如此紧张的医患关系根源在哪里？ Therese Hesketh 教授和他的同事认为医疗行的商业化是这种情况恶化的主要原因。虽然中国政府在努力改善医保，但是即使有医保患者通常也要支付大量治疗费用，报销的金额非常有限。而且，有些医院的资金是自筹或半自筹，因此这些医院的目的就是为了创收。所以现在可能没有短期解决中国医疗行业经济难题的方案。
Which future for doctors in China?
Medical practice has become a high-risk job in China. Doctors' legitimate rights and interests cannot be fully guaranteed; many are under threat of intimidation and violence, and several have been killed because of their medical activities.
On Nov 29, 2012, the head of the acupuncture department of Tianjin University of Traditional Chinese Medicine, was killed in her clinic;1 and this is only one example of a long list. Although the Chinese Government has introduced policies to protect doctors, there are no meaningful measures at present to stop such tragedies. 12 cases of violence against doctors have been reported so far in 2013; by this time last year, 14 cases had been reported.2, 3
What is the source of so much tension between patients and doctors? According to Therese Hesketh and colleagues,4commodification of the health-care system is the main cause of deteriorating conditions. Patients pay most treatment costs themselves; even with health insurance, the proportion and the amount of reimbursement is limited, despite efforts of the Chinese Government to improve the situation. Moreover, some hospitals are self-financing or semi self-financing, and aim to increase revenue generation. So, there might not be short-term solutions to the financial problem.
Beyond that, many patients and their relatives misunderstand the medical profession. They believe that, no matter what the disease is, if they get treatment in hospital they will have a remarkable therapeutic effect or even be cured. If the treatment is not satisfactory, patients and their relatives will vent their dissatisfaction with doctors. Additionally, some media have reported false medical disputes to increase audience ratings.
As for doctors, 80% describe themselves as overworked and underpaid in secondary and tertiary facilities. Even in cities, many doctors earn as little as 5000 yuan (US$780) a month or less. Senior doctors earn consultation fees of just 7 yuan ($1·14) in most hospitals. Doctors' workloads have increased, and many forgo their rest hours to serve outpatients or do operations. The recent deaths of four doctors have been attributed to overwork.5
Overworked, underpaid, and under threat, I wonder who will be the next doctors in China?