Survey of Medical Professionalism from the

Patient PerspectiveWork group: Zhizheng Du Mingjie Zhao Yi Qin Yang Yang

一、 Project Design and Methodology

1 、 Purpose

patient is the subject of medical professionalism, their acknowledgement and attitude about medical professionalism is important .

purpose of our project: enhance the development of China medical professionalism by understanding and analyzing the patients’ views of medical professionalism and health care in modern China

2 、 selected sample

1 、 criteria: patient who has been hospitalized in recent years (or family members of the patient who has been accompanying the patient)

2 、 Eliminated Condition: doctors 3 、 stratified random sampling method with a total sam

ple amount of 2400 ; divided the whole country into developed, developing

and underdeveloped regions according to their economic prosperity. Ten cities such as Shanghai, Dalian, Jinan, Shijiazhuang are selected. 200 samples per city.

3 、 method

1 、 pre-investigation αtesting and βtesting, revision and modification of the questionnaire outline

2 、 all the questionnaires are required to be filled out of hospitals

3 、 patients gathered together to carry out the survey

4 、 the Investigator training (39 in total)

4 、 Quality Control

1 、 carefully revised questionnaire and items

2 、 team cooperation and communication

3 、 investigator training of precautions

4 、 supervision in time

二、 sample analyzing

A 、 handout: 4000; collected: 4000; valid:3932; validity:98.3% ，

city:2013; countryside:1919 B 、 sex: male:1751; female:2181 C 、 hospitals: provincial (and above, including university affiliated

hospitals):315 （ 8.4% ）， Municipal hospital : 2458 （ 62.5% ）， county hospital:1084 （ 26% ）， clinic: 75 （ 1.9% ）。

D 、 the department :

internal medicine 1700 43.2%

surgery 1034 ·26.3%

gynecology 518 13.2%

Neurology 128 3.3%

Otolaryngology 136 3.5%

others 416 10.6%

Total 3923 100 。 0

E 、 Average time your are in hospital :

1-10 days: 1701 43.3%

10-20 days: 1373 34.9%

20-30 days: 524 13.3%

more than 30 days 334 8.5%

F 、 average monthly income ： less than 1000: 2510 （ 63.8% ）。 1000-3000:1072 （ 27.3% ）， 3000-5000: 265 （ 6.7% ）， 5000-10000: 85 （ 2.2% ）

G ； medical insurance ：

medical services at state expense 685 （ 17.4% ），medical insurance for urban workers 1235 （ 31.4 ），

rural cooperative medical insurance 1464 （ 37.2% ）， business insurance 104 （ 2.6% ），without any insurance 444 （ 11.3% ）

三、 general views of medical professionalism from patient perspective

this report just illustrate some issues selected

1 、 general conclusion of medical professional responsibility

A 、 assess the medical professional responsibility in the hospital you stayed:

choice sample# percentVery satisfied 733 18.6satisfied 2450 62.3 Unsatisfied 600 15.3Very bad 149 13.8Total 3932 100

B 、 as to the health of patients, physicians

choice sample# percent

care for 657 16.7

Somewhat care for 2583 65.7

Not very care for 584 14.9

Not care for at all 108 2.7

total 3932 100.0

C 、 What’s physicians’ priority in their practice

choice sample# percent

The health of patients 1559 39.6

improve their skill 833 21.2

Economic Interest of

their own and hospital 1540 39.2

total 3932 100.0

D 、 The No. 1 reason why you are unsatisfied with the hospital or physician

choice sample# percent

irresponsibility 1761 44.8

Poor skill 569 14.5

Poor equipment 252 6.4

High charges 1146 29.1

others 204 5.2

total 3932 100.0

E 、 the things you worried most during your stay

choice sample# percentirresponsibility 883 22.5misdiagnosis 1484 37.7Shirking responsibility 303 7.7High expense 940 23.9inattentive attitude 213 5.4Poor management 74 1.9Poor environment 35 0.9 total 3932 1000

conclusion

as illustrated above ： ●patients that are very satisfied only takes up 18.6% of the t

otal, combining the ones somewhat satisfied, it takes up 80.9% ；

●patients’ welfare first (39.6% )V.S. individual interest (39.2%) first

●the things worried most ： 1st, professional responsibility; 2nd, malpractice ; 3rd, high expense

