A Preliminary Study on the Abnormal Deaths and Work Burden of Chinese Physicians: A Mixed Method Analysis and Implications for Smart Hospital Management

Background: The population of Chinese physicians is frequently threatened by abnormal death, including death by overwork or homicide. This is not only a health problem, but also a social problem that has attracted the attention of both hospitals and the government.Objective: This study aims to analyze the characteristics of abnormal death in physicians in Chinese hospitals from 2007 to 2020 and to investigate the relationship between abnormal death and physician workload, in order to provide information for policy makers and request improvement technologies.Methods: A mixed research method was used. In order to ensure accuracy and completeness, a relatively comprehensive search was conducted using multiple heterogeneous data sources on the abnormal death of physicians in Chinese hospitals from 2007 to 2020. The collected cases were then descriptively analyzed using the work-related overwork death risk concept framework and the deductive grounded theory approach. In addition, the workload of physicians was calculated between 2007 and 2019 based on three important workload indicators.Results: Between 2007 and 2020, 207 abnormal death events of physicians on the Chinese mainland were publicly reported. Among the 207 victims, the majority (~79%) died from overwork or sudden death. The number of victims who were men was 5.5 times higher than that of women, and victims were between the ages of 31–50 years. These physicians mainly belonged to the departments of surgery, anesthesiology, internal medicine, and orthopedics. Further analysis of the direct causes of death in cases of overwork death showed that 51 physicians (31.1%) died from cardiogenic diseases. Additionally, the per capita workload of physicians in China increased drastically by about 42% from 2007 to 2019, far exceeding physician workloads in Europe, Asia, and Australia (number of inpatients per physician in 2017: 72 vs. 55, 50, 45). The analysis revealed that there was a strong correlation between the number of abnormal deaths of physicians in China and the number of inpatients per physician (r = 0.683, P = 0.01).Conclusion: High-intensity working conditions may be positively correlated with the number of abnormal deaths among physicians. Smart hospital technologies have the potential to alleviate this situation.

Buddhism and Healing in China

The history of Buddhism in China is deeply connected with healing. Some of the scriptures that were translated into Chinese discuss Indic conceptions of the body as an amalgamation of elements, and causes of illness in the tridoṣa, that is pathogenic body fluids and internal winds. Others discuss materia medica, and monastic rules on healing and hygiene in the monastery. Yet others set forth the ritual worship of the Medicine Buddha (Skt. Bhaiṣajyaguru; Ch. Yaoshi fo 藥師佛), the Bodhisattva Avalokiteśvara (Guanyin pusa 觀音菩薩), and other deities that promise healing. Apart from the translated scriptures, there is a huge body of indigenous works that synthesized the wealth of information on Indic healing which arrived in China between the 2nd and 10th centuries ce. Foremost among those are Yijing’s義淨 (635–713) account of Indian monastic practices, Daoxuan’s道宣 (596–667) vinaya commentary, and Daoshi’s道世 (?–683) encyclopedia chapter on illness. Chinese compositions, such as Zhiyi’s 智顗 (538–597) treatises on meditation, and Huizhao’s 慧皎 (497–554) hagiographies bear witness to the hybridity to which the reception of Indic ideas in China gave rise. With the widening reach of Buddhism into every layer of Chinese society during the Sui and Tang dynasties, eminent Chinese physicians, such as Tao Hongjing 陶弘景 (452–536), Chao Yuanfang 巢元方 (550–630), Wang Tao 王焘(670–755), and Sun Simiao 孫思邈 (581–682) also began to incorporate Buddhist ideas into their medical treatises. Chinese Buddhist monasteries introduced hospital services to China, and certain lineages of monks continued to provide medical care to the laity in late imperial China. Their healing was based on Chinese medical theories, however, and there is no evidence that they persisted in applying Indic medical ideas.

