Analysis of the characteristics, efficiency, and influencing factors of third-party mediation mechanisms for resolving medical disputes in public hospitals in China.

BACKGROUND: Medical disputes, which are prevalent in China, are a growing global public health problem. The Chinese government has proposed third-party mediation (TPM) to resolve this issue. However, the characteristics, efficiency, and influencing factors of TPM in resolving medical disputes in public hospitals in China have yet to be determined. METHODS: We conducted a systematic study using TPM records from medical disputes in Gansu Province in China from 2014 to 2019. A χ2 test was used to compare differences between groups, and binary logistic analysis was performed to determine the factors influencing the choice of TPM for resolving medical disputes. RESULTS: We analyzed 5,948 TPM records of medical disputes in Gansu Province in China. The number of medical disputes and the amount of compensation awarded in public hospitals in the Gansu Province increased annually from 2014 to 2019, with most of the disputes occurring in secondary and tertiary hospitals. Approximately 89.01% of the medical disputes were handled by TPM; the average compensation amount with TPM was Chinese Yuan (CNY) 48,688.73, significantly less than that awarded via court judgment and judicial mediation. TPM was more likely to succeed in settling medical disputes in the < CNY10,000 compensation group than in the no-compensation group (odds ratio [OR] = 3.14, 95% confidence interval [CI] 1.53-6.45). However, as the compensation amount increased, the likelihood of choosing TPM decreased significantly. Moreover, TPM was less likely to be chosen when medical disputes did not involve death (OR = 0.49, 95% CI 0.36-0.45) or when no-fault liability was determined (vs. medical accidents; OR = 0.37, 95% CI 0.20-0.67). CONCLUSION: Our findings demonstrate that TPM mechanisms play a positive role in efficiently reducing compensation amounts and increasing medical dispute resolution rates which was the main settlement method in resolving medical disputes in public hospitals of Gansu Province in China. TPM could help greatly reduce conflicts between doctors and patients, avoid litigation, and save time and costs for both parties. Moreover, compensation amounts, non-fatal outcomes, and no-fault liability determinations influence the choice of TPM for settling medical disputes.

The Efficacy of Rule of Law Publicity Short Video Platforms in the Prevention of Medical Disputes Among Healthcare Professionals: A Propensity Score Analysis.

Background: Medical disputes are a recurrent and pressing issue in hospitals, posing significant challenges to the functioning of medical institutions. We aimed to investigate whether receiving rule of law publicity on short video platforms is relevant to preventing medical disputes among healthcare professionals. Methods: We collected the data from 37,978 medical professionals from 130 tertiary public hospitals. Participants were classified into two groups according to the presence of receiving rule of law publicity on short video platforms. A subgroup analysis was performed before and after propensity score analysis, and multiple logistic regression was used to identify risk factors for medical disputes. Results: Among all participants, 46.1% (17,506/37,978) experienced medical disputes. Before propensity score analysis, the prevalence of medical disputes among participants who received rule of law publicity on short video platforms was similar to that among participants who did not (P = 0.639). However, after propensity score analysis, participants who received the rule of law publicity on short video platforms did not show a benefit effect. These participants had a significantly higher rate of suffering from medical disputes than participants who did not receive publicity on this platform (P=0.020). Multiple logistic regression analysis confirmed that receiving the rule of law publicity through short video platforms (P=0.010) or MicroBlog (P = 0.016), and previously facing legal issues outside of medical work (P < 0.001) were risk factors for medical disputes; participating in legal training organized by hospitals (P=0.004) and the hospital rule of law being very good (P=0.045) were protective factors. Conclusion: Medical disputes are a common occurrence within the healthcare profession. However, using short video platforms to promote the rule of law is not an effective method to prevent disputes. Instead, healthcare professionals can benefit from participating in legal training and having a well-established rule of law within the hospital construct.

Acute water intoxication in hysteroscopic myomectomy: a rare case report.