2 、 trust in physician-patient relationship

trust

physician-patient relationship

medical professionalism

A 、 do you trust you doctors?

choice sample# %

very 525 13.4

somewhat 2699 68.6

Not very 581 14.8

Not at all 127 3.2

total 3932 100.0

B 、 After seeing a doctor in a hospital, do you still go to another hospital ?

choice sample# %

yes 2125 54.0

no 1807 46.0

total 3932 100.0

C 、 the reason for taking the another hospital

choice sample# %

no answer 818 20.8

Poor skill 1336 34.0

Poor hardware facilities 574 14.6

High expense 990 25.2

poor physician attitude 214 5.4

total 3932 100.0

D 、 Have you ever paid attention to your doctors’ behavior

choice sample# %

yes and it’s necessary 1159 29.5

never, but it’s necessary 1308 33.3

never, and it’s unnecessary 1465 37.2

Total 3932 1000

conclusion

●worth trusting takes13.4% ， adding to that can be somewhat trusted, up to 81.0%

●seeking for another hospital takes 54.5% ，mainly because of poor skill

●62.6% patients would pay attention to their doctors’ behavior ， just 37.2% thought it is unnecessary

3 、 monetary gift

a tough issue in our society

A 、 Did you give “monetary gift” to your doctors during you stay in the hospital?

choice sample# %

yes 2140 54.4

no 1792 45.6

total 3932 100.0

B 、 the amount of monetary gift is

choice sample# %

Less than1000 1341 46..4

1000-2000 934 32.4

2000-3000 420 14.6

3000-4000 106 3.6

more than 400086 3.0

total 2887 99.6

Note: 1036 no answer

C 、 Does low-income justify monetary gift?

choice sample# %

very much justify 341 8.7

somewhat justify 502 12.8

Can’t justify 1725 43.9

Can’t justify at all 1163 29.9

Others 201 5.1

Total 3932 100.0

D 、 What is the motivation of patients who give monetary gift?

Choice sample# %hope to get special care from doctors (including post-operative care)

1575 40.1have better doctor to perform the operation

993 25.3the operation could be arranged sooner

449 11.4reduce worry

606 15.4save medical expenditure

124 3.2express appreciation

185 47 total 3932 100.0

E 、 If after giving the monetary gift, your goals are not achieved, you will:

choice sample# %Not care 555 14.1Be dissatisfied, but be understanding 1186 30.2worry about having given less money than needs

1108 28.2angry

806 20.5accuse the doctor 277 7.0 total 3932 100.0

F 、 The attitude of the majority of doctors on monetary gift is:

choice sample# %refusal 738 18.8Want to accept but feel worried 1619 41.2Depends 430 10.9Always accept 831 21.1Hint patients to give 257 6.5Return after receiving 57 1.4 总计 3932 100.0

G 、 In your opinion, what impact would receiving monetary gift exert to physicians:

Choice sample# %

No impact 493 12.5

impair their reputation 2062 52.4

encourages corruption 1377 35.0

Total 3932 100.0

conclusion

● monetary gift issue may be exaggerated

● the disapproval of patients on such a behavior

● should concern more on doctors' attitude

● the motivation of bribery

4 、 informed consent and autonomy

One of the principles in the

Medical Professionalism in the New Millennium: A Physicians' Charter

A 、 You think physician’s implementation of informed consent is

choice # %

Very necessary 1502 38.2

necessary 1850 47.0

Not very necessary 348 8.9

unnecessary 232 5.9

total 3932 100.0

B. Who sign on the consent when the patient is conscious?

choice # %

Patient self 1555 39.5

family member 2078 52.8

Colleague or friend 171 4.3

physician 128 3.3

total 3932 100.0

C 、 When the doctor explains condition and treatment of illness, you hope it to be?

choice # %

straightforward 2430 61.8

obscure 510 13.0

Told to family members only 992 25.2

Total 3932 100.0

D 、 what do you think of requirement of signature of patients or their families before surgery?

