Chinese doctors are under a high risk of sudden death
Editorial

Chinese doctors are under a high risk of sudden death

Zhantao Deng1*, Jiewen Jin2, Qiying Dai3, Jingxin Pan1*, Xiaoyan Wang4*, Rui Liu5*, Xiao Li6*, Yicun Wang7, Qiujian Zheng1

1Department of Orthopedics, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China; 2State Key Laboratory of Chemistry for Life Science & Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing 210093, China; 3Metrowest Medical Center, Framingham, MA, USA; 4Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China; 5Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China; 6Department of Urologic Surgery, Affiliated Cancer Hospital of Jiangsu Province of Nanjing Medical University, Nanjing 210009, China; 7Department of Orthopedics, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, China *Written on behalf of the Academic Made Easy, Excellent and Enthusiastic (AME) Collaborative Group

Correspondence to: Qiujian Zheng. Department of Orthopedics, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China. Email: zhengqiujian_GGH@163.com.

Received: 10 August 2017; Accepted: 10 August 2017; Published: 25 August 2017.

doi: 10.21037/amj.2017.08.15


Since 2015, the Chinese health-care system reforms have been emphasizing the importance of constructing hierarchical medical system. Hierarchical medical system policy was aimed to enhance the development of primary medical care and redistribute medical resources more rationally. At present, most of patients prefer to go to tertiary hospitals, which increases the working load on doctors there.

Although these extra burdens on doctors have been realized, no corresponding action has been taken. At the same time, it has been noticed that the rate of sudden death of doctors has been increasing in the past five years (Figure 1). On 26th July, 2017, a 30-year-old anesthetist died suddenly on his night shift in a tertiary hospital in China. He was the 14th doctors who had sudden death in 2017 (Table 1). According to systematic search of public reports on local media, medical websites and official documents, 45 doctors are found to be killed by sudden death since 2012. The majority of the doctors worked in tertiary hospitals. Most of them are surgeons or anesthetists (Table 1, Figure 1). Filled with tension and pressure, Chinese doctors are under a high risk of sudden death.

Figure 1 The characteristics of enrolled 45 Chinese doctors who killed by sudden death since 2012. (A) The number of doctors killed by sudden death since 2012 every year; (B) the distribution of department of affected doctors; (C) the proportion of doctors who worked more than 12 hours before sudden death; (D) the bar chart of affected doctors sorted by age; (E) the gender distribution of affected doctors; (F) the distribution of hospital of affected doctors; (G) the medical titles distribution of affected doctors; (H) the education background distribution of affected doctors; (I) the cause of sudden death of affected doctors; (J,K) the regional distribution of affected doctors in map (J) and in bar graph (K).
Table 1
Table 1 General characteristics of enrolled doctors
Full table

This phenomenon may be largely due to lack of enough medical resources and its uneven distribution. China is a big country with 22% of world’s total population while it occupies only 2% of world’s medical resources (1). China only owns less than half of medical resources per capita (1.2 physicians/1,000 population vs. 2.8 physicians/1,000 population) compared with developed countries (1). All these factors contribute to the increasing burden on Chinese doctors in general. Moreover, since the access for a physician is not as strict as in western countries, patients are tended to tertiary hospitals for seeking better medical care (2). Including the large number of patients transferred from community hospitals, doctors in tertiary hospitals faced an extremely heavy burden in both outpatients and inpatients. Among the 45 doctors who had sudden death since 2012, 86% of them were from tertiary hospitals and 49% of them had been worked more than 12 hours before sudden death (Figure 1). In 2015, 2,402 doctors were enrolled in a survey which was conducted by Ding Xiang Yuan (the most popular biomedical website in China) (3). The survey showed that only 3% of doctors had less than 40 hours of working time every week while 37% of doctors had more than 60 hours to work every week (Figure 2). In addition, 47% of doctors had less than 1 day for rest every week (Figure 2) and 75% of them never had time for paid leave (Figure 2).

Figure 2 The survey on working status of Chinese doctors conducted by Ding Xiang Yuan in 2015 (n=2,402). (A) The distribution of working time per week. (B) the distribution of rest time per week; (C) the time for paid leave; (D) the distribution of activities in the rest time; (E) the frequency of feeling tired; (F) the distribution of treatment when feeling uncomfortable; (G) the distribution of hospital of enrolled interviewee; (H) the medical titles of enrolled interviewee; (I) the frequency of interval for night shift; (J) the number of patients received in outpatients half a day; (K) the surgery time of surgery on operation day; (L) the distribution of rest time in Spring Festival and National Day.

Getting promotion is another big challenge for Chinese doctors, especially in tertiary hospitals. Having National Natural Science Foundation and published paper listed in the Science Citation Index (SCI) are the criteria for candidates (4). As a result, doctors had to spend extra time on researches. As showed in Ding Xiang Yuan survey (3), study occupies almost all their time after work (Figure 2). Living in such conditions, half of doctors feel overwhelmed (Figure 2), but half of them would do no treatment when they felt uncomfortable (Figure 2).

The hierarchical medical system is an ideal method which is supposed to solve the problems above. However, it failed to cover the problems as follows: First, more medical resources should be created to relieve the extreme lack of total medical resources in China. Second, the quality of medical service in primary hospitals should been improved and the communication network among primary, secondary and tertiary hospitals should been well-rounded and timely, to ensure that patients could receive equal medical care. Third, the financial support from the government should been strengthened, especially for tertiary hospitals. It can relieve the pressure for hospitals to generate income as well as to reduce the competition among primary, secondary and tertiary hospitals (5). If only taken all these into consideration, would the current situation be changed.


Acknowledgements

None.


Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.


References

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doi: 10.21037/amj.2017.08.15
Cite this article as: Deng Z, Jin J, Dai Q, Pan J, Wang X, Liu R, Li X, Wang Y, Zheng Q. Chinese doctors are under a high risk of sudden death. AME Med J 2017;2:125.

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