Correspondence
hospitals, doctors are overworked and under pressure from politicians who can interfere with medical admission, affecting doctors’ self-esteem. The main reasons for patients’ relatives to become violent are unnecessary investigations, delay in attending patient, request of advance payments, or withholding a deceased body until settlement of final billing. Ultimately the medical trade now involved in this noble profession has resulted in doctors, patients, and relatives’ unrest.3 Today, doctors are not recommending to their children to go to medical colleges, which is a real misery for the medical profession. Another important issue is the involvement of drug companies in unethical trade including sponsoring doctors’ tours abroad, conferences, and offering expensive gifts. 30 mg of tenectiplase, a thrombolytic drug used for acute myocardial infarction, costs 27 000 rupees (US$450) to patients (beneficiaries), which is the maximum retail price. However, the same drug costs only 21 000 rupees ($350) to the treating physician. Patients are used for research, but benefits are given to doctors.3 I declare no competing interests.
Himmatrao Saluba Bawaskar himmatbawaskar@rediffmail.com Bawaskar Hospital and Research Centre, Mahad, Dist-Raigad, Maharashtra 402301, India 1 2 3
The Lancet. Violence against doctors: why China? Why now? What next? Lancet 2014; 383: 1013. Sachan D. Tackling corruption in Indian medicine. Lancet 2013; 382: e23–24. Bawaskar HS. The medical trade. Indian J Med Ethics 2013; 10: 278.
Publication pressure on Chinese doctors— another view In China, the debate about doctors’ promotion and publications (through science index citation) has been ongoing for years.1–4 Many doctors, and espec ially young doctors, complain about the huge pressure 956
for publication. 1 However, others, including ourselves, hold the view that it is necessary for doctors to be engaged in research,2,5 and that “engaging in research is likely to develop analytical skills and promote critical thinking”.2 Scientific research is not a luxury but a necessity. China, as a country, provides a large number of disease cases, with important potentials for relevant research, and so, not only for China, but also for other countries worldwide. However, whether a doctor should be engaging in research or not is not the key point of the debate. In China, patients can choose their medical providers, and this can lead to excess. A patient with a cold is likely to go to a well-equipped hospital, and a doctor will have to spend some time on this patient who could or should have been treated in primary health-care facilities. Hence, many doctors who would do research are too often overloaded and do not have enough time for academic research. Therefore, the key point here is the conflict between the academic expectation laid on doctors and the time that they have. There are two problems involved here: the first one is how to guide patients’ rational use of different health-care providers. The second one is how to establish a reasonable standard for doctors’ promotion. Although, there is growing research on health-seeking behaviours, very few studies have looked at promotion mechanisms of doctors in China. In fact, in China, no requirement for publications is made at the national level, however lots of hospitals have brought the number of articles published and the research implemented by doctors into their promotion mechanisms. To determine whether this approach is reasonable or not, and how to improve it, will require more research. We acknowledge funding from the Natural Science Foundation of China (71203068), Health and Family Planning Commission of Wuhan Municipality, and Guiyang city health bureau. We declare no competing interests.
Shanquan Chen, Yao Pan, Qiang Yao, Lan Yao, Zhiyong Liu, *Li Xiang [email protected] School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China 1 2 3
4
5
Ye B, Liu AHJ. Inadequate evaluation of medical doctors in China. Lancet 2013; 381: 1984. Hong JX, Xu JJ, Sun XH. Young doctors and the pressure of publication. Lancet 2013; 381: e10. Yuan HF, Xu WD, Hu HY. Young Chinese doctors and the pressure of publication. Lancet 2013; 381: e4. Yu NZ, Hassan KZ, Long X, Wang XJ. Young doctors and the pressure of publication. Lancet 2013; 381: e10. Holden J. The work and research of a single non-academic family physician. Family Practice 2009; 26: 75–78.
Department of Error Wang H, Liddell CA, Coates MM, et al. Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384: 957–79—In this Article (published online on May 2), changes have been made to the author list and affiliations. These corrections have been made to the online version as of Sept 12, 2014, and the printed Article is correct. Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, et al. Global, regional, and national levels and causes of maternal mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384: 980–1004—In this Article (published online on May 2), changes have been made to the author list and affiliations, and the key of figure 5C has been corrected. These corrections have been made to the online version as of Sept 12, 2014, and the printed Article is correct. Murray CJL, Ortblad KF, Guinovart C, et al. Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990—2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384: 1005–70—In this Article (published online on July 22), changes have been made to the author list and affiliations, and to data in table 5. These corrections have been made to the online version as of Sept 12, 2014, and the printed Article is correct.
