Survey of Medical Professionalism from the Patient Perspective

Survey of Medical Professionalism from the Patient Perspective Work group: Zhizheng Du Mingjie Zhao Yi Qin Yang Yang

一、Project Design and Methodology 1、Purpose patient is the subject of medical professionalism, their acknowledgement and attitude about medical professionalism is important . purpose of our project: enhance the development of China medical professionalism by understanding and analyzing the patients’ views of medical professionalism and health care in modern China

2、selected sample 1 、criteria: patient who has been hospitalized in recent years (or family members of the patient who has been accompanying the patient) 2、Eliminated Condition: doctors 3、stratified random sampling method with a total sample amount of 2400 ; divided the whole country into developed, developing and underdeveloped regions according to their economic prosperity. Ten cities such as Shanghai, Dalian, Jinan, Shijiazhuang are selected. 200 samples per city.

1、pre-investigation αtesting and βtesting, revision and modification of the questionnaire outline 2、all the questionnaires are required to be filled out of hospitals 3、patients gathered together to carry out the survey 4、the Investigator training (39 in total) 3、method

4、Quality Control 1、carefully revised questionnaire and items 2、team cooperation and communication 3、investigator training of precautions 4、supervision in time

二、sample analyzing A、handout: 4000; collected: 4000; valid:3932; validity:98.3%， city:2013; countryside:1919 B、 sex: male:1751; female:2181 C、hospitals: provincial (and above, including university affiliated hospitals):315 （8.4%）， Municipal hospital : 2458 （62.5%）， county hospital:1084（26%）， clinic: 75（1.9%）。

D、the department : internal medicine 1700 43.2% surgery 1034 ·26.3% gynecology 518 13.2% Neurology 128 3.3% Otolaryngology 136 3.5% others 416 10.6% Total 3923 100。0

E、Average time your are in hospital : 1-10 days: 1701 43.3% 10-20 days: 1373 34.9% 20-30 days: 524 13.3% more than 30 days 334 8.5%

F、average monthly income ：less than 1000: 2510（63.8%）。1000-3000:1072 （27.3%），3000-5000: 265 （6.7%），5000-10000: 85 （2.2%） G； medical insurance ： medical services at state expense 685 （17.4%）， medical insurance for urban workers 1235（31.4）， rural cooperative medical insurance 1464（37.2%）， business insurance 104（2.6%）， without any insurance 444 （11.3%）

三、general views of medical professionalism from patient perspective this report just illustrate some issues selected

1、general conclusion of medical professional responsibility A、assess the medical professional responsibility in the hospital you stayed: choice sample# percent Very satisfied 733 18.6 satisfied 2450 62.3 Unsatisfied 600 15.3 Very bad 149 13.8 Total 3932 100

B、as to the health of patients, physicians choice sample# percent care for 657 16.7 Somewhat care for 2583 65.7 Not very care for 584 14.9 Not care for at all 108 2.7 total 3932 100.0

C、What’s physicians’ priority in their practice choice sample# percent The health of patients 1559 39.6 improve their skill 833 21.2 Economic Interest of their own and hospital 1540 39.2 total 3932 100.0

D、The No. 1 reason why you are unsatisfied with the hospital or physician choice sample# percent irresponsibility 1761 44.8 Poor skill 569 14.5 Poor equipment 252 6.4 High charges 1146 29.1 others 204 5.2 total 3932 100.0

E、the things you worried most during your stay choice sample# percent irresponsibility 883 22.5 misdiagnosis 1484 37.7 Shirking responsibility 303 7.7 High expense 940 23.9 inattentive attitude 213 5.4 Poor management 74 1.9 Poor environment 35 0.9 total 3932 1000

conclusion as illustrated above： ●patients that are very satisfied only takes up 18.6% of the total, combining the ones somewhat satisfied, it takes up 80.9%； ●patients’ welfare first (39.6% )V.S. individual interest (39.2%) first ●the things worried most：1st, professional responsibility; 2nd, malpractice ; 3rd, high expense

2、trust in physician-patient relationship trust physician-patient relationship medical professionalism

A、do you trust you doctors? choice sample# % very 525 13.4 somewhat 2699 68.6 Not very 581 14.8 Not at all 127 3.2 total 3932 100.0

B、After seeing a doctor in a hospital, do you still go to another hospital ? choice sample# % yes 2125 54.0 no 1807 46.0 total 3932 100.0

C、the reason for taking the another hospital choice sample# % no answer 818 20.8 Poor skill 1336 34.0 Poor hardware facilities 574 14.6 High expense 990 25.2 poor physician attitude 214 5.4 total 3932 100.0

D、Have you ever paid attention to your doctors’ behavior choice sample# % yes and it’s necessary 1159 29.5 never, but it’s necessary 1308 33.3 never, and it’s unnecessary 1465 37.2 Total 3932 1000

conclusion ●worth trusting takes13.4%，adding to that can be somewhat trusted, up to 81.0% ●seeking for another hospital takes 54.5%，mainly because of poor skill ●62.6% patients would pay attention to their doctors’ behavior，just 37.2% thought it is unnecessary

3、monetary gift a tough issue in our society

A、Did you give “monetary gift” to your doctors during you stay in the hospital? choice sample# % yes 2140 54.4 no 1792 45.6 total 3932 100.0

B、the amount of monetary gift is choice sample# % Less than1000 1341 46..4 1000-2000 934 32.4 2000-3000 420 14.6 3000-4000 106 3.6 more than 4000 86 3.0 total 2887 99.6 Note: 1036 no answer

