Correspondence
Regulations subsequently followed in 2013. Furthermore, a national electronic organ allocation system was introduced, which has a medically derived allocation algorithm that helps to allocate the donor organs equitably. Concurrently, the entire structure of the new national transplantation infrastructure was established.2 These measures, led by former Vice Minister of Health Jiefu Huang, were welcomed by WHO, and generated substantial increases in donations. As of July 7, 2014, according to the China Organ Donation Administrative Centre, 1963 donations enabled 5388 patients to receive organs for transplantation. The Hangzhou Resolution illustrates the consensus and resolve for change among Chinese transplant professionals. 3 According to Jiefu Huang, the reliance on executed prisoners as an organ source is coming to an end soon.4 Many centres no longer use this organ source for all the right reasons, which western countries and the medical community have raised. We deem the new system to be founded on justice, equity, and national consensus. In this sense, this is truly the beginning of a new era for transplantation in China. The new system is still developing and will undergo many changes. It is only a beginning, not a celebratory finish. Much work is to be done and progress is to be made. In a populous nation, such as China, with a long history of civilisation and culture, continued criticisms and pressures without recognition of rapid positive changes can be detrimental to continued progress. We declare no competing interests. The opinions expressed here are the authors’ personal opinions.
*Qiquan Sun, Xinpu Gao, Dicken Shiu-Chung Ko, Xian Chang Li [email protected] Division of Renal Transplantation, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510530, China (QS); China Organ Donation Administrative Center, Beijing, China (XG); Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (DS-CK); and Immunobiology and Transplantation Research, Houston Methodist Hospital, Texas Medical Center, Houston, TX, USA (XCL)
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1
2
3
4
Sun Q, Gao X, Wang H, et al. A new era for organ transplantation in China. Lancet 2014, 383: 1971–72. Huang J, Wang H, Fan ST, et al. The national program for deceased organ donation in China. Transplantation 2013; 96: 5–9. Huang JF, Zheng SS, Liu YF, et al. China organ donation and transplantation update: the Hangzhou Resolution. Hepatobiliary Pancreat Dis Int 2014; 13: 122–24. Organ transplantation is moving towards the rule of law, organs from executed prisoners will be history (in Chinese). http://finance. ifeng.com/a/20140818/12944828_0.shtml (accessed Aug 18, 2014).
Evolution of the perception of the doctor’s role in China The doctor–patient relationship is often associated with mistrust or even conflict in China today.1–3 Over time, there have been major changes in the role of doctors and their perception by patients: from god, emperor, and father to neighbour and friend, to merchant, and in some patients’ minds even to greedy liar. This perception of doctors could be an important reason for doctor–patient conflict, and doctors should be aware of it. In ancient times, medicine was done through superstition, and medical practitioners were wielding various mystical powers which other human beings can only obey. As civilisation advances, medical knowledge and experience accumulate. According to a Chinese tradition, all Chinese are proud “children of Yan and Huang”, legendary founder of traditional Chinese medicine. The Chinese language also reveals the honour doctors once enjoyed. Chinese call doctors “Dai Fu” (which also means scholar-bureaucrats) and “Xian Sheng” (master); medicine is seen as protective and authoritive. After the enlightenment movement, in modern China, western medicine is widespread. In this modern culture, medical practitioners are considered equal to other citizens. Patients can easily get medical knowledge from media, such as the internet, and the mystery around medicine
is almost removed. Doctors are no longer on a high altar. And with market economics, in some patients’ eyes, doctors are seen as servants, merchants, or even greedy liars. Today we can witness all these different scenarios in medicine. Still many people see “Feng Shui” masters for health and fortune,4 but they also go to traditional Chinese medicine or western medicine doctors; this could to some extent be explained by the polytheistic Chinese culture. When the doctor’s self-perception and the patient’s expectation don’t match, discontent arises (for example, when the doctor acts like a father, but the patient expects a friendly neighbour, or when the doctor works like a businessman, but the patient expects a father-like figure). This mismatch between projection, expectation, and reality can be seen as reasons by the patients to be angry or violent. Moreover, a patient might have several images of his doctor. Doctors need to understand this aspect of the relationship and address their patient accordingly. We declare no competing interests.
Jinya Cao, *Jing Wei [email protected] Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing 100730, China 1 2 3
4
Hesketh T, Wu D, Mao L, Ma N. Violence against doctors in China. BMJ 2012; 345: e5730. The Lancet. Violence against doctors: Why China? Why now? What next? Lancet 2014; 383: 1013. Jing W, Otten H, Sullivan L, et al. Improving the doctor–patient relationship in China: the role of balint groups. Int J Psychiatry Med 2013; 46: 417–27. Xinhuanet. Behind the “master”, why the power “sleeps”? (in Chinese). http://news.xinhuanet. com/comments/2013-07/31/c_116752885. htm (accessed July 31, 2013).
