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Patient–physician mistrust and violence against physicians in Guangdong Province, China: a qualitative study
  1. Joseph D Tucker1,2,3,4,
  2. Yu Cheng3,4,
  3. Bonnie Wong2,5,
  4. Ni Gong3,4,
  5. Jing-Bao Nie6,
  6. Wei Zhu7,
  7. Megan M McLaughlin8,
  8. Ruishi Xie9,
  9. Yinghui Deng9,
  10. Meijin Huang9,
  11. William C W Wong10,11,
  12. Ping Lan9,
  13. Huanliang Liu9,12,
  14. Wei Miao9,
  15. Arthur Kleinman13
  16. and the Patient-Physician Trust Project Team
  1. 1Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
  2. 2UNC Project-China Office, Guangdong Provincial STD Control Center, Guangzhou, Guangdong, China
  3. 3School of Sociology and Anthropology, Sun Yat-sen University, Guangzhou, Guangdong, China
  4. 4Center for Medical Humanities, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
  5. 5School of Medicine, Stanford University, Palo Alto, California, USA
  6. 6University of Otago, Dunedin, New Zealand
  7. 7School of Medicine, Fudan University, Shanghai, China
  8. 8Harvard Medical School, Harvard University, Boston, Massachusetts, USA
  9. 9The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China
  10. 10University of Hong Kong, Ap Lei Chau, Hong Kong
  11. 11University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
  12. 12Guangdong Institute of Gastroenterology, Sun Yat-sen University, Guangzhou, Guangdong, China
  13. 13Harvard Asia Center, Harvard University, Cambridge, Massachusetts, USA
  1. Correspondence to Dr Joseph D Tucker; jdtucker{at}


Objective To better understand the origins, manifestations and current policy responses to patient–physician mistrust in China.

Design Qualitative study using in-depth interviews focused on personal experiences of patient–physician mistrust and trust.

Setting Guangdong Province, China.

Participants One hundred and sixty patients, patient family members, physicians, nurses and hospital administrators at seven hospitals varying in type, geography and stages of achieving goals of health reform. These interviews included purposive selection of individuals who had experienced both trustful and mistrustful patient–physician relationships.

Results One of the most prominent forces driving patient–physician mistrust was a patient perception of injustice within the medical sphere, related to profit mongering, knowledge imbalances and physician conflicts of interest. Individual physicians, departments and hospitals were explicitly incentivised to generate revenue without evaluation of caregiving. Physicians did not receive training in negotiating medical disputes or humanistic principles that underpin caregiving. Patient–physician mistrust precipitated medical disputes leading to the following outcomes: non-resolution with patient resentment towards physicians; violent resolution such as physical and verbal attacks against physicians; and non-violent resolution such as hospital-mediated dispute resolution. Policy responses to violence included increased hospital security forces, which inadvertently fuelled mistrust. Instead of encouraging communication that facilitated resolution, medical disputes sometimes ignited a vicious cycle leading to mob violence. However, patient–physician interactions at one hospital that has implemented a primary care model embodying health reform goals showed improved patient–physician trust.

Conclusions The blind pursuit of financial profits at a systems level has eroded patient–physician trust in China. Restructuring incentives, reforming medical education and promoting caregiving are pathways towards restoring trust. Assessing and valuing the quality of caregiving is essential for transitioning away from entrenched profit-focused models. Moral, in addition to regulatory and legal, responses are urgently needed to restore trust.


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