Dev World Bioeth. 2018 Mar;18(1):45-55. doi: 10.1111/dewb.12164. Epub 2017 Sep 25.
In China's healthcare sector, a popular and socio-culturally distinctive phenomenon known as guanxi jiuyi (medical guanxi), whereby patients draw on their guanxi (personal connections) with physicians when seeking healthcare, is thriving. Integrating anthropological investigation with normative inquiry, this paper examines medical guanxi through the lens of patient-physician trust and mistrust. The first-hand empirical data acquired - on the lived experiences and perspectives of both patients and physicians - is based on six months' fieldwork carried out in a county hospital in Guangdong, southern China, which included in-depth interviews with 20 patients and 20 medical professionals. Patients who emphasized the positive effects of guanxi on patient-physician trust believed that it facilitates access to experienced medical specialists, enhances clinical communication, and reduces the financial and medical risks of over diagnosis and overtreatment by physicians. At the same time, these findings reveal patients' strong sense of mistrust, not only towards individual health professionals but also to the medical profession and China's commercialized healthcare industry. While some health professionals in the study responded favourably to medical guanxi, most were opposed to it on the grounds that it undermines professional standards and equitable healthcare. We found that the practice of medical guanxi is not morally justifiable, chiefly because it reinforces the present high levels of patient-physician mistrust and erodes trust between patients and the medical profession as a whole. In China, both the medical profession and the state need to promote patient-physician trust based on medical professionalism and institutional norms, rather than on guanxi or individual relationships.
在中国的医疗保健领域，一种流行的、具有社会文化特色的现象——关系就医（医疗关系）——正在蓬勃发展。患者在寻求医疗服务时利用与医生的关系。本文通过医患信任和不信任的视角，运用人类学调查与规范研究相结合的方法，研究了医疗关系。第一手的经验数据是基于在中国南方广东省的一家县级医院进行的六个月实地调查获得的，包括对 20 名患者和 20 名医疗专业人员的深入访谈。强调关系对医患信任积极影响的患者认为，它有助于获得经验丰富的医学专家，加强临床沟通，并降低医生过度诊断和过度治疗的经济和医疗风险。与此同时，这些发现揭示了患者对个体医疗专业人员以及整个医疗行业和中国商业化医疗保健行业的强烈不信任感。虽然研究中的一些医疗专业人员对医疗关系持积极态度，但大多数人反对这种关系，理由是它破坏了专业标准和公平的医疗保健。我们发现，医疗关系的实践在道德上是不可接受的，主要是因为它加剧了目前医患之间高度的不信任，侵蚀了患者对整个医疗行业的信任。在中国，医疗行业和国家都需要在医学专业精神和制度规范的基础上促进医患信任，而不是依赖关系或个人关系。
