Rebuilding trust in the physician–patient relationship: addressing causes and implementing reforms in China

This is the authors' abstract. We don't add key points for this paper.

As medical professionals, we find the article “Public expectations of good primary health care in China: a national qualitative study” 1 thought-provoking. In this article,1 the authors utilized qualitative data from 6 provinces in China to generate knowledge that revealed the perspectives and expectations of the public regarding high-quality primary healthcare. Ultimately, this study1 demonstrates that the government needs to further enhance the delivery system and medical training programme in order to better meet the public’s expectations in these areas. Undoubtedly, nurturing positive physician–patient relationships is an essential foundation for providing high-quality care. However, recent research indicates that physician–patient conflicts persist as an urgent societal issue in China.2 Rebuilding trust between physicians and patients has become a primary concern.3 But to mitigate the problem, we must first grasp its underlying causes. First, the financing mechanism of public hospitals and the income structure of physicians are identified as major causes of the public outcry against physicians’ moral ethics.3,4 Public hospitals in China rely on a self-finance model, pressuring frontline physicians to generate revenue. This perception erodes public trust in profit-oriented institutions. Furthermore, doctors in public hospitals receive a government-set salary and bonuses from hospital management. However, basic salaries for doctors at all levels are relatively low.4 Some hospitals directly link doctor’s income to the number of tests and examinations they order. When physicians’ incomes largely rely on bonuses and patients generally lack the expertise to assess medical procedures, the potential conflict of interest can lead patients to view physicians’ treatment negatively.3 Second, information asymmetry in healthcare places patients in a vulnerable position, necessitating trust in medical care providers. Traditional Chinese society highlights doctors’ benevolent intent, but challenges arise with conflicting demands for patient interests and revenue generation. Rising mistrust has led to violent incidents2 and practices like cash gifts and personal connections for access to care, amplifying concerns about the integrity of healthcare practitioners. Third, increasing distrust in hospitals and medical practitioners reflects the government’s failure to provide citizens with quality healthcare and uphold social justice.3 Prioritizing economic growth has resulted in limited financial support for essential services such as education and medical care. As a result, public hospitals operate similarly to private facilities, treating patients as consumers.4 However, the physician–patient relationship requires a higher level of trust than a mere commercial transaction, raising ethical concerns when treated as a business contract. To address these issues, we propose institutional reforms like separating physicians’ income from patients’ payments and increasing basic salaries.4 Lessons can be learned from successful models in the United Kingdom, where fixed salaries based on seniority and clinical performance have been implemented. Furthermore, substantial overhaul of the hospital care financing mechanism is imperative. Individual physicians can contribute to rebuilding trust through caring attitudes, addressing psychosocial needs, and improving communication.2 Enhancing medical ethics training and reforming promotion criteria to prioritize clinical outcomes and doctor–patient interaction are essential steps towards rebuilding trust.5 In conclusion, comprehensive institutional reforms, combined with individual practices and medical ethics training, are crucial to rebuild trust in physicians in China. By addressing underlying causes and strengthening the physician–patient relationship, overall healthcare quality can be significantly improved. None declared. Ethical approval was not required for this research. The study was funded by departmental resources. Data sharing is not applicable to this article as no new data were created or analysed in this study.