C、Does low-income justify monetary gift? choice sample# % very much justify 341 8.7 somewhat justify 502 12.8 Can’t justify 1725 43.9 Can’t justify at all 1163 29.9 Others 201 5.1 Total 3932 100.0

D、What is the motivation of patients who give monetary gift? Choice sample# % hope to get special care from doctors (including post-operative care) 1575 40.1 have better doctor to perform the operation 993 25.3 the operation could be arranged sooner 449 11.4 reduce worry 606 15.4 save medical expenditure 124 3.2 express appreciation 185 47 total 3932 100.0

E、If after giving the monetary gift, your goals are not achieved, you will: choice sample# % Not care 555 14.1 Be dissatisfied, but be understanding 1186 30.2 worry about having given less money than needs 1108 28.2 angry 806 20.5 accuse the doctor 277 7.0 total 3932 100.0

F、The attitude of the majority of doctors on monetary gift is: choice sample# % refusal 738 18.8 Want to accept but feel worried 1619 41.2 Depends 430 10.9 Always accept 831 21.1 Hint patients to give 257 6.5 Return after receiving 57 1.4 总计 3932 100.0

G、In your opinion, what impact would receiving monetary gift exert to physicians: Choice sample# % No impact 493 12.5 impair their reputation 2062 52.4 encourages corruption 1377 35.0 Total 3932 100.0

conclusion ● monetary gift issue may be exaggerated ● the disapproval of patients on such a behavior ● should concern more on doctors' attitude ● the motivation of bribery

4、informed consent and autonomy One of the principles in the Medical Professionalism in the New Millennium: A Physicians' Charter

A、You think physician’s implementation of informed consent is choice # % Very necessary 1502 38.2 necessary 1850 47.0 Not very necessary 348 8.9 unnecessary 232 5.9 total 3932 100.0

B. Who sign on the consent when the patient is conscious? choice # % Patient self 1555 39.5 family member 2078 52.8 Colleague or friend 171 4.3 physician 128 3.3 total 3932 100.0

C、When the doctor explains condition and treatment of illness, you hope it to be? choice # % straightforward 2430 61.8 obscure 510 13.0 Told to family members only 992 25.2 Total 3932 100.0

D、what do you think of requirement of signature of patients or their families before surgery? choice # % Very necessary 1586 40.3 necessary 1519 38.6 Somewhat necessary 638 16.2 unnecessary 189 4.8 total 3932 100.0

E、Before your sign the consent, the information given by doctors is: choice # % Very clear 1173 29.8 clear 1786 45.4 Not very clear 600 15.3 Very unclear 156 4.0 unclear due to limited time 217 5.5 total 3932 100.0

F、What do you think of signing before operation? choice # % Respect to patient’s right 1948 49.5 Hospital is pushing aside responsibility 1484 37.7 Proof for potential court trial if necessary 284 7.2 Go through the motion 216 5.5 total 3932 100.0

G、You sign the consent with choice # % Deliberated consideration 2169 55.2 Insufficient consideration 856 21.8 The pressure of the hospital You don’t sign it at all 907 23.1 total 3932 100.0

H、preoperative signing may make patients choices sample# % More worried 1530 34.3 Emotionally unstable 1471 37.4 More confident 1111 28.3 Total 3932 100.0

I、With signing, if the operation failed or had mistake, you think the doctor 选项人数 % Don’t have to be accountable 440 11.2 Be accountable partially 1079 27.4 Be mainly accountable 1041 26.5 Be fully accountable 366 9.3 It depends 1006 25.6 总计 3932 100.0

conclusion • Chinese patients are concern about their right • The influence of Chinese family • Misunderstanding of signing before the operation • Signing and responsible for operation failure • impact of signing to the patients before the operation

5、informed refusal autonomy V.S. informed consent

A、After being informed the illness condition or treatment by doctors, you don not think the advices are appropriate, you will: 选项人数 % Express your disagreement and hold your own opinion 1467 37.3 Receive their advice after explanation 2459 62.5 other 6 0.2 总计 3932 100.0

B、The reasons that you do not agree with the view of doctors of treatment is: 选项人数 % doubt of their judgment 1361 34.6 They are making money by doing so 782 19.9 Can’t afford it 1404 35.7 Worry about family member’s disagreement 385 9.8 总计 3932 100.0

C、Face to disagreement of patients, the doctors should ： 选项人数 % Accept it unconditionally 549 14.0 Explain with patience Insist their first judgment 2804 53.0 It depends 1299 33.0 总计 3932 100.0

D、After several rounds of communication, patients still persist, you think doctors should: 选项人数 % Take patient’s opinion 1901 48.3 Proceed with their own opinion 1336 34.0 Ask patient to transfer to another facility 695 17.7 总计 3932 100.0

E、In emergency conditions, you think : 选项人数 % patients should obey physician’s judgment 3310 84.2 Patient should have the right to decide 622 15.8 总计 3932 100.0

F、When patient persistence leaded to death or other adverse consequences after doctors inform patients the dangers for many times, 选项人数 % Doctor is not responsible for it 2807 53.1 Doctor is responsible for it 1845 46.0 总计 3932 100.0

conclusion • Informed refusal: most patients would follow the doctors’ advise • The reason of informed refusal: 1st is high cost (36.7%)； • Who would be responsible for the refusal?

Survey of Medical Professionalism from the Patient Perspective