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Culture

Where It Hurts Most

The Chinese Doctor, a nine-episode documentary that dissects the country’s increasingly volatile doctor-patient relationships, strikes a chord with audiences during the Covid-19 outbreak

By NewsChina Updated May.1

The Chinese Doctor seemed to arrive right on time.  

It debuted on January 27 as medical workers nationwide were mobilizing to fight the Covid-19 outbreak. Some of the doctors featured were sent to the frontlines in Wuhan, Hubei Province. 

Focused on the ongoing plight of China’s doctors, the nine-part web series attracted immediate attention. The Chinese Doctor soon was the top-rated documentary on streaming platform iQiyi and garnered a 9.3/10 rating on Douban, China’s leading review website. On Sina Weibo, there were more than 100 million posts about the documentary.  

The crew spent one year filming more than 30 doctors, from experienced department heads to new graduates, at six of the best hospitals in China. They also conducted over 200 patient interviews.  

The documentary explores the lives of Chinese medical workers, their working conditions, and China’s complicated, sometimes violent physician-patient relationships.  

“We respect doctors not because they are morally flawless angels but because they represent a light of hope that signifies human beings can use science and knowledge to confront their own impermanence and vulnerability,” Douban user “Shuqi” commented.  

Limits of the Heart 
Working titled The Doctor’s Heart, the project was directed by Zhang Jianzhen, assistant researcher at the Institute of Journalism and Communication, Chinese Academy of Social Science. Her previous work includes reality shows such as Chinese Dream, the Chinese version of The Glee Project, and a doctor-themed variety show from 2014 called Oath of Angels. 

From 2008 to 2009, Zhang spent one year living in a hospital as both her parents battled cancer. She got to know the young doctors. Over time, Zhang gained insight into the feelings and perspectives of doctors and their patients.  

Zhang sought to strip away the drama and show the real face of China’s medical workers. “This was the narrative I insisted on. We would not exaggerate certain emotions or create conflicts and controversies. We just attempted to show the authentic working and living conditions of doctors and the real doctor-patient relationship,” Zhang told NewsChina. 

Xu Ye is a promising young doctor working at the Nanjing Gulou Hospital burn center. Handsome and idealistic, Xu is known for his bedside manner and ability to connect with patients. 

“The most difficult thing is to understand patients’ feelings, to understand their suffering,” Xu said. “A doctor might feel a patient’s pain, but multiply that 100 times and that’s what the patient really feels.” 

When assistant director Zhang Zheng first contacted Xu, he was handling the most serious case his burn unit had seen that year. The patient, a middle-aged steel mill technician, was on the brink of death. He had burns covering 95 percent of his body after a molten steel spill. 

The patient’s family had already spent more than 1 million yuan (US$142,855) on treatment. To guarantee a full recovery, the family needed at least 1 million more. This was a huge financial burden for the steel worker’s family, especially considering his son was about to get married, which also required a large amount of money.  

Xu persuaded the family not to give up on treatment and managed to raise 20,000 yuan (US$ 2,857) from the hospital.  

However, the young doctor’s enthusiasm was not enough. The family chose to forego treatment. The medical expenses would drain the family of everything they had.  

“A senior doctor in the burn unit once told me that when we operate on patients, particularly those with severe burns, in many situations we may find that in the end, we’re not facing the limits of our own skills, but those of the human heart,” Xu said. 

People choosing to stop treatment isn’t rare. But this time, the patient and his family left without saying goodbye. The documentary captured the young doctor’s silent disappointment when he found the bed empty, his fingers unconsciously tapping on its railing.  

“Life is but a journey. Individuals have their own challenges, and so do doctors. […] Why do people say doctors look very cold? It’s not coldness. It’s calmness. They have witnessed countless situations as bad as this one, so they appear very calm. It’s a process that every doctor goes through,” Xu said.  

On Thin Ice
“I will tear you to pieces!”  

The documentary opens with doctor Zhu Liangfu, 44, looking straight into the camera and repeating a death threat he received from a patient’s family. Zhu is the chief physician of cerebrovascular diseases at Henan Provincial People’s Hospital.  

“That elderly woman was the wife of one of my patients who died during treatment. She threatened she would kill me and said I had killed her husband. […] But the next time she came, she said she had blood pressure problems and asked me to check. The thing is that she knows you’re a good doctor, but that doesn’t stop her from reporting you,” Zhu said.  

Zhu fights a disease with the highest mortality rate in China-stroke. Chances of death are even greater if the patient is not treated within the first six hours.  

Zhu races against death every day. But he’s not always fast enough, and sometimes, he’ll receive a death threat from the patients’ family.  

Disputes and conflicts between doctors and patients are common in China. Reports of patients or family members attacking, sometimes murdering, doctors when treatment does not work out are increasingly common. 

