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      Investigation of the differences between the medical personnel’s and general population’s view on the doctor-patient relationship in China by a cross-sectional survey

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          Abstract

          Background

          Due to economic development and an increase in the aging population, the demand for medical resources is increasing. A good doctor-patient relationship (DPR) can optimize patients’ medical experience and improve treatment efficiency. The DPR, however, is currently in crisis in China. To explore ways to improve DPR, this study assessed the views on the status of the DPR, medical services, and the general situation of medical work among medical personnel (MP) and the general population (GP).

          Methods

          This cross-sectional study, conducted between December 2019 and March 2020, targeted the MP and the GP in Nanjing City, Jiangsu Province, and Zhengzhou City, Henan Province. A total of 154 MP and 329 GP answered a self-administered questionnaire through Questionnaire Star and WeChat apps. Wilcoxon’s Sign Rank Test, Chi-square test, and frequency distributions and percentages were used to process the data.

          Results

          Only 11.04% of the MP and 14.89% of the GP believed that the current DPR was harmonious. Moreover, 54.55% of the MP and 71.12% of the GP believed that the medical industry was a service industry. While 14.29% of the MP and 64.44% of the GP thought medical staff earned high salaries, 19.48% of the MP and 47.11% of the GP wanted their children to be in the medical industry. The recognition of the current status of the DPR did not affect the GP’s preference for their children’s practice ( p < 0.05). Most MPs hoped to improve salaries (40.26%), followed by safety (17.53%) and social status (12.99%); only 8.44% of the MP wanted to improve the DPR.

          Conclusion

          The MP’s and GP’s views on the current status of DPR, the importance of medical service attitudes, and the general sense of the medical industry were similar. However, there was a significant difference in the perception of the nature of medical services and the income of the people employed in the medical industry between the two groups. Balancing the expectations of patients in the medical industry and increasing public awareness of the actual situation in the medical industry may be a feasible way to improve the DPR.

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          Most cited references19

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          The development and reform of public health in China from 1949 to 2019

          Background Public health system plays a vital role in the development of health sector in China and protects the health of Chinese people. However, there are few comprehensive reviews and studies focusing on its evolution and reform. It is worthwhile to pay attention to the public health development in China, given that the history and structure of public health system have their own characteristics in China. Methods The study is a retrospective review of the development public health over seven decades in China. It presents the findings from some national or provincial survey data, interviews with key informants, reviews of relevant published papers and policy contents. Results This study identified four key stages that public health experienced in China: the initial stage centering on prevention, the stage of deviation with more attention to treatment but little to prevention, the recovery stage after SARS(Severe Acute Respiratory Syndromes) Crisis, and the new stage to an equitable and people-centered system. In the latest stage, the National Basic Public Health Service Program (NBPHSP) is implemented to respond the threat of noncommunicable diseases (NCDs) and has achieved some initial results, while there are still many challenges including service quality, poor integration among service items and IT system, lack of quality professionals and insufficient intersectoral endeavor. Discussion There are unique Chinese wisdom and remarkable achievements as well as twists and turns on the development of China’s public health. Prevention-first, flexible structure of the system, multi-agency collaboration and mass mobilization and society participation are the main experience of public health in early stage. Despite twists and turns since 1980s, public health system in China shows substantial resilience which may be from the government’s continuous commitment to social development and people’s livelihoods and its flexible governance. In 2010s, in order to achieve the well-off society, Chinese government pays unprecedented attention to health sector, which bring a new wave of opportunities to public health such as remaining the NBPHSP for priority. The evolution and reform of China’s public health is based on its national condition, accumulates rich experience but also faces many common worldwide challenges. Getting this development and reform right is important to China’s social and economic development in future, and China’s experience in public health may provide many lessons for other countries. Conclusion Public health in China needs to focus on prevention, strengthen multi-agency coordination mechanism, improve the quality of public health services in the future.
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            Prevalence of Anxiety and Depressive Symptoms and Related Risk Factors among Physicians in China: A Cross-Sectional Study

            Background Physicians’ poor mental health not only hinders their professional performance and affects the quality of healthcare provided but also adversely affects patients’ health outcomes. Few studies in China have evaluated the mental health of physicians. The purposes of this study are to quantify Chinese physicians’ anxiety and depressive symptoms as well as evaluate associated risk factors. Methods In our study, 2641 physicians working in public hospitals in Shenzhen in southern China were recruited and interviewed by using a structured questionnaire along with validated scales testing anxiety and depressive symptoms. Multivariable logistic regression models were used to identify risk factors for anxiety and depressive symptoms. Results An estimated 25.67% of physicians had anxiety symptoms, 28.13% had depressive symptoms, and 19.01% had both anxiety and depressive symptoms. More than 10% of the participants often experienced workplace violence and 63.17% sometimes encountered it. Among our study population, anxiety and depressive symptoms were associated with poor self-reported physical health, frequent workplace violence, lengthy working hours (more than 60 hours a week), frequent night shifts (twice or more per week), and lack of regular physical exercise. Conclusions Our study demonstrates that anxiety and depressive symptoms are common among physicians in China, and the doctor-patient relationship issue is particularly stressful. Interventions implemented to minimize workload, improve doctor-patient relationships, and assist physicians in developing healthier lifestyles are essential to combat anxiety and depressive symptoms among physicians, which may improve their professional performance.
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              The doctor-patient relationship, defensive medicine and overprescription in Chinese public hospitals: evidence from a cross-sectional survey in Shenzhen city.

