor is a serious crime, punishable by one year in prison at the light end and nearly ten years at the heavy end; but in China it often amounts only to a verbal warning from police or a few days of criminal detention.

So I myself am now very sensitive to doctor-patient disputes. If a patient or inquirer speaks insolently, or appears irritable and volatile, I will do everything I can not to establish a doctor-patient relationship with them. The outside world cannot provide us with security; we can only protect ourselves.

Large surveys by American medical institutions show that about 15% of visitors are difficult patients, and this proportion is roughly similar around the world. This means that if a doctor sees 100 patients a day, 15 are potential safety hazards. Generally speaking, every Chinese doctor sees no fewer than 20 patients a day, and of those 20 about 3 are difficult patients—whether paranoid in character or with violent tendencies. So the profession of doctor is very high-risk.

Many grassroots doctors deal every day with patients who do not register and barge straight into the consultation room. I was once invited to see patients in Ruzhou, Henan; the person who invited me was a family member of a local doctor. This doctor came to pick me up himself and told me that every day more than a third of the patients in his clinic did not register; after the doctor wrote them a prescription, they did not fill it at the hospital pharmacy but went straight outside to buy the medicine. Many people there instinctively assume the worst of others, suspecting that doctors are trying to make money off them, so they feel fully justified in seeking care this way. This doctor said he dared not offend these patients, because at the least they would hurl abuse, and violent conflict could even break out.

Many of my friends are doctors, and everyone has encountered the same situations; I myself also frequently encounter patients who ask endless questions without paying. In their view, doctors ought to do this kind of work for them for free.

As consultations piled up, I had to require them to pay; most patients do pay when asked. But a minority of patients or family members refuse, and some ask me self-righteously: if I pay, what if you then don't provide me the service? In their minds, a doctor is only qualified, and only worthy of being called ethical, if they serve them for free; otherwise they deserve to be cursed, as if doctors need not feed their own families. Generally, inquirers who question me like this are deleted by me; I feel such people are unreasonable and can only be kept at a distance.

Doctors who treat severe illnesses and those nagging chronic conditions are in somewhat greater danger than ordinary doctors. Doctor-patient conflicts happen frequently in the emergency department, and intoxicated or brawling visitors are more prone to violence. Condemning these unreasonable visitors is of no use; many have already failed in character education, and I am pessimistic about changing their human nature. I believe the only thing doctors can do is to stay vigilant, hone in work the ability to identify high-risk visitors, and take protective measures as soon as some unhealthy sign appears, nipping trouble in the bud.

An experienced doctor can tell which visitors are high-risk. We can read their character from conversation. People who question without cause, whose emotions are extreme, or who shamelessly humiliate others tend to have violent tendencies—yet they give themselves the flattering label of plainspoken. People who, in conversation, always blame others for their own misfortunes, or who readily presume medical staff guilty, also have the makings of medical-disturbance troublemakers. Those with a history of humiliating or threatening other medical staff may likewise go on to humiliate or threaten their new doctor, because a person's thinking and behavior are consistent.

So we must value communication with visitors: on one hand, communication deepens understanding and benefits most patients; on the other, it lets us discover the hidden dangers in a few extreme visitors and take preventive measures early. We cannot expect doctor-patient conflicts to vanish; I think even when human civilization advances further, these conflicts will still be widespread. Having chosen this profession, we must learn to prevent doctor-patient contradictions from escalating into fierce conflict, and ultimately into vicious violent incidents.

After encountering such a difficult visitor, a doctor easily develops negative emotions, especially since some extreme visitors deliberately do things that are extremely unpleasant—intentionally cursing or humiliating the doctor. Doctors must understand that this is a problem we cannot avoid; as long as we do this work, no one can avoid such things. I once asked several of my own teachers whether they had encountered such unpleasantness at work, and every one said they had. I also asked some peers, and likewise every one had. So we ourselves need strong psychological resilience to digest these unpleasantnesses.

Is medicine a science? Yes—and not entirely. Medicine draws on much scientific knowledge, but for a clinician, mastering only the science related to medicine is far from enough. We deal with all kinds of living beings in this vast world; even the Buddha feared dealing with the sick, and the Buddha's-bequeathed sutra explicitly forbids Buddhists from engaging in medical work. So besides professional medical knowledge, we must also master the ability to deal with all sorts of people in the world.

My official account has thousands of doctors among its followers, and I sincerely hope every one of my colleagues stays safe for a lifetime. I also hope every visitor can put themselves in the doctor's shoes and think from the doctor's side. Visitors who are overly extreme or who lack trust in doctors ultimately harm their own health; when doctors dare not or are unwilling to treat you, have you really won?