Water intoxication is rarely seen in forensic practice and is typically associated with excessive water consumption, amphetamine intake, and child abuse. Iatrogenic water intoxication is rare but usually related to medical disputes. Here, we report a 44-year-old female was admitted to the hospital due to a 3-month history of excessive menstrual bleeding. B-ultrasound revealed multiple substantial intrauterine masses, leading to a diagnosis of multiple uterine fibroids. After admission, she underwent submucous myomectomy, endometrial resection, and transcervical resection of endometrial polyps. During the procedure, the patient suffered dizziness and chest tightness, her blood pressure decreased to 89/52 mmHg, and moist rales were heard in her both lungs; she died despite medical efforts. A forensic autopsy was performed and revealed severe pulmonary edema. Considering the patient's clinical history, acute water intoxication was considered to be the cause of death. This highlights the need for forensic pathologists to be vigilant of postoperative water intoxication, a rare complication in obstetrics, to ensure accurate assessments.

Prediction of Medical Disputes Between Health Care Workers and Patients in Terms of Hospital Legal Construction Using Machine Learning Techniques: Externally Validated Cross-Sectional Study.

BACKGROUND: Medical disputes are a global public health issue that is receiving increasing attention. However, studies investigating the relationship between hospital legal construction and medical disputes are scarce. The development of a multicenter model incorporating machine learning (ML) techniques for the individualized prediction of medical disputes would be beneficial for medical workers. OBJECTIVE: This study aimed to identify predictors related to medical disputes from the perspective of hospital legal construction and the use of ML techniques to build models for predicting the risk of medical disputes. METHODS: This study enrolled 38,053 medical workers from 130 tertiary hospitals in Hunan province, China. The participants were randomly divided into a training cohort (34,286/38,053, 90.1%) and an internal validation cohort (3767/38,053, 9.9%). Medical workers from 87 tertiary hospitals in Beijing were included in an external validation cohort (26,285/26,285, 100%). This study used logistic regression and 5 ML techniques: decision tree, random forest, support vector machine, gradient boosting decision tree (GBDT), and deep neural network. In total, 12 metrics, including discrimination and calibration, were used for performance evaluation. A scoring system was developed to select the optimal model. Shapley additive explanations was used to generate the importance coefficients for characteristics. To promote the clinical practice of our proposed optimal model, reclassification of patients was performed, and a web-based app for medical dispute prediction was created, which can be easily accessed by the public. RESULTS: Medical disputes occurred among 46.06% (17,527/38,053) of the medical workers in Hunan province, China. Among the 26 clinical characteristics, multivariate analysis demonstrated that 18 characteristics were significantly associated with medical disputes, and these characteristics were used for ML model development. Among the ML techniques, GBDT was identified as the optimal model, demonstrating the lowest Brier score (0.205), highest area under the receiver operating characteristic curve (0.738, 95% CI 0.722-0.754), and the largest discrimination slope (0.172) and Youden index (1.355). In addition, it achieved the highest metrics score (63 points), followed by deep neural network (46 points) and random forest (45 points), in the internal validation set. In the external validation set, GBDT still performed comparably, achieving the second highest metrics score (52 points). The high-risk group had more than twice the odds of experiencing medical disputes compared with the low-risk group. CONCLUSIONS: We established a prediction model to stratify medical workers into different risk groups for encountering medical disputes. Among the 5 ML models, GBDT demonstrated the optimal comprehensive performance and was used to construct the web-based app. Our proposed model can serve as a useful tool for identifying medical workers at high risk of medical disputes. We believe that preventive strategies should be implemented for the high-risk group.

The Intra-Hospital Medical Dispute Burden and Capacities: A Nationwide Survey in Taiwan.