choice # %

Very necessary 1586 40.3

necessary 1519 38.6

Somewhat necessary 638 16.2

unnecessary 189 4.8

total 3932 100.0

E 、 Before your sign the consent, the information given by doctors is:

choice # %

Very clear 1173 29.8

clear 1786 45.4

Not very clear 600 15.3

Very unclear 156 4.0

unclear due to limited time 217 5.5

total 3932 100.0

F 、 What do you think of signing before operation?

choice # %

Respect to patient’s right 1948 49.5

Hospital is pushing aside responsibility

1484 37.7

Proof for potential court trial if necessary

284 7.2

Go through the motion 216 5.5

total 3932 100.0

G 、 You sign the consent with

choice # %

Deliberated consideration 2169 55.2

Insufficient consideration 856 21.8

The pressure of the hospital

You don’t sign it at all 907 23.1

total 3932 100.0

H 、 preoperative signing may make patients

choices sample# %

More worried 1530 34.3

Emotionally unstable 1471 37.4

More confident 1111 28.3

Total 3932 100.0

I 、 With signing, if the operation failed or had mistake, you think the doctor

选项 人数 %

Don’t have to be accountable 440 11.2

Be accountable partially 1079 27.4

Be mainly accountable 1041 26.5

Be fully accountable 366 9.3

It depends 1006 25.6

总计 3932 100.0

conclusion

• Chinese patients are concern about their right

• The influence of Chinese family • Misunderstanding of signing before the opera

tion • Signing and responsible for operation failure • impact of signing to the patients before the o

peration

5 、 informed refusal

autonomy V.S. informed consent

A 、 After being informed the illness condition or treatment by doctors, you don not think the advices are appropriate, you will:

选项 人数 %Express your disagreement and hold your own

opinion1467 37.3

Receive their advice after explanation 2459 62.5

other 6 0.2 总计 3932 100.0

B 、 The reasons that you do not agree with the view of doctors of treatment is:

选项 人数 %

doubt of their judgment 1361 34.6

They are making money by doing so

782 19.9

Can’t afford it 1404 35.7

Worry about family member’s disagreement 385 9.8

总计 3932 100.0

C 、 Face to disagreement of patients, the doctors should ：

选项 人数 %

Accept it unconditionally

549 14.0

Explain with patience

Insist their first judgment

2804 53.0

It depends 1299 33.0

总计 3932 100.0

D 、 After several rounds of communication, patients still persist, you think doctors should:

选项 人数 %

Take patient’s opinion 1901 48.3

Proceed with their own opinion

1336 34.0

Ask patient to transfer to another facility 695 17.7

总计 3932 100.0

E 、 In emergency conditions, you think :

选项 人数 %

patients should obey physician’s judgment 3310 84.2

Patient should have the right to decide

622 15.8

总计 3932 100.0

F 、 When patient persistence leaded to death or other adverse consequences after doctors inform patients the dangers for many times,

选项 人数 %

Doctor is not responsible for it

2807 53.1

Doctor is responsible for it

1845 46.0

总计 3932 100.0

conclusion

Informed refusal: most patients would follow the doctors’ advise

The reason of informed refusal: 1st is high cost (36.7%) ；

Who would be responsible for the refusal?

6 、 medical error and report

medical error is inevitable

report is another problem

A 、 You think the errors that doctors make in practice?

选项 人数 %

Can be totally avoided 923 23.5

Can be avoided 1841 46.8

Hard to avoid 918 23.3

unavoidable 250 6.4

总计 3932 100.0

B 、 Medical treatment has risks, in your opinion, who is assumed to take the responsibility of the risks?

选项 人数 %

doctor 524 13.3

You and doctor 1122 28.5

patient 247 6.3

hospital 801 20.4

Insurance company 1238 31.5

总计 3932 100.0

C 、 Generally speaking, what is the attitude of doctors and hospitals to malpractice?

