Saturday, 5 January 2013

Medicine loses its appeal as a career in China

High pressure, low incomes and increasingly tense relationships with patients have sent medical workers' career satisfaction to a new low, research has found.
Not only are doctors unhappy with their jobs - they are discouraging their children from following in their footsteps.
"I used to strongly encourage my daughter to study medicine, but now I'm not sure about that, given the several cases (of injured and murdered doctors) in the last year-and-a-half," said Lu Hai, vice-director of the ophthalmology department of Tongren Hospital in Beijing, which is famous for its eye treatment.
In September 2011, a male patient slashed Xu Wen, a doctor in Tongren Hospital's otolaryngology department, three years after he sued the hospital. The patient had accused Xu, who operated on the patient in 2006 in an effort to cure his throat cancer, of failing to root out the tumor, which he believed could have been eliminated in the first surgery, thus leading to a relapse.
Xu was seriously wounded but survived. Nevertheless, a court sentenced Wang to 15 years in prison in April 2012.
In the latest serious case, a 62-year-old man killed a female doctor, Kang Hongqian, with an ax in North China's Tianjin on Nov 29, 2012.
The man went to the first hospital affiliated with Tianjin University of Traditional Chinese Medicine twice in 2011 to be treated for hemiplegy caused by a stroke, China Youth Daily reported.
The man was acting strangely, a doctor in the hospital told the newspaper, but said he couldn't remember any dispute between him and the hospital before the killing took place.
Han Baojie, a doctor in the hospital and Kang's former colleague, said he and many co-workers made up their minds not to allow their children to practice medicine after the case.
The Chinese Medical Doctor Association found that 78 percent of the 3,700 doctors it surveyed in March 2011 said they didn't want their children to study medicine, while in 2009, 62.5 percent of the 3,200 subjects surveyed expressed the same opinion.
In all the surveys conducted around the country in 2002, 2004, 2009 and 2011, the association found that the rate of doctors willing to see their children become medical students was dropping.
The lack of value and pride in the job was also evident in the fact that 96 percent of doctors surveyed in 2011 believed that their salary didn't match their labor.
"Being a doctor should be a job that elites aspire to," said Deng Liqiang, director of the association's legal affairs department, who was also in charge of the survey.
"However, the heavy workload and salaries that don't match the effort make many doctors feel that their job is not that decent. In Beijing, a top doctor can get up to only 300,000 yuan of legal income a year. But in most cases, their income ranges from 3,000 yuan to 8,000 yuan a month. On the other hand, there are doctors taking illegal money like bribes, but this kind of income doesn't make them feel more decent".
A doctor of 22 years, 45-year-old Lu, agreed.
"A resident in my department gets only 3,000 to 4,000 yuan a month," he said. "Top doctors in the department, such as me, get about 10,000 yuan a month."
Several outstanding young doctors in the department left in recent years because "they didn't see any hope", he said.
Yet the "especially heavy workload" that doctors believe should be worth more is not the only cause of their pressure.
More than 70 percent of those polled said that medical disputes and "too many expectations from patients" also add to their work pressure.
"Only one-third of diseases can be effectively treated by medical science, and sometimes it's hard to predict how a disease will develop," said Deng, who was a doctor in Henan for eight years. "However, sometimes medical disputes occur when patients and/or their families feel that the treatment doesn't meet their expectations."
A rule issued by the Supreme People's Court in 2001 stated that hospitals must provide evidence that proves they are not responsible for injury to patients if a patient sues for allegedly flawed treatment.
Though the rule was scrapped in 2010, "more and more people had already formed the stereotyped thinking that any dissatisfaction they feel about the treatment has something to do with the hospital, and that they will get compensation as long as they draw attention to their dissatisfaction," Deng said.
As a lawyer, Deng said he has seen different ways of drawing attention: Not just filing complaints and lawsuits, but brawling, stalking and threatening.
Deng Bingbin, an intern in a public hospital in Beijing, believed the high expectations comes from a lack of knowledge.
"Some regard paying for medical treatment as paying to get a cabbage in the market," she said.
"However, it is not cabbage. One cannot simply expect that their diseases will be cured as long as they pay for the treatment. One cannot purchase life and health."
"I hope the public can get more information about what doctors can do when they fall ill, which is limited. The most important thing is to take care of yourself and watch out for their own health," the intern added.
What's more, the inclination to blame the hospital has helped nurture some professional "hospital troublemakers", groups of people take advantage of the dissatisfaction of the patients and their family, the intern said.
"Because of them, sometimes in disputes, a hospital gives compensation even when there is nothing much to compensate for, in a compromise for peace. I rather fear that I will meet them when I begin to work as a doctor," said the 23-year-old, though she insisted that the medical disputes and even violent cases have not deterred her from pursuing her chosen career.
However, such cases have deterred some doctors from taking risks for their patients, said Lu Hai, of Tongren Hospital.
"Some doctors will not try to do better even when they can. When they feel they are not so sure of the treatment, they will push their patients away to another doctor or another hospital, even persuade them to give up treatment," he said.
"After these kinds of dispute and murders, even I feel the sometimes delicate and subconscious change in my attitude toward patients -like I can't persuade myself to be truly nice."
A survey conducted by five college students in Central China's Hunan province got similar results.
The Hunan Normal University survey, which polled 363 doctors in 19 hospitals in the province from July to September, found that 61 percent of doctors don't like their jobs.
"Some doctors I interviewed said that they used to love their career, but their sense of accomplishment has faded when medical disputes and violent cases in hospitals are reported frequently and patients become less trusting," said Tan Xin, a member of the team majoring in psychology.
Tan said the survey "overturned" her views about doctors, after seeing how their daily work goes.
"I used to be upset when doctors treated me coldly during a consultation, thinking it was unacceptable that I had to suffer their attitude. However, they were mentally stressed when they had only three minutes for each visiting patient, and it's impossible for them to answer all that a patient wants to know," she said.
"Yet a patient often wants to know more about his condition, and the cool attitudes and often cursory answers by doctors may well upset them."
This dissatisfaction among patients may in turn be vented out on doctors themselves, she added.
"I hope that the two sides can understand each other more," said Tan. "Doctors can smile more and be less cold, and patients can try to tolerate doctors because their work burden is really heavy."
Source: China Daily

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