www.thelancet.com Vol 384 September 13, 2014
hospitals, doctors are overworked and under pressure from politicians who can interfere with medical admission, affecting doctors’ self-esteem. The main reasons for patients’ relatives to become violent are unnecessary investigations, delay in attending patient, request of advance payments, or withholding a deceased body until settlement of final billing. Ultimately the medical trade now involved in this noble profession has resulted in doctors, patients, and relatives’ unrest.3 Today, doctors are not recommending to their children to go to medical colleges, which is a real misery for the medical profession. Another important issue is the involvement of drug companies in unethical trade including sponsoring doctors’ tours abroad, conferences, and offering expensive gifts. 30 mg of tenectiplase, a thrombolytic drug used for acute myocardial infarction, costs 27 000 rupees (US$450) to patients (beneficiaries), which is the maximum retail price. However, the same drug costs only 21 000 rupees ($350) to the treating physician. Patients are used for research, but benefits are given to doctors.3 I declare no competing interests.
Himmatrao Saluba Bawaskar himmatbawaskar@rediffmail.com Bawaskar Hospital and Research Centre, Mahad, Dist-Raigad, Maharashtra 402301, India 1 2 3
The Lancet. Violence against doctors: why China? Why now? What next? Lancet 2014; 383: 1013. Sachan D. Tackling corruption in Indian medicine. Lancet 2013; 382: e23–24. Bawaskar HS. The medical trade. Indian J Med Ethics 2013; 10: 278.
Publication pressure on Chinese doctors— another view In China, the debate about doctors’ promotion and publications (through science index citation) has been ongoing for years.1–4 Many doctors, and espec ially young doctors, complain about the huge pressure 956
for publication. 1 However, others, including ourselves, hold the view that it is necessary for doctors to be engaged in research,2,5 and that “engaging in research is likely to develop analytical skills and promote critical thinking”.2 Scientific research is not a luxury but a necessity. China, as a country, provides a large number of disease cases, with important potentials for relevant research, and so, not only for China, but also for other countries worldwide. However, whether a doctor should be engaging in research or not is not the key point of the debate. In China, patients can choose their medical providers, and this can lead to excess. A patient with a cold is likely to go to a well-equipped hospital, and a doctor will have to spend some time on this patient who could or should have been treated in primary health-care facilities. Hence, many doctors who would do research are too often overloaded and do not have enough time for academic research. Therefore, the key point here is the conflict between the academic expectation laid on doctors and the time that they have. There are two problems involved here: the first one is how to guide patients’ rational use of different health-care providers. The second one is how to establish a reasonable standard for doctors’ promotion. Although, there is growing research on health-seeking behaviours, very few studies have looked at promotion mechanisms of doctors in China. In fact, in China, no requirement for publications is made at the national level, however lots of hospitals have brought the number of articles published and the research implemented by doctors into their promotion mechanisms. To determine whether this approach is reasonable or not, and how to improve it, will require more research. We acknowledge funding from the Natural Science Foundation of China (71203068), Health and Family Planning Commission of Wuhan Municipality, and Guiyang city health bureau. We declare no competing interests.
Shanquan Chen, Yao Pan, Qiang Yao, Lan Yao, Zhiyong Liu, *Li Xiang [email protected] School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China 1 2 3
4
5
Ye B, Liu AHJ. Inadequate evaluation of medical doctors in China. Lancet 2013; 381: 1984. Hong JX, Xu JJ, Sun XH. Young doctors and the pressure of publication. Lancet 2013; 381: e10. Yuan HF, Xu WD, Hu HY. Young Chinese doctors and the pressure of publication. Lancet 2013; 381: e4. Yu NZ, Hassan KZ, Long X, Wang XJ. Young doctors and the pressure of publication. Lancet 2013; 381: e10. Holden J. The work and research of a single non-academic family physician. Family Practice 2009; 26: 75–78.
Department of Error Wang H, Liddell CA, Coates MM, et al. Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384: 957–79—In this Article (published online on May 2), changes have been made to the author list and affiliations. These corrections have been made to the online version as of Sept 12, 2014, and the printed Article is correct. Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, et al. Global, regional, and national levels and causes of maternal mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384: 980–1004—In this Article (published online on May 2), changes have been made to the author list and affiliations, and the key of figure 5C has been corrected. These corrections have been made to the online version as of Sept 12, 2014, and the printed Article is correct. Murray CJL, Ortblad KF, Guinovart C, et al. Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990—2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014; 384: 1005–70—In this Article (published online on July 22), changes have been made to the author list and affiliations, and to data in table 5. These corrections have been made to the online version as of Sept 12, 2014, and the printed Article is correct.
www.thelancet.com Vol 384 September 13, 2014