选项 人数 %

Try to hide 1655 42.1

Report to higher level 1877 47.7

Tell no one 400 10.2

总计 3932 100.0

D 、 If you or your family encountered malpractice:

选项 人数 %

It must be informed candidly

1988 50.6

Should be informed candidly

1729 44.0

I don’t care 215 5.5

总计 3932 100.0

E 、 If doctors tell you candidly about the medical error or malpractice, you:

选项 人数 %

will surely forgive 751 19.1

May forgive 2569 65.3

unforgiving 612 15.6

总计 3932 100.0

conclusion

misunderstanding of medical error Different views about who would be

responsible for medical error The report of medical error

7 、 confidentiality

one of the professional responsibility

A 、 It_______for doctors to keep confidentiality:

选项 人数 %

Is very important 2889 73.5

Would be good 944 24.0

Doesn’t matter 99 2.5

总计 3932 100.0

B 、 After telling doctor personal your status of illness and illness experience , you :

选项 人数 %

Trust that doctor can keep it confident

2637 67.1

Worry doctor can’t keep it confident

1295 32.9

总计 3932 100.0

C. Doctor’s public talk about your privacy will:

选项 人数 %hurt your on your self-respect 1467 37.3Influence your confidence in treatment 1055 26.8Influence your relation with others 334 8.5Influence your trust in the doctor 285 7.2Let you feel the doctor unprofessional 749 19.0Lead to your accusation of the doctor 42 1.1 总计 3932 100.0

D 、 There are many other people standing by when you are seeing doctor, how do you feel about this?

人数 %

选项I don’t care 717 18.2

I hate it 1380 35.1

It should be avoided

1835 46.7

总计 3932 100.0

conclusion

Chinese patients are concerned about their privacy (97.5% )

67.1% patients trust their doctors The negative influences of privacy disclosure

8 、 conflict of interests

a central topic in contemporary society

A 、 Is there a conflict of interests between doctors and patients ？

选项 人数 %

yes 1939 49.3

Maybe yes 1273 32.4

Maybe no 409 10.4

Don’t know 311 7.9

总计 3932 100.0

B 、 If so, what is the main reason of current conflict of interests between patients and doctors?

选项 人数 %Hospital aims at profit 1566 39.8Unable to provide satisfactory service 1384 34.3Poly-treatment/regimen 467 11.9Physicians make unreasonable requirements

127 3.2Patients make unreasonable requirements

117 3.0Patients have too high expectation 307 7.8 总计 3932 100.0

C 、 can conflict of interests between patients and doctors be avoided?

选项 人数 %

yes 1934 49.2

It’s hard 1566 39.8

It’s hard to avoid totally

432 11.0

总计 3932 100.0

D 、 What is your assessment of the hospital charges currently ？

选项 人数 %

Somewhat reasonable 1317 33.5

Not very reasonable 1855 47.2

Very unresonable 759 19.3

No comment 1 0.0

总计 3932 100.0

E 、 Have you encountered the situation that your doctor induced you to buy the high-priced medicine?

选项 人数 %

often 964 24.5

occasionally 1914 48.7

never 1054 26.8

总计 3932 100.0

F 、 Have you encountered the situation that your doctor induced you to do high-tech inspection?

选项 人数 %

often 1018 25.9

occasionally 1635 41.6

never 1279 32.5

总计 3932 100.0

conclusion

Some important differences 。 unreasonable charges of hospital The reasons of conflict of interests between p

atients and doctors Problems of induction

四、 socio-analyzing of the medical professionalism from the patient perspective

it is so complicated in china, here just taking a few cases studied

1 、 urban and rural area

Differences and inequalities

Samples: 3932

including: city 2013

country 1919

A 、 assess of medical care

city % country %

选项 Very satisfying 289 14.4 444 23.1

Somewhat satisfying 1343 667 1107 57.7

Not very satisfying 326 162 274 14.3

Very unsatisfying 55 2.7 94 4.9

总计 2013 100.0 1919 100.0

B 、 doctors’ responsibility to patients’ health

city % country %

选项Very responsible 244 12.1 413 23.1

Somewhat responsible

1422 70.6 1166 60.5

Not very responsible 313 15.5 271 14.1

Very irresponsible 34 1.7 74 3.9

总计 2013 100.0 1919 100.0

C. Physicians prioritize

city % country %

选项 patient’s interest

726 36.1 833 43.4

Personal skill 423 21.0 410 21.4

Economic interest

864 42.9 676 35.2

总计 2013 100.0 1919 100.0

D 、 currently, most doctors are

items city % country %

Very credible 210 10.4 315 16.4

Somewhat credible 1405 69.8 1294 67.4

Not very credible 342 17.0 239 12.5

untrustworthy 56 2.8 71 3.7

总计 2013 1000 1919 100.0

E 、 Have you ever paid attention to your doctors’ words and deeds

items city % country %

Yes and necessary

564 28.0 592 30.8

No but necessary

724 36.0 581 30.3

Don’t have to trust doctors

723 35.9 739 38.5

其他 2 0.1 7 0.4

F 、 the reason of terrible patient-physician relationship

items city % country %doctors are irresponsible

504 25.0 477 24.9hospitals aim at profit

1296 64.4 1054 54.9patients are unreasonable 96 4.8 178 9.3patient have excessive expectation

