Media’s medicine: Alleviating the social symptoms of China’s healthcare system

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Can a doctor show, ER Doctors《急诊科医生》alleviate some of the social symptoms (医患冲突) of China’s healthcare system?

By Markayle Schears (席凯乐）

NANJING, China — During my experience working as an intern in several Chinese hospitals, I wondered why many of the doctor-patient relationship dynamics I witnessed appeared strained, often characterized by brief interactions or frustration for both parties. As part of my research, I spoke with a young surgeon named Dr. Lin about my observations. He said that today, most medical students in China do not study how to interact kindly with patients—and that the healthcare system gives them little time to do so.

*ER Doctors’ Dr. Liu (far left) with her trainee at a patient’s bedside.* Photo credits: baidu.com

Dr. Lin used wordplay to illustrate the problem. In discussing serious conditions such as cancer with their patients, some hurried doctors will quickly discuss chemotherapy treatment, or huà liáo (化疗), without offering much in the way of compassion or comfort. Some patients become so upset that in a frightening number of instances, they have jumped to their deaths from their hospital windows. Dr. Lin opined that Chinese doctors must make an effort to provide a treatment that begins with healing words, or huà liáo (话疗) – a homonym for “chemotherapy.” He believes doctors’ interactions with patients should be considered part of the treatment and infused with compassion and patience.

It wasn’t until I took part in the Hopkins-Nanjing Center’s first film class in the spring of 2019 that I considered the doctor-patient relationship through a new lens—a camera lens. Beyond its entertainment value, visual media can serve to educate and socialize individuals. People and places once distanced, unrelated or unfamiliar to viewers become real, human and close. What struck me in this class was the possibility that a television show could be the impetus for resolution of social challenges such as societal conflicts, stigma or ignorance. I decided to explore the complexities of the doctor-patient relationship by analyzing how a popular medical show, ER Doctors《急诊科医生》portrays this relationship in the country.

I was intrigued to find that the series is supported by a number of Chinese governmental arms and medical organizations, including the National Health and Family Planning Commission, Peking Union Medical College Hospital and Beijing Chaoyang Hospital. It seems as though the Chinese government believes that exposing the general public to hospital dynamics and a curated version of the doctor-patient relationship could help educate the masses, and perhaps even relieve mounting social conflict that has arisen over the years.

Since the founding of the People’s Republic of China (PRC), China’s healthcare system has made impressive leaps by significantly improving health conditions across the population. Yet many problems began to emerge after the “Basic Health Insurance System” was implemented during the economic reforms in the 1980s. Significant reform shifted healthcare from a social welfare initiative to a system that places the burden of financing on the individual. Adding further pressure, some scholars argue, is the fact that underlying institutions within China’s healthcare system are presently still in flux. Today the government faces the difficult challenge of meeting growing healthcare needs while continuing to develop the health industry. Over the last several decades, healthcare reforms have led to a variety of decentralization issues. This shift forced hospitals to compete for patients, generate revenue and capitalize on the deregulation of drug prices. In response to these financial pressures, some hospitals and providers responded by speeding up patient consultations or over-prescribing expensive medications. Over the long term, these actions have contributed to the exponential growth of healthcare expenditures in China. The results of these reforms have yet to be fully determined, but serious inequities in healthcare remain.

Unsurprisingly, this has created tension in the relationship between healthcare representatives and the general public. On an individual level, institutional moves made in response to reform pressures have resulted in the widespread mistrust of hospitals and doctors. Patients point to a lack of privacy in hospitals, medical treatment privileges awarded to only the well-connected patients, and arrogant, uncaring doctors. Conversely, doctors express dissatisfaction in their wages, overwhelming workloads and a lack of professional autonomy. Together, these factors have severely worsened the doctor-patient relationship dynamic in China. This strain has culminated in an alarming trend of patients, or patients’ family members, using violence against doctors and health professionals in hospital settings. A survey conducted across 90 county-level hospitals found the workplace violence incidence rate to be a staggering 69.38% in 2016, a glaring symptom of the larger issues regarding healthcare reform in China. To address this concerning trend, stopgap measures aimed at increasing the social consciousness of patient populations and to buy time for reform are underway. Creative examples of this can be found in the socialization efforts in the media and in the boom of Chinese medical TV shows.