(1) Background: Medical disputes have long been resolved via lawsuits. Alternative dispute resolutions have been promoted for their benefits and win-win results. This study aims to investigate Taiwanese hospital medical dispute capacities and burdens. (2) Methods: This study used 2015 nationwide questionnaire data. The number and value of medical disputes that occurred in 2014 was examined to evaluate hospitals' capabilities. Poisson regressions were used to determine the impact of coping abilities on the incidence of disputes and the associated compensation. (3) Results: The response rate of the questionnaire was 90%. Hospital features associated with higher medical disputes incidence included those of a scale ≤ 100 or 200-499 and having a dispute-inform process of over 4 h. In contrast, hospitals whose compensation fund was solely based on medical liability insurance reported less medical dispute incidence. The features associated with higher compensation were lack of continuing training and having a dispute-inform process over 4 h. In contrast, hospitals with standard operating procedures for in-hospital mediation and solicitude paid lower compensation. (4) Conclusions: Hospitals with quicker response times experienced fewer medical disputes and paid lower compensation. Dispute coping skills, other than reaction time, were more visible in compensation bargaining, but were not significantly correlated with incidence.

Are They Thinking Differently? The Perceptions and Differences in Medical Disputes between Veterinarians and Clients.

Medical disputes in veterinary practices are widespread; yet, a limited amount of research has been conducted to investigate the factors contributing to medical disputes. This study examined veterinarians' and clients' perceptions regarding risk factors and possible solutions to medical disputes. A total of 245 respondents from Taiwan, including 125 veterinarians and 120 clients, completed an electronic self-administered, semi-structured questionnaire in 2022. The questionnaire covered six dimensions: medical skills, complaint management, the attitudes of stakeholders during interactions, medical expenses, clients' perspectives, and communication modes. The results highlighted significant differences in the perceptions of risk factors for inducing medical disputes and possible solutions between clients and veterinarians in veterinary practice. First, young veterinarians and clients perceived medical skills as the highest risk factor for inducing medical disputes, while experienced veterinarians disagreed (p < 0.001). In addition, veterinarians with medical dispute experience identified stakeholders' attitudes during interactions as the top contributing factor. Second, regarding possible solutions, all veterinarians preferred offering clients cost estimates and cultivating empathy and compassion towards them. On the other hand, clients underscored the importance of obtaining informed consent for treatments and expenses and suggested that veterinarians should supply comprehensive written information to facilitate this process. This study underlies the importance of understanding stakeholders' perceptions to mitigate medical disputes and advocates for improved communication education and training for young veterinarians. These findings provide valuable insights for veterinarians and clients, contributing to preventing and managing medical disputes in veterinary practices.

Perceptions of Veterinarians and Veterinary Students on What Risk Factors Constitute Medical Disputes and Comparisons between 2014 and 2022.

This study compared the risk perceptions of medical disputes among veterinarians and veterinary students in Taiwan between 2014 and 2022. Online validity-tested questionnaires were used to collect data, with 106 (73 veterinarians and 33 students) and 157 (126 veterinarians and 31 students) surveys collected in 2014 and 2022, respectively. Respondents would be asked to rate their perceptions on how likely each risk factor constitutes a medical dispute according to their past experiences on a five-point Likert scale from 1 to 5: "Very unlikely, unlikely, neutral, likely, very likely." The results showed that overall risk perceptions increased significantly in 2022 compared to 2014, with the top risk factors being attitudes during interactions and complaint management among experienced veterinarians. In contrast, students considered medical skills and clients' perspectives as the top two risk factors, with complaints management ranking as the least significant factor. The findings suggest that effective communication and complaint management are crucial in preventing medical disputes, highlighting the importance of developing these skills in young veterinarians and veterinary students to reduce medical disputes. The study also recommends increasing practical experiences of medical disputes and complaint management in veterinary education to bridge the gap between the perceptions of experienced veterinarians and students.

Medical Dispute Cases Caused by Errors in Clinical Reasoning: An Investigation and Analysis.