The Influence of Transaction Process With Doctors on Patient Satisfaction, Self-Rating Anxiety and Self-Efficacy Among International Students in China

Objectives: To investigate the communication mechanism between international students and Chinese physicians by evaluating the influence of the transaction process on patient satisfaction, self-rating anxiety and self-efficacy.Methods: A cross-sectional survey was conducted among international students living in Central, Northern and Eastern China; enrolled at Chinese universities and experienced outpatient and inpatient healthcare services. Guided by the elements of King's transaction process: IR, Initiating and Responding; IP, Identifying Problems; MGS, Mutual Goal Setting; and EM, Exploring means and agreeing on means to achieve goals. We used spearman correlation analysis to calculate the correlation of the variables: patient satisfaction, self-efficacy, transaction process, IR, IP, MGS, and EM and regression analysis to measure the influence of transaction process on patient satisfaction, self-rating anxiety and self-efficacy.Results: Four hundred and four (404) participants were investigated for this study. The results of correlation analysis showed that there was a significant positive correlation among patient satisfaction, self-efficacy, transaction process, IR, IP, MGS, and EM (p < 0.05). Regression analysis showed that the higher scores of IR (β = 0.176, p = 0.003) and MGS (β = 0.249, p = 0.002) was associated with the higher score of patient satisfaction; the higher the score of IR and IP was associated with the higher self-efficacy score (β = 0.148,0.225; p = 0.016,0.001); and higher the MGS score was associated the lower the self-rating anxiety (β = −0.220, p = 0.022).Conclusion: The influence of transaction process on patient satisfaction, self-rating anxiety and self-efficacy between Chinese physicians and international students (Patients) was established. Findings support the urgent implementation of tools at healthcare facilities to improve the communication between Chinese doctors and international students, therefore improving patient satisfaction and self-efficacy, and reducing anxiety.

A Chinese survey on clinical practice in hyperthyroidism management: comparison with recent studies and guidelines

Objective: To conduct a questionnaire survey of the current clinical practice for overt hyperthyroidism in China. Methods: An online questionnaire survey was conducted in July 2020. The two questionnaires covered 35 and 8 questions about nonpregnancy and pregnancy clinical practice for overt hyperthyroidism, respectively. Results: One thousand, two hundred fifty-six physicians participated. Chief physicians and associate chief physicians accounted for 58.6% of the participants. Approximately 95.2% of the respondents chose the thyrotropin receptor antibody (TRAb) test to clarify the etiology of thyrotoxicosis, while only 27.0% of them chose radioactive iodine uptake (RAIU). In terms of the treatment for nonpregnant patients, antithyroid drugs (ATDs) were the first choice, and most of the clinicians chose methimazole. Compared with clinicians in recent studies, Chinese physicians used serum TRAb to diagnose Graves’ disease more commonly, and there were obviously more physicians preferring ATDs. For maternal hyperthyroidism, most physicians preferred propylthiouracil administration before or during the first trimester, which is consistent with the 2016 American Thyroid Association (ATA) guidelines. In terms of the initial ATD dose, monitoring of the treatment process, indications for ATD withdrawal, and treatment of special cases, the preferences of Chinese physicians were generally consistent with the guidelines. Conclusion: Chinese physicians can generally follow the ATA guidelines for the diagnosis and treatment of hyperthyroidism. Moreover, there are small differences from foreign studies or the guidelines with respect to particular problems. These findings provide evidence for future clinical research in China.

Association of Organizational Behavior with Work Engagement and Work-Home Conflicts of Physician in China

This study aimed to examine how organizational behavior is associated with work engagement (WE) and work-home conflicts (WHCs) of physicians. The data were from a national cross-sectional survey of 3255 Chinese physicians. We examined organizational fairness, leadership attention, and team interaction for organizational behavior. The results indicate that greater organizational fairness is associated with higher WE and lower WHCs. High task fairness was associated with greater pride, and more enjoyment in work, lower sense of guilt towards their family, and less complaints from family members. Physicians reporting higher levels of leaders’ attention to their opinions reported experiencing more enjoyment of their work, and less effects on their care for family. A greater number of dinners with colleagues per month was associated with higher WE and lower WHCs, whilst a greater number of clinical case meetings per month was associated with higher WE and higher WHCs. The results suggest that the behavior of organizations could be an important intervention to improve the wellbeing of physicians.

