By Qi Yue (啟越)
Economic Observer
Commentary, page 15
Apr 2, 2012
Translated by Laura Lin
Original article: [Chinese]

Last week, Wang Hao (王浩), a young medical intern working at a Harbin city hospital in northern China was stabbed to death by an angry patient. Three of his fellow doctors were seriously injured.

Last year alone, there were 10 incidents involving the violent death of medical staff. There is growing concern that if trust between doctors and patients cannot be rebuilt soon, this kind of violence will soon become a common occurence.

The violence appears to be linked to abnormal conditions becoming the norm in Chinese hospitals: queuing overnight for registration, treatment for a simple cold costing over 1,000 RMB, an increase in the frequency of medical malpractice, the arbitration of medical disputes often dragging on for years ... the list goes on.

As for doctors, they too have plenty of pent-up resentment. They work more than 10 hours a day and can examine more than 100 patients per shift. Any prescription arouses questions by patients suspicious that the doctor might be scamming them. The medical system forces them to over-prescribe expensive medication, otherwise neither they nor the hospitals can survive.

The consequence, in its most extreme form, is doctors with bodyguards.

The traditional philosophy where the doctor should treat patients as a parent treats their child has been replaced by widespread animosity across the medical profession.

Murder is an atrocious crime. Only an authorized justice system can deprive one of life, nobody else. We condemn any form of violence.

Nevertheless, we must ask ourselves why there is so much violence around us today?

Why does it seem to manifest itself in the weak against the strong?

The street hawkers are angry because the Chengguan (城管), low-level law-enforcement officers tasked with keeping order, chased them and knocked over their stalls.

Evicted householders throw Molotov cocktails at the authorities after their houses are forcibly demolished by officials.
 
Medical patients are also weak, if a mistake was made when they lay on the surgery table, how could they not be angry?

Marketplace of Responsibility

It's not difficult to explain the current physician-patient confrontation from a rational perspective. If we take a holistic review of each of these medical disputes we find that they all follow more or less the same pattern. The patient has paid an astronomical cost (materially or mentally) for treatment that is either not satisfactory, or even contrary to what was promised.

Part of the problem is that patients have no channel to vent their grievances, thus the probability that some of them will turn to violence is bound to rise.

One of the more obvious ways to address the conflict is by reforming the medical system itself: finding new ways to finance medical care; building more hospitals; and streamlining regulations to resolve medical disputes more smoothly.

But a good system can't solve everything, the patient-doctor violence is an indication that our society is lacking a sense of responsibilty.

Friedrich von Hayek, one of the major economists and political philosophers of the 20th century wrote that the most important moral foundation of the free market economy is a "sense of responsibility," this ethical sense which makes each individual take responsibility for the consequences of his behavior.

Any profession will eventually lose its social value if it is not based on moral responsibility.

In the face of this truth, what happens when a doctor prescribes drugs indiscriminately or even overtreats patients just to boost his own income?

Can an urban law enforcer beat up a handicapped hawker to demonstrate his authority?

Can officials casually tear down someone's house for the sake of urban development?

And what happens, as we've seen so often in China, when people are afraid to help strangers because they believe it puts them at risk of being falsely accused or sued?

If this "sense of responsibility" disappears, then trust will go and our society will become something truly scary.

Our food would be toxic, our hospitals unsafe and our roads dangerous. The whole of society would have fallen into a "mutual harming" pattern where everybody is harming everybody and can get harmed themselves.

The patient could be hurt by a doctor; the doctor's house could be demolished; the patient could also be a profiteer selling "toxic milk" ... you get the idea.

This is why it's not enough to blame China's current health care problems entirely on the medical system itself.

Naturally, a bad system will foster the evil in human nature, whereas a good system can encourage good deeds.

If each person sticks to his job requirements and controls abuse, or at least decides "not to be evil," the bad system will eventually be transformed.

Otherwise, we will wind up with a society based on stand-offs, where patient-doctor, public-police, citizen-politician relationships become an illness that weakens society as a whole.

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