China needs to tackle the decline in medical school applicants We read The Lancet’s Editorial about violence against Chinese doctors with great interest.1 In the past 5 years, more than 30 Chinese doctors have www.thelancet.com Vol 384 August 30, 2014
Regulations subsequently followed in 2013. Furthermore, a national electronic organ allocation system was introduced, which has a medically derived allocation algorithm that helps to allocate the donor organs equitably. Concurrently, the entire structure of the new national transplantation infrastructure was established.2 These measures, led by former Vice Minister of Health Jiefu Huang, were welcomed by WHO, and generated substantial increases in donations. As of July 7, 2014, according to the China Organ Donation Administrative Centre, 1963 donations enabled 5388 patients to receive organs for transplantation. The Hangzhou Resolution illustrates the consensus and resolve for change among Chinese transplant professionals. 3 According to Jiefu Huang, the reliance on executed prisoners as an organ source is coming to an end soon.4 Many centres no longer use this organ source for all the right reasons, which western countries and the medical community have raised. We deem the new system to be founded on justice, equity, and national consensus. In this sense, this is truly the beginning of a new era for transplantation in China. The new system is still developing and will undergo many changes. It is only a beginning, not a celebratory finish. Much work is to be done and progress is to be made. In a populous nation, such as China, with a long history of civilisation and culture, continued criticisms and pressures without recognition of rapid positive changes can be detrimental to continued progress. We declare no competing interests. The opinions expressed here are the authors’ personal opinions.
*Qiquan Sun, Xinpu Gao, Dicken Shiu-Chung Ko, Xian Chang Li [email protected] Division of Renal Transplantation, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510530, China (QS); China Organ Donation Administrative Center, Beijing, China (XG); Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA (DS-CK); and Immunobiology and Transplantation Research, Houston Methodist Hospital, Texas Medical Center, Houston, TX, USA (XCL)
742
1
2
3
4
Sun Q, Gao X, Wang H, et al. A new era for organ transplantation in China. Lancet 2014, 383: 1971–72. Huang J, Wang H, Fan ST, et al. The national program for deceased organ donation in China. Transplantation 2013; 96: 5–9. Huang JF, Zheng SS, Liu YF, et al. China organ donation and transplantation update: the Hangzhou Resolution. Hepatobiliary Pancreat Dis Int 2014; 13: 122–24. Organ transplantation is moving towards the rule of law, organs from executed prisoners will be history (in Chinese). http://finance. ifeng.com/a/20140818/12944828_0.shtml (accessed Aug 18, 2014).
Evolution of the perception of the doctor’s role in China The doctor–patient relationship is often associated with mistrust or even conflict in China today.1–3 Over time, there have been major changes in the role of doctors and their perception by patients: from god, emperor, and father to neighbour and friend, to merchant, and in some patients’ minds even to greedy liar. This perception of doctors could be an important reason for doctor–patient conflict, and doctors should be aware of it. In ancient times, medicine was done through superstition, and medical practitioners were wielding various mystical powers which other human beings can only obey. As civilisation advances, medical knowledge and experience accumulate. According to a Chinese tradition, all Chinese are proud “children of Yan and Huang”, legendary founder of traditional Chinese medicine. The Chinese language also reveals the honour doctors once enjoyed. Chinese call doctors “Dai Fu” (which also means scholar-bureaucrats) and “Xian Sheng” (master); medicine is seen as protective and authoritive. After the enlightenment movement, in modern China, western medicine is widespread. In this modern culture, medical practitioners are considered equal to other citizens. Patients can easily get medical knowledge from media, such as the internet, and the mystery around medicine
is almost removed. Doctors are no longer on a high altar. And with market economics, in some patients’ eyes, doctors are seen as servants, merchants, or even greedy liars. Today we can witness all these different scenarios in medicine. Still many people see “Feng Shui” masters for health and fortune,4 but they also go to traditional Chinese medicine or western medicine doctors; this could to some extent be explained by the polytheistic Chinese culture. When the doctor’s self-perception and the patient’s expectation don’t match, discontent arises (for example, when the doctor acts like a father, but the patient expects a friendly neighbour, or when the doctor works like a businessman, but the patient expects a father-like figure). This mismatch between projection, expectation, and reality can be seen as reasons by the patients to be angry or violent. Moreover, a patient might have several images of his doctor. Doctors need to understand this aspect of the relationship and address their patient accordingly. We declare no competing interests.
Jinya Cao, *Jing Wei [email protected] Department of Psychological Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing 100730, China 1 2 3
4
Hesketh T, Wu D, Mao L, Ma N. Violence against doctors in China. BMJ 2012; 345: e5730. The Lancet. Violence against doctors: Why China? Why now? What next? Lancet 2014; 383: 1013. Jing W, Otten H, Sullivan L, et al. Improving the doctor–patient relationship in China: the role of balint groups. Int J Psychiatry Med 2013; 46: 417–27. Xinhuanet. Behind the “master”, why the power “sleeps”? (in Chinese). http://news.xinhuanet. com/comments/2013-07/31/c_116752885. htm (accessed July 31, 2013).
China needs to tackle the decline in medical school applicants We read The Lancet’s Editorial about violence against Chinese doctors with great interest.1 In the past 5 years, more than 30 Chinese doctors have www.thelancet.com Vol 384 August 30, 2014