Studies that examine medical dispute cases (MDC) due to clinical reasoning (CR) are scarce in Taiwan. A retrospective analysis was undertaken to review MDC filed at four hospitals in Taiwan between 2011 and 2015. Cases were examined for the healthcare professionals involved, their relevance to CR errors, clinical specialties, and seniority. Seventy-eight MDC were identified and 57.7% of which were determined to be related to CR errors (n = 45). Among the 45 cases associated with CR errors, 82.2% (37) and 22.2% (10) were knowledge- and skill-related errors, respectively. The healthcare professionals with the most MDC were obstetrician-gynecologists (10/90, 11.1%), surgeons (8/90, 8.9%), and emergency physicians (7/90, 7.8%). The seniority of less than 5 years or lower had the highest number of attending physicians to be associated with MDC. In contrast, the highest seniority (>25 years) in the physician group and year 6 in the resident group are both shown with zero MDC. In our study, the larger hospitals had a significantly higher incidence of MDC compared to the smaller hospitals (Pearson Correlation Coefficient = 0.984, p = 0.016). An examination of MDC reveals the frequency and nature of medical errors in Taiwanese hospitals. Having identified that CR errors contributed a substantial fraction to the overall MDC, strategies to promote reasoning skills and hence reduce medico-legal issues help safeguard both patients and healthcare professionals.

Antecedents, Consequences, and the Role of Third Parties in the Trust Repair Process: Evidence Taken from Orthodontics.

Orthodontic treatment has popularized in Taiwan. Healthcare institutions can be responsive in their coping strategies and determine whether third-party intervention should take place involving medical disputes related to orthodontics in order to repair patient trust. This study draws on orthodontic treatment to explore the effect of various trust repair strategies employed by healthcare institutions and third-party involvement positively affecting outcomes related to trust repair. Patients were recruited among those who have undergone orthodontic treatments, and 353 valid scenario-based questionnaires were collected through an online survey. Results revealed that: (1) the affective and informational repair strategies positively impacted trust repair while the functional repair strategy did not; (2) trust repair positively impacted patient satisfaction/word-of-mouth and mediated between repair strategies and satisfaction/word-of-mouth; and (3) third-party involvement moderated the relationship between trust repair and word-of-mouth. The findings suggest that rather than receiving monetary compensation, patients usually prefer that healthcare institutions acknowledge their fault, offer apologies, and engage in active communications to clarify the causes of medical dispute. Further, an objective third party should be involved to mediate the medical disputes to afford satisfaction all around.

Association between hospital legal constructions and medical disputes: A multi-center analysis of 130 tertiary hospitals in Hunan Province, China.

Background: Medical disputes are common in hospitals and a major challenge for the operations of medical institutions. However, few studies have looked into the association between medical disputes and hospital legal constructions. The purpose of the study was to investigate the relationship between hospital legal constructions and medical disputes, and it also aimed to develop a nomogram to estimate the likelihood of medical disputes. Methods: Between July and September 2021, 2,716 administrators from 130 hospitals were enrolled for analysis. The study collected seventeen variables for examination. To establish a nomogram, administrators were randomly split into a training group (n = 1,358) and a validation group (n = 1,358) with a 50:50 ratio. The nomogram was developed using data from participants in the training group, and it was validated in the validation group. The nomogram contained significant variables that were linked to medical disputes and were identified by multivariate analysis. The nomogram's predictive performance was assessed utilizing discriminative and calibrating ability. A web calculator was developed to be conducive to model utility. Results: Medical disputes were observed in 41.53% (1,128/2,716) of participants. Five characteristics, including male gender, higher professional ranks, longer length of service, worse understanding of the hospital charters, and worse construction status of hospital rule of law, were significantly associated with more medical disputes based on the multivariate analysis. As a result, these variables were included in the nomogram development. The AUROC was 0.67 [95% confident interval (CI): 0.64-0.70] in the training group and 0.68 (95% CI: 0.66-0.71) in the validation group. The corresponding calibration slopes were 1.00 and 1.05, respectively, and intercepts were 0.00 and -0.06, respectively. Three risk groups were created among the participants: Those in the high-risk group experienced medical disputes 2.83 times more frequently than those in the low-risk group (P < 0.001). Conclusion: Medical dispute is prevailing among hospital administrators, and it can be reduced by the effective constructions of hospital rule of law. This study proposes a novel nomogram to estimate the likelihood of medical disputes specifically among administrators in tertiary hospitals, and a web calculator can be available at https://ymgarden.shinyapps.io/Predictionofmedicaldisputes/.

Who Is Responsible for Causing and Solving the Problem? Responsibility Attribution of Medical Disputes in Chinese Print Media.

