Table 4

Quotations supporting policy responses to patient–physician mistrust

ThemeQuotes
Increased hospital security forces inadvertently precipitate mistrust(1) “I don't really like this feeling of having the security guards making inspections. I understand why the hospitals are doing this now, they're worried about patients stirring up trouble. But the security guards are walking back and forth, and sometimes when I take a walk in the hallway I run into them. I have the feeling of a prisoner being let out to exercise. This makes me feel very uncomfortable. I feel like I am not free and I'm being watched.”—Patient
Increased media attention reinforces mistrust between physicians and patients(1) “If reported incorrectly, media portrayals of medical disputes tarnish the image of physicians. Increasingly the media holds responsibility for conflicts between physicians and patients. Of course, many common people don't really understand, and then the media exaggerates to make it look more serious. For example, expectations about the cost and ability to cure an illness should be reasonable. They can't be too high. I think the media should disseminate medical knowledge. When a dispute occurs, the media should report it objectively. Before reporting, they should interview physicians, understand the situation a little. Sometimes the media reports are inaccurate and its clear the media doesn't understand medicine.”—Physician
(2) “Some [media stories] are true, but some are taken out of context. The media goes and amplifies one point of view. Because the media always wants to find a flashpoint, a highlight, to attract people to read or watch the report. There certainly is this kind of news report, but you need to look at whether the perspective is balanced. The way the media reports many things is not from a balanced perspective. One reason is that they don't have this kind of specialized knowledge, and second, I think they write with a certain aim. Some media stories are real, but some media really carries its own purpose. When the media provokes negative emotions in the public, it is difficult to control. Reading about so many terrible incidents, if you see something, you will think there is a problem.”—Patient
(3) “They [patients] often see too many negative news. Basically every day the news on TV always has something about medical treatment scandals, about this type of thing, or else it's a dispute between a patient and doctor. Many people just take the side of the media. After an exposé, the common people just think that many [doctors or hospitals] are not trustworthy.”—Physician
A hospital using a new primary care model has started the process of gradually restoring patient–physician trust(1) “I think general practitioners can completely solve this problem [of patients crowding large hospitals]. If these things [minor medical issues] are given to general practitioners to handle, then patients won't need to crowd the large hospitals, then the large hospitals probably won't have to call on the big physicians in each specialty so much, and they will have more time and energy to do more specialized [cases]. I think general practitioners ought to have an even greater function.”—Physician
(2) “It's not that I will just prescribe whatever medication you want me to prescribe, rather I will prescribe whatever medication your condition requires…I don't need to order so many diagnostic tests. Second, pharmaceutical misuse is a big part of it. Third, prescribing medications and ordering diagnostic tests affects the cost problem. If I reduce the patient's expenses, he is also very satisfied.”—Physician
(3) “Compared to other hospitals in China, the salaries for physicians at this hospital [the primary care model] are quite good, even considering that doctors in some of the large hospitals receive money under the table [red packets or payments from pharmaceutical representatives]. Altogether the salary here has been carefully thought through [by the administration], it's a dignified salary. The salary structure incentivises quality performance.”—Physician