83 4.1 166 8.7Media provocation 34 1.7 44 2.3 总计 2013 100.0 1919 100.0

G 、 What do you look at respecting of autonomy

items city % country %

Very necessary 817 40.6 685 35.7

necessary 916 45.5 934 48.7

Not very necessary 179 8.9 169 8.8

Not necessary 101 5.0 131 6.8

total 2013 100.0 1919 100.0

H 、 how about reporting medical error

items city % country %

Must tell candidly

1117 55.5 871 45.4

should tell candidly

820 40.7 909 47.4

Never mind 76 3.8 139 7.2

总计 2013 100.0 1919 100.0

2 、 Shanghai and Zunyi

COMPARISON

A 、 you think doctors

items Shanghai % Zunyi %

Can treat patients equally

100 40.0 68 35..2

Can’t treat patients equally

150 60.0 125 64.8.

总计 250 100.0 193 100.0

B 、 hospital should consider more for vulnerable groups

items Shanghai % Zunyi %

yes 214 85.6 147 76.2

unnecessary 36 14.4 46 23.8

总计 250 100.0 193 100.0

C 、 Do you think it is necessary to provide wards with lower charges?

items Shanghai % Zunyi %

necessary 222 88.8 1 60 82.9

unnecessary 28 11.2 33 17.1.

总计 250 100.0 193 100.0

D 、 you think patient-designated doctors for surgery?

items Shanghai % Zunyi %

reasonable

192 76.8 127 65.8

unreasonable

58 23.2 66 34.2

总计 250 100.0 193 100.0

E 、 Did you ever pay attention to your doctors’ words and deeds during their practice

items Shanghai % Zunyi %

Yes and necessary 28 11.2 62 32.1

Never but necessary 203 81.2 74 38.3.

Never and unnecessary

17 6.8 57 29.5.

other 2 0.8

总计 250 100.0 193 100.0

F 、 do you know that you should give “Bribery Money” to your doctors during you stay in the hospital or when you have operation?

items Shanghai % Zunyi %

yes 149 59.6 90 46.6

no 101 40.4 103 53.4

总计 250 100.0 193 100.0

五、 conclusion and discussion

1 、 changes of views

2 、 the promising patient-physician relationship in China

3 、 the negative influence to medical professionalism from the industrialization

4 、 patients’ understanding of medical professionalism

5 5 、 China is different from western countries on autonomy and other rights

6 、 patients’ attitude on informed refusal is objective and calm

7 、 understanding the differences between city and country

8 、 conclusion from the comparison between Shanghai and Zunyi

9 、 our plan for next step:

不同地区、不同人群患者医学专业精神认识差异分析；知情同意若干问题的病人观点；知情不同意的调查分析；非正式支付——红包的病人心理学分析与研究；病人观点：医生应当主动向病人告知医疗差错吗？病人如何看待医疗纠纷？病人心目中的理想医生等提出专题报告，拟明年六月完成上述研究。

acknowledgement

Cong Yali, Peking University Health Science Center, Cao Yongfu, Chen Xiaoyang, Shandong University, Chen Gang, Fudan University, He Yumin, Shanghai University of Chinese Medicine Zhang Jie, Wuhan University People's Hospital, Lan Liji, Sichuan University,

acknowledgement

Wang Hongqi, Shanxi Medical University, Guo Zhaojiang, Fourth Military Medical University, He Yunqi, Zunyi Medical College, Ping Xiaoyue, Second Hospital, Dalian Medical Univ

ersity Bian Lin, Hebei Medical University, Research Office of the Dalian Federation of Trade U

nions

thanks