Friday, 1 February 2013

Deep reflection needed on China's medical-help-seeking culture

by Harry Yi-Jui Wu, Centre for the Humanities and Medicine, University of Hong Kong
 On Nov 7, 2012, the South People—regarded as the most independent and outspoken newspaper in mainland China—published an article entitled “Sha yi” (“Killing the doctor”), exploring an incident in which a junior doctor was stabbed to death by a 17-year-old patient.
The teenage killer seemed determined to slay anyone in a white coat. Although his actions were extreme, his case is only one among many examples of despair caused by the repeated frustrations of having to travel long distances for basic primary care, and placement of unrealistically high hopes on the available services.
Scholars have commented extensively on the effect of migration on the health-care system, claiming that increased urbanisation in China has led to the exclusion of migrants in urban areas and the abandonment of populations in rural regions.  Relatively little is known about the number of patients who bypass the available primary care at home and travel to cities looking for better medical care. In China, the unequal distribution of medical resources is severe; however, is it not so severe as to force the majority of patients to seek health care afar. There is, nonetheless, a common belief that services at home are not making them better.
In the landscape of unbalanced globalisation and an ever-expanding neoliberal medical market in post-socialist China, patients often suffer from a belief that they are being denied the health-care opportunities provided by the budding entrepreneurial, scientifically supported medical care systems.  In China, the improving biomedical industries have created new lines of exclusion and have transformed patients' consuming behaviours and moral codes. The dissociation between the high hopes of the patients and the severe constraints of an ostensibly promising yet bureaucratic and corrupt medical care system often leads to perceived malpractice, consequently widening the gap of trust between medical providers and patients.
China's 18th National Congress recently concluded with a blueprint to provide its citizens with effective, convenient, and affordable public health and basic medical services. However, the manifesto seems no different from what was raised in the last National Congress, 4 years ago. The tragedy described above exposes the serious structural problems involving all victims—the murderous patient, the dead doctor, and the perpetually uncared-for. A deeper understanding of the moral structure of contemporary Chinese medical culture will certainly help health authorities through the long road of reforms.
Source: Lancet

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