Gender Differences in Job Satisfaction and Work-Life Balance Among Chinese Physicians in Tertiary Public Hospitals

Background: Gender has been associated with job-related experience, including job satisfaction and work-life balance. This study aimed to identify gender differences in job satisfaction and work-life balance among Chinese physicians in a large, nationally representative sample.Methods: A national cross-sectional survey was conducted between March 18 and 31, 2019, using an anonymous online questionnaire. The questionnaire included the short-form MSQ (Chinese version) and a work-life balance item. The demographic and job-related factors were also collected.Findings: In total, 22,128 physicians (9,378 males and 12,750 females) from 144 tertiary public hospitals completed the survey. The overall MSQ score (job satisfaction) was 70.31 ± 12.67, and it was 69.89 ± 13.24 in males, and 70.63 ± 12.22 in females, respectively (p < 0.001). Only 931 (4.21%) physicians were very satisfied with WLB (421 males, 510 females), and 2,534 (11.45%) were rated as satisfied. Age, education, monthly income, working hours, specialty, and professional titles were significantly associated with job satisfaction; while number of children, specialty, professional titles, monthly income, age, working hours were significantly associated with WLB. No significant gender differences were observed in job satisfaction or WLB after controlling confounding factors (both p > 0.05).Interpretation: While many demographic and work-related factors are significantly associated with job satisfaction and WLB, we found no significant gender differences, which is different from many other studies. To improve Chinese physicians' job satisfaction and work-life balance, interventions should be focused on certain specialties and on other modifiable factors, such as income, working hours.

Status, causes and consequences of physicians’ self-perceived professional reputation damage in China: a cross-sectional survey

Background Conflict between physicians and patients is an increasingly serious problem, leading to the disrepute attached to Chinese physicians’ social image and position. This study assesses the status of physicians’ self-perceived professional reputation damage and explains it’s the adverse outcomes including withdrawal behavior and workplace well-being. Moreover, potential causes of Chinese physicians’ disrepute have been outlined. Methods Primary data were collected through a cross-sectional online survey of physicians from 10 provinces in China, who were invited to complete an anonymous survey from December 2018 to January 2019. A total of 842 physicians (effective response rate: 92.22%) were recruited as participants. Results About 83% of the participants self-perceived professional reputation damage from the sense of the public opinion concept. Approach half of participants exhibited the idea of turnover intention (47.3%) and one or more symptoms of burnout (46.4%). About 74.9% of the participants experienced a degree of stress. Additionally, three out of five participants reported low-level subjective well-being. More than 70% of the participants disapproved of their offspring becoming a physician. Four factors leading to physicians’ damaged professional reputations are those addressed: conflict transfer, cognitive bias, improper management, and individual deviance. Stigmatised physicians are more likely to practice high-frequent defensive medicine (β = 0.172, P <0.001), intend to leave the profession (β = 0.240, P <0.001), disapprove of their children becoming physicians (β = 0.332, P<0.001) and yield worse levels of workplace well-being, including high levels of perceived stress (β = 0.214, P <0.001), increasing burnout (β = 0.209, P <0.001), and declining sense of well-being (β = − 0.311, P<0.001). Conclusion Chinese physicians were aware of damaged professional reputations from the sense of the public opinion concept, which contributes to increasing withdrawal behaviors and decreasing workplace well-being—a worsening trend threatening the entire health system. This novel evidence argues a proposal that Chinese health policy-makers and hospital administrators should promote the destigmatization of physicians immediately.

Bereavement After Patient Deaths Among Chinese Physicians and Nurses: A Qualitative Description Study

In order to achieve an in-depth understanding of professional caregivers’ experiences of bereavement after patient deaths in Mainland China, qualitative description was employed. 24 physicians and nurses from hospitals in Nanjing, China, participated in one-to-one, semi-structured interviews. Thematic analysis was adopted for data analysis. Five themes were generated: the nature of professional bereavement experiences, the meaning of patient deaths, immediate bereavement reactions, long-term changes, and coping strategies. Each theme included personal and professional dimensions. Professional bereavement experiences in Mainland China were found to be influenced by workplace violence against professional caregivers, traditional Chinese medical ethics, the strong death taboo, and inadequacies of the healthcare system. Professional bereavement experiences are meaning-driven, comprehensive, and usually disenfranchised. They involve multidimensional reactions and have both short-term and long-lasting, both event-specific and accumulated impacts. Cultural and systemic factors could shape professional bereavement experiences.