This study provides an insight into medical journalism practice by examining how news media have framed who is responsible for causing and solving the growing problem of medical disputes in Mainland China. We identified responsibility-attribution information presented in 490 news articles about medical disputes published in the People's Daily, Health News, and Southern Metropolis Daily between 2012 and 2017. Our data reveal that, mentions of personal causes have significantly outnumbered those of societal causes. Specifically, health workers were discussed most often as being responsible for the occurrence of medical disputes. In terms of how to solve the problem, the media were focusing heavily on societal-level efforts, while post-event solutions were addressed more frequently than preventative actions. City press was less likely to discuss societal causes and solution suggestions compared with party press and professional newspapers. In the conclusion, we discussed the potential consequences of such framing patterns, and how media professionals can be meaningfully engaged in the future reporting on public health problems.

Medical disputes and patient satisfaction in China: How does hospital management matter?

OBJECTIVE: Satisfaction with healthcare may be captured by surveys of patients and staff, or in extreme cases, the number and severity of medical disputes. This study tries to investigate the relationship between satisfaction and hospital management as well as the role of good management in preventing medical disputes ex ante. METHOD: We investigate this relationship using information on management practices collected from 510 hospitals in mainland China using the World Management Survey questionnaire and combined with medical malpractice litigation data and patient/staff satisfaction surveys. Multiple regression models were used to analyse the relationship between hospital management scores and medical litigation outcomes as well as patient and staff satisfaction during 2014-2016. RESULTS: An increase of one standard deviation in the management score was related to 13.1% (p < 0.10) lower incidence of medical disputes, 12.4% (p < 0.05) fewer medical litigations, and 51.3% (p < 0.10) less compensation. Better management quality of hospitals was associated with higher inpatient satisfaction (p < 0.05) and staff well-being (p < 0.01). CONCLUSION: Improving hospital management could reduce hospital costs generated by lawsuits, reduce potential harm to patients, and improve patient and staff satisfaction, thus leading to a better patient-physician relationship.

Troublemaking in hospitals: performed violence against the healthcare professions in China.

Yi Nao describes a type of violence displayed in Chinese hospitals which involves organised disturbances led by patients' relatives and/or Yi Nao gangs. Drawing on media reports of Yi Nao, we argue that the phenomenon of Yi Nao transforms hospitals into 'power arenas' in which a struggle over moral and political resources (capital) takes place between patients, Yi Nao gangs, doctors, government agencies, and hospital management. Two interrelated rules that are crucial to understanding the ad hoc local strategies of the actors involved in Yi Nao are examined: the 'publicity rule', and the 'rule of risk-avoidance'. We also argue that the political discourse of 'stability' has been internalised by the officials in the Chinese government and public hospitals in mediating social disputes. At the same time, Yi Nao actors use this discourse to creatively adapt to social resistance, as reflected in the disposition to use performative disturbance in pursuit of material or symbolic compensation.

The Therapeutic Relationship in China: A Systematic Review and Meta-Analysis.

With a surge of conflicts between healthcare workers and patients in recent years, the therapeutic relationship (TR) in China is presently in tension. Meanwhile, consequent issues have begun to emerge, such as the distrust between healthcare workers and patients and the decline in the quality of medical services. Although many empirical studies about the TR have been conducted in China, previous studies on TR and its influencing factors have been contradictory. Therefore, this study conducted a systematic review and meta-analysis to assess the current situation of the TR and to identify factors associated with the TR in Chinese hospitals from three perspectives (healthcare worker, patient, and therapeutic interaction). Two reviewers independently searched the literature, selected researches, and extracted data through comprehensively searching of three international electronic databases and three Chinese electronic databases to identify all relevant observational studies on influencing factors for TR in China published in English and Chinese from January 2000 to January 2020. Among the 3290 records initially identified, 11 studies met the selection criteria. A total of 96,906 individuals were included in the review. The results showed that 55.73% of healthcare workers consider the TR to be tense, and 33.7% of patients hold this view. The meta-analysis indicated that healthcare workers who were male, older, less educated, working in a non-surgical department, and had a senior title were more likely to be pessimistic about the TR. Patients who were rural residents, highly educated, and had no medical insurance were more likely to be pessimistic about the TR. Furthermore, the mutual trust could improve rapport between healthcare workers and patients. The 25 other related factors related to the TR were analyzed and described using a narrative approach. The findings might deserve consideration in the design of relative policies to promote harmony between doctors and patients.