              Alex He (2014)
              Defensive medicine describes physicians' behavioral response to threats from medical malpractice litigation. Previous studies have found widespread practice of defensive medicine that is responsible for the global escalation of health care costs. Defying the traditional explanations, this study, with a case of a Chinese city, reveals that in a country where medical malpractice lawsuits are rare, physicians' self-perceived threats from patients may constitute a major reason for defensive practices. Defensive behaviors in the Chinese context mainly take the form of overprescribing diagnostic tests, procedures and drugs. The existing literature tends to explain this in terms of Chinese doctors' desire to supplement their low incomes. Behind this is a series of misaligned incentives deeply embedded in the Chinese health system. Using a cross-sectional survey of physicians, this study shows that overprescription in Chinese hospitals is driven not only by hard economic incentives, but also by doctors' motive of avoiding disputes with patients. The survey was carried out in Shenzhen City, in December 2013. A sample containing 504 licensed physicians was drawn by random sampling. Descriptive analyses identified significant dissatisfaction with income and workload as well as severe tensions between doctors and patients. Drawing from the literature on defensive medicine, multivariate analysis revealed that physicians' previous experience of medical disputes is significantly associated with defensive behaviors, particularly overprescription. Low income continued to be a critical predictor, reinforcing the target income hypothesis and suggesting the resilience of perverse economic incentives. This study sheds fresh light on China's recent health policy reforms by highlighting the critical impact of the doctor-patient relationship. The effort to contain health care costs must progress on two fronts, mitigating the tensions between doctors and patients while still reforming the remuneration scheme cautiously to enable physicians to respond to right incentives.
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                Author and article information

                Contributors
                20181062@njucm.edu.cn
                zhouhongli946845@163.com
                260261@njucm.edu.cn
                260729@njucm.edu.cn
                shihaibo0806@163.com
                150952@njucm.edu.cn
                260105@njucm.edu.cn
                Journal
                Global Health
                Global Health
                Globalization and Health
                BioMed Central (London )
                1744-8603
                15 October 2020
                15 October 2020
                2020
                : 16
                : 99
                Affiliations
                [1 ]GRID grid.410745.3, ISNI 0000 0004 1765 1045, Institute of Oncology, The First Clinical Medical College, , Nanjing University of Chinese Medicine, ; Nanjing, 210046 Jiangsu Province China
                [2 ]GRID grid.411356.4, ISNI 0000 0000 9339 3042, Liaoning University of Chinese Medicine, ; Shenyang, 110847 Liaoning Province China
                [3 ]Wuxi Xishan Hospital of Traditional Chinese Medicine, Wuxi, 214000 Jiangsu Province China
                [4 ]GRID grid.410745.3, ISNI 0000 0004 1765 1045, Science and Technology Department, Jiangsu Collaborative Innovation Center of Traditional Chinese Medicine Prevention and Treatment of Tumor, , Nanjing University of Chinese Medicine, ; Nanjing, 210046 Jiangsu Province China
                [5 ]GRID grid.410745.3, ISNI 0000 0004 1765 1045, Department of Oncology, , Affiliated Hospital of Nanjing University of Chinese Medicine, ; Nanjing, 210029 Jiangsu Province China
                Author information
                http://orcid.org/0000-0002-6315-7713
                Article
                625
                10.1186/s12992-020-00625-9
                7560186
                33059720
                277baeca-4fc1-4713-ba40-89c0fffd6a04
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 15 July 2020
                : 29 September 2020
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100001809, National Natural Science Foundation of China;
                Award ID: 81973737
                Award ID: ZYX03JG002
                Award Recipient :
                Funded by: A Project Funded by the Priority Academic Program Development of Jiangsu Higher Education Institutions
                Award ID: PAPD
                Award Recipient :
                Funded by: The Open Projects of the Discipline of Chinese Medicine of Nanjing University of Chinese Medicine Supported by the Subject of Academic priority discipline of Jiangsu Higher Education Institutions
                Award ID: ZYX03KF003
                Award Recipient :
                Categories
                Research
                Custom metadata
                © The Author(s) 2020

                Health & Social care
                doctor-patient relationship (dpr),medical dispute,patient satisfaction,people’s republic of china

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