title: Patient-physician mistrust and violence against physicians in Guangdong Province, China: a qualitative study.
abstract: OBJECTIVE
  To better understand the origins, manifestations and current policy responses to patient-physician mistrust in China.
  
  
  METHODS
  Qualitative study using in-depth interviews focused on personal experiences of patient-physician mistrust and trust.
  
  
  METHODS
  Guangdong Province, China.
  
  
  METHODS
  One hundred and sixty patients, patient family members, physicians, nurses and hospital administrators at seven hospitals varying in type, geography and stages of achieving goals of health reform. These interviews included purposive selection of individuals who had experienced both trustful and mistrustful patient-physician relationships.
  
  
  RESULTS
  One of the most prominent forces driving patient-physician mistrust was a patient perception of injustice within the medical sphere, related to profit mongering, knowledge imbalances and physician conflicts of interest. Individual physicians, departments and hospitals were explicitly incentivised to generate revenue without evaluation of caregiving. Physicians did not receive training in negotiating medical disputes or humanistic principles that underpin caregiving. Patient-physician mistrust precipitated medical disputes leading to the following outcomes: non-resolution with patient resentment towards physicians; violent resolution such as physical and verbal attacks against physicians; and non-violent resolution such as hospital-mediated dispute resolution. Policy responses to violence included increased hospital security forces, which inadvertently fuelled mistrust. Instead of encouraging communication that facilitated resolution, medical disputes sometimes ignited a vicious cycle leading to mob violence. However, patient-physician interactions at one hospital that has implemented a primary care model embodying health reform goals showed improved patient-physician trust.
  
  
  CONCLUSIONS
  The blind pursuit of financial profits at a systems level has eroded patient-physician trust in China. Restructuring incentives, reforming medical education and promoting caregiving are pathways towards restoring trust. Assessing and valuing the quality of caregiving is essential for transitioning away from entrenched profit-focused models. Moral, in addition to regulatory and legal, responses are urgently needed to restore trust.
authors.affiliation: Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA UNC Project-China Office, Guangdong Provincial STD Control Center, Guangzhou, Guangdong, China School of Sociology and Anthropology, Sun Yat-sen University, Guangzhou, Guangdong, China Center for Medical Humanities, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tucker
authors.affiliation: School of Sociology and Anthropology, Sun Yat-sen University, Guangzhou, Guangdong, China Center for Medical Humanities, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Cheng
authors.affiliation: UNC Project-China Office, Guangdong Provincial STD Control Center, Guangzhou, Guangdong, China School of Medicine, Stanford University, Palo Alto, California, USA.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Wong
authors.affiliation: School of Sociology and Anthropology, Sun Yat-sen University, Guangzhou, Guangdong, China Center for Medical Humanities, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China.
authors.forename: Ni
authors.initials: N
authors.lastname: Gong
authors.affiliation: University of Otago, Dunedin, New Zealand.
authors.forename: Jing-Bao
authors.initials: JB
authors.lastname: Nie
authors.affiliation: School of Medicine, Fudan University, Shanghai, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhu
authors.affiliation: Harvard Medical School, Harvard University, Boston, Massachusetts, USA.
authors.forename: Megan M
authors.initials: MM
authors.lastname: McLaughlin
authors.affiliation: The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
authors.forename: Ruishi
authors.initials: R
authors.lastname: Xie
authors.affiliation: The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
authors.forename: Yinghui
authors.initials: Y
authors.lastname: Deng
authors.affiliation: The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
authors.forename: Meijin
authors.initials: M
authors.lastname: Huang
authors.affiliation: University of Hong Kong, Ap Lei Chau, Hong Kong University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China.
authors.forename: William C W
authors.initials: WC
authors.lastname: Wong
authors.affiliation: The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Lan
authors.affiliation: The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China Guangdong Institute of Gastroenterology, Sun Yat-sen University, Guangzhou, Guangdong, China.
authors.forename: Huanliang
authors.initials: H
authors.lastname: Liu
authors.affiliation: The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Miao
authors.affiliation: Harvard Asia Center, Harvard University, Cambridge, Massachusetts, USA.
authors.forename: Arthur
authors.initials: A
authors.lastname: Kleinman
mesh_terms: D002681:China; D005260:Female; D018166:Health Care Reform; D006801:Humans; D008297:Male; D010817:Physician-Patient Relations; D010820:Physicians / Q000331:legislation & jurisprudence*; D011287:Prejudice; D036301:Qualitative Research; D014754:Violence / Q000706:statistics & numerical data*
keywords: PUBLIC HEALTH; QUALITATIVE RESEARCH