In October 2019, a 42-year-old doctor surnamed Feng at Gansu Provincial People’s Hospital was stabbed to death by a patient. Two months later, Yang Wen, a deputy head of ICU at Beijing’s Civil Aviation General Hospital was stabbed to death by a patient’s son.  

According to The 2018 White Paper on the Chinese Licensed Medical Practitioners, issued by the Chinese Medical Doctor Association (CMDA), 62 percent of doctors had experienced medical disputes at some level. Sixty-six percent had suffered abuse from patients, 51 percent of which was verbal abuse.  

Emergency rooms are a common place for conflicts to erupt.  

“The most distinctive difference between emergency physicians and those in other departments is that they spend 80 percent of their energy communicating with patients and their families,” Zhang Zheng told NewsChina.  

“In every interaction between doctors and patients, perhaps a certain word a doctor says, a certain tone or a certain expression on their face might trigger misunderstandings and conflicts. Doctors generally feel they’re treading on thin ice,” Zhang said. 

On weekends when most departments are closed, patients will rush to the emergency department. Some receive 500-600 patients per day, often tripling their weekday numbers.  

The greatest challenge for an emergency physician is how to convey information to patients and their family in a limited time.  

Usually the patient’s family is burdened with making big decisions very quickly, such as whether to elect for an invasive operation or opt for more conservative treatment.  

“I’ve talked with many emergency room doctors. They all said they could only offer suggestions and leave the patient’s family to decide,” Zhang said. This is a protective measure for doctors, Zhang explained, since telling a family what to decide means taking responsibility and bearing the risks.  

Xu Hua in The Chinese Doctor

‘Afraid to Die’
Wang Dongjin is surgeon at Nanjing Gulou Hospital. A heart specialist, Wang has practiced for over 30 years. He has conducted tens of thousands of operations with a success rate of 99 percent. In 2017 alone, he performed 2,989 operations, 407 involving the great arteries. His ability for precision in high-pressure situations has earned him the monicker “the bomb disposal expert” of cardiothoracic surgery. 

Wang usually arrives at 8am. He’ll often work for 17 hours, leaving after midnight.  

Operations, research, lectures, academic conferences and working at free clinics take up most of Wang’s time. He rarely takes a day off.  

“Only surgeons who are physically strong can withstand a cardiology department workload,” Wang said. “Anyone who is physically weak and cannot tolerate the toil of operations has long been sifted out.”  

According to the 2018 white paper, 23.6 percent of the 146,200 surveyed doctors from 44,600 hospitals have never taken annual leave, while 4.4 percent said they weren’t aware they had leave.  

On average, hospitals in China see 20 million patients per day. Doctors in tertiary hospitals work an average 51.05 hours over a five-day workweek. Doctors in surgery departments, in particular, work an average 53.3 hours per week. Two-fifths of all surveyed doctors said they sleep less than six hours per day.  

Zhu Liangfu admitted that he was “afraid to die.” “With the heavy workload and irregular rest every day, I’m afraid I might just collapse one day. But I can’t. I haven’t fulfilled my responsibilities to my family, and as a doctor I still have a responsibility for my hospital. I can’t die. It takes the country 25 years to train a head doctor like myself. I’m 44 this year, and if I collapse, it’s a waste of national resources,” Zhu said. 

To maintain his physical and mental strength, Zhu lives a very disciplined lifestyle. He runs about five kilometers every day and journals daily for reflection.  

“He [Zhu Liangfu] is extremely strict on himself, like an ascetic,” Liu Ya, the project’s assistant director who filmed Zhu, told NewsChina. 

But Zhu’s definition of a “good doctor” impressed Liu the most. He said, “Being nice and showing concern are not what’s most important. A good doctor should be the one who, once at the operation table, treats patients just like they’re treating a dog.” 

“What does that mean? It means a doctor should not have any emotions. Emotions interfere with treatment. No matter who is on the operation table, a stranger, a governor or the doctor’s own father, the doctor should treat every patient equally without discrimination. That’s what makes a good doctor.”  

Many of the doctors featured in the documentary went to Wuhan, the epicenter of the Covid-19 pandemic. He Qiang, the deputy director of the Zhejiang Provincial People’s Hospital, is treating Covid-19 patients in a makeshift hospital. Yin Fanghong, deputy head of ICU at the West China Hospital of Sichuan University, was transferred to the Wuhan Red Cross Hospital.  

Shi Binggen, director of the First Affiliated Hospital of Xi’an Jiaotong University and veteran of the 2003 SARS epidemic, is back on the frontlines and leading a medical support team in Hubei Province. 

Zhu Liangfu (left) in The Chinese Doctor

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