Forensic Analysis of 43 Medical Disputes Caused by Death after Cardiac Surgery.

ABSTRACT: Objective To explore the causes and characteristics of medical disputes caused by death after cardiac surgery and to analyze the pathological changes after cardiac surgery and the key points of forensic anatomy, thus to provide pathological evidence for clinical diagnosis and treatment of cardiac surgery and judicial appraisal as well as reference for the prevention of medical disputes in such cases. Methods Forensic pathological cases of medical disputes caused by death after cardiac surgery which were accepted by the Center for Medicolegal Expertise of Sun Yat-Sen University from 2013 to 2018 were analyzed retrospectively from aspects such as causes of death, pathological diagnosis, surgery condition, medical misconduct, and so on. Results The causes of death after cardiac surgery of 43 patients were abnormal operation, low cardiac output syndrome, postoperative infection, postoperative thrombosis, and other diseases. Among the 43 cases, there were 18 cases without medical fault while 25 cases had medical fault. Conclusion The medical disputes caused by death after cardiac surgery are closely related to the operative technique and postoperative complications. The causes of medical faults include defects in diagnosis and treatment technique, as well as unfulfillment of duty of care.

The practice of resolving medical disputes by the mediation studio specially invited by the people′s court / 中华医院管理杂志

Based on the main problems existing in the current way of handling medical disputes, the authors explored a new method for handling medical disputes, and summarized the advantages of the mode of mediation studio specially invited by the people′s court. This mode effectively connected the traditional medical dispute resolution approaches, complemented each other′s advantages, and provided a faster, more efficient and national compulsory solution for medical disputes.

Forensic Analysis of 43 Medical Disputes Caused by Death after Cardiac Surgery / 法医学杂志

Objective To explore the causes and characteristics of medical disputes caused by death after cardiac surgery and to analyze the pathological changes after cardiac surgery and the key points of forensic anatomy, thus to provide pathological evidence for clinical diagnosis and treatment of cardiac surgery and judicial appraisal as well as reference for the prevention of medical disputes in such cases. Methods Forensic pathological cases of medical disputes caused by death after cardiac surgery which were accepted by the Center for Medicolegal Expertise of Sun Yat-Sen University from 2013 to 2018 were analyzed retrospectively from aspects such as causes of death, pathological diagnosis, surgery condition, medical misconduct, and so on. Results The causes of death after cardiac surgery of 43 patients were abnormal operation, low cardiac output syndrome, postoperative infection, postoperative thrombosis, and other diseases. Among the 43 cases, there were 18 cases without medical fault while 25 cases had medical fault. Conclusion The medical disputes caused by death after cardiac surgery are closely related to the operative technique and postoperative complications. The causes of medical faults include defects in diagnosis and treatment technique, as well as unfulfillment of duty of care.

Relating Medical Errors to Medical Specialties: A Mixed Analysis Based on Litigation Documents and Qualitative Data.