In 2017, several new Chinese medical dramas aired, representing a new wave in a previously small genre in China. One of these shows, ER Doctors, is anchored in the lives of three doctors: Dr. He, Dr. Jiang and Dr. Liu, all of whom work together in a Beijing emergency room. The show follows the complex web of interactions between the doctors, their patients, their families and their larger communities both in and outside the hospital.

From this foundation, the viewer observes the personal, professional, moral and social choices of the doctors. Viewers are immediately positioned to learn more about the life and experiences of the doctors compared to the patients. Memorably, the pilot episode begins with a highly intense scene in which Dr. Jiang pursues a young thief attempting to steal her purse. The thief suddenly collapses as he is running away. We watch as Dr. Jiang works to assess the boy’s condition and get him safely to the hospital, all while the boy’s friends make off with her purse. Dr. Jiang is presented as a hero who places the value of another’s life above her own material possessions and as a professional who will provide care in spite of the fact that the patient took advantage of her.

As the other two doctors’ characters are developed, the camera tends to follow Dr. He and Dr. Liu in their daily lives. Such scenes are centered around common experiences such as having dinner with their families and conversations in the car while driving to work or school. A slower, leveled approach to character development and narrative flow provides contrast to the hectic emergency room pace, but more importantly, humanizes doctors for the viewers. Observers see how doctors are also just people who are raising families, sitting in traffic and going out to eat hot pot. At the hospital, viewers see the humanized doctors struggle with ethical issues such as consent or delivering difficult health news. Their professional skills are highlighted as the doctors are depicted explaining (and then re-explaining) medical treatments simply and concisely to confused patients and their families. Viewers watch as senior doctors remind the trainees to be more professional and place the patient’s needs above all. As viewers take in the scenes of doctors doing real life chores and spending time with their families, they can relate to and even admire these characters.

Throughout the series, the viewer has little to no information about the patients’ backgrounds, and usually learn more about family members than the patient themselves. Family members tend to be presented as rude, cheap, abrasive, dishonest, uneducated or violent. According to scholars, patients being presented as relatively one-dimensional is characteristic of the majority of medical films, and in line with other countries’ medical TV show portrayals. Such bad behaviors likely also serve to illustrate to the viewer the social challenges Chinese doctors face on a daily basis. Patients’ families usually play active, but brief, roles in which they might accuse doctors of inventing reasons to make their son get more expensive surgeries, slap the nurse or talk loudly on their phones in the hospital. Based on the show, it appears that most Chinese patients aren’t always consulted directly; although the doctor will ask the patient questions, their attention and advice is aimed at the family of the patient. In rare scenes, doctors and patients interact directly; usually, these are the most heartfelt.

There are many lessons to be taken from China’s ER Doctors. Viewers learn about the doctor side of the doctor-patient relationship. They are reminded that doctors are humans too, with good values, though perhaps not without ego or fault. Themes such as consent, full disclosure of information and doctor-driven charity all surface as potential solutions to creating a more transparent and cooperative partnership between physicians and patients off screen. It is a clear message in the show that Chinese patients want frank assessments and direct care. Viewers are encouraged to notice that medicine in China is changing, but it is not happening overnight. The discussions and conflicts that arise are rooted in the old paternalistic system and the precarious balance of the new economic order.

Overall, based on highly positive ratings, this government-backed TV series is successfully exposing the wider population to a healthier view of doctors, with the intention of increasing trust all while exploring deep-seated conflicts within the healthcare system. By portraying doctors’ burdens and strong morals and humanizing their struggles, viewers and potential real-life patients can learn to trust and respect doctors. Conversely, young future doctors watching may take away from the series the most successful strategies for better communication methods. It remains to be seen whether the government’s efforts to promote medical shows can truly ease real-life social conflict, but at the very least something can be learned about social interactions in healthcare settings and the ways to communicate with viewers through a camera lens.