BACKGROUND: We know a great deal about types, causes, and prevention of medical errors, as well as the risks of each medical specialties. Although we know something about medical errors, much remains to be done in this area particularly around effective prevention. However, little is known about whether medical errors are related to medical specialties. Our objective was to categorize and map the distribution of medical errors and analyze their relationships with medical specialties. METHODS: First, public cases of medical disputes were searched on "China Judgment Online" according to the key words including medical errors. Second, we set up a database with 5237 medical litigations. After removing unrelated judgment documents, we used systematic random sampling to extract half of these. Then, we hired two frontline physicians with M.D. to review the litigation documents and independently determine the medical errors and the departments in which they took place. A third physician further reviewed the divergent results. After the descriptive statistical analysis and mind map analysis, semi-structured interviews were further conducted with 63 doctors to reveal the relationships mentioned above. RESULTS: More than 97.8% of medical errors occurred in clinical departments. The insufficient implementation of informed consent obligations is the top medical error in all medical departments [internal medical departments (12.86%, N=36), surgical departments (14.57%, N=106), specialist departments (13.16%, N=86)]. The types of medical errors in diverse medical departments might be associated with therapeutic means used by physicians. Errors related to surgical operations were common in surgical departments, errors related to diagnoses were common in internal medicine departments, and errors related to therapy were common in specialist departments. A lack of clinical experience and undesirable work system design have contributed to the occurrence of medical errors. Inadequate human resources and unreasonable shift systems have increased the workload of staff members and this has in turn increased the incidence rate of medical errors. CONCLUSION: Medical departments are facing medical errors both in humanity and technology. Medical institutions should be alert to the harm caused by medical humanity (mainly including insufficient communication between physicians and patients, insufficient implementation of infringement of informed consent, infringement of patient's privacy and overtreatment). Improving the clinical skill and vigilance of medical staff is a top priority. Medical institutions should also improve undesirable system designs.

Experience of Medical Disputes, Medical Disturbances, Verbal and Physical Violence, and Burnout Among Physicians in China.

BACKGROUND: Medical disputes, medical disturbances, verbal and physical violence against physicians, and burnout have reached epidemic levels. They may negatively impact both physicians and the healthcare system. The experience of medical disputes, medical disturbances, verbal, and physical violence, and burnout and the correlates in physicians working in public hospitals in China needed to be investigated. METHODS: A nationwide cross-sectional survey study was conducted between 18 and 31 March 2019. An anonymous online questionnaire was administered. The questionnaire included the 22-item Maslach Burnout Inventory-Human Services Survey (Chinese version). We also collected data on demographic and job-related factors, as well as physicians' experiences of medical disputes, medical disturbances, verbal and physical violence from patients and the patients' family members. FINDINGS: In total, 22,213 physicians from 144 tertiary public hospitals in all of China's 31 provinces completed the survey. The overall burnout rate among the surveyed physicians was 31.28%. Moreover, 33.48% of physicians experienced disputes, 20.86% experienced disturbances, 48.52% experienced verbal violence, and 5.84% experienced physical violence in the past 12 months. Factors found to be significantly associated with burnout included younger age, being divorced or widowed, having a lower educational background, working in internal medicine departments, longer working hours per day, working in general hospitals, being in East China, as well as having experienced disputes, disturbances, and physical and verbal violence. INTERPRETATION: Close to a third of the Chinese doctors working in the tertiary hospitals reportedly experienced burnout, and the problem is related to the unsafe working environment caused by the worsening doctor-patient relationship.

The weakness of the strong: Examining the squeaky-wheel effect of hospital violence in China.

Hospital violence has become a worldwide issue that disturbs health care systems. China is in a particular dilemma between meeting the healthcare demand of 1.39 billion residents and ensuring the safety of 12.3 million health professionals. Drawing on data from an administrative survey, we presented the types and distribution of disruptive behaviors, as well as the summary statistics of 225 medical disputes that took place from 2012 to 2013 in Z city. Logit and OLS regression analyses show that disruptive behaviors, characterized by the number of protest participants and the length of protest, can significantly predict whether the claimant receives compensation and the amount of compensation. All else equal, a one-person increase in the number of participants is associated with 3.94% higher odds of getting compensated, whereas a one-day increase in the length of protest is associated with a 1.03% increase in the odds of receiving compensation. Further analyses show that the link between disruptive behaviors and compensation outcomes is due to the involvement of the state, which tends to press hospitals to pay when substantial violence is present. Chinese government's overwhelming emphasis on social stability gives protestors leverage against hospitals, which can be summarized as "the squeaky wheel gets the grease." Ironically, the sensitivity of Chinese government towards social stability becomes a weakness of its own. Government's active intervention to reach a peace-oriented goal will incentivize patients to resort to violence in pursuit of compensation. This study has implications for understanding the Chinese government's logic of addressing social problems that range from hospital violence, labor disputes, land disputes to demolition compensation and civil petitions.