The doctor-patient relationship is another pressing issue for China. Several brutal attacks against doctors in recent years have raised public awareness. What's driving patients and families to violence? 

This is the calm before the storm.

Dr Wang Qian, one of China’s leading rheumatologists is on his way to work with his wife, ICU Dr Peng Jinmin. They both work at Peking Union Medical College Hospital, known locally as Xiehe. Founded in 1921 by the Rockefeller foundation it is widely considered to be China’s no.1 General Hospital.

"In the morning before clinic starts normally we go to the toilet, because we won’t have time during the day. The morning is like preparing for battle. Whatever we can do in advance, we do it," said Dr. Wang Qian, Peking Union Medical College Hospital.

The hospital employs many of China’s top medical specialists. Patients come from all over the country to see them. This means it’s very hard to get an appointment here, particularly in the departments where the hospital is ‘country leading’, like Dr Wang’s.

We have 700,000 coming to Beijing for medical help every day.

On an average clinic day, Dr Wang sees between 50 and 70 patients. He’s calculated that this allows him an average of 6 minutes per patient.

The overwhelming patient numbers mean there’s no way he can provide them with the quality of care he would hope to offer.

This lack of time is one of a host of reasons why the doctor-patient relationship in China is at an all time low. Around 2/3 of Chinese don’t trust doctors’ professional diagnosis and treatment according to a recent nationwide survey.

But like doctors all across China, Wang realises he must make the best of it – even though the heavy workload may be among the least of his worries.

On March 23rd, 2012, at one of Harbin’s top hospitals, 28 year old trainee doctor Wang Hao was brutally murdered. The killer was a 17-year-old rheumatology patient, Li Mengnan. Frustrated after what he saw as years of misdiagnosis and over-prescription of drugs that had ruined his family’s finances, Li had armed himself with a fruit knife and gone to the rheumatology department, where he lashed out at the first white coat he saw.

Li Mengnan was sentenced to life in prison.

Many doctors are reluctant to discuss such issues, for fear of being disciplined. But after the Wang Hao case, orthopaedic surgeon Dr Yu Keyi, who works at a leading Beijing hospital, decided he must do something. For he was convinced that the future of his profession in China was at stake.

"In the wake of the Wang Hao case many women doctors in particular feel nervous. We feel angry and helpless, fearing that maybe one day we’ll be stabbed. One of the doctors in the emergency room, says she feels so scared she’s afraid to sit with a patient behind her. She always has the feeling that anyone behind her wants to attack her. It’s a kind of trauma," said Dr. Yu Keyi, Orthopaedic Surgeon.

Dr Yu feels passionately that it’s vital to raise public awareness of the issue. To this end he writes blog articles and posts on social media site weibo, where he’s now got nearly 60,000 followers. He has founded a series of online campaigns including one which argues for zero-tolerance for violence against hospital staff.

But he’s aware that what he is doing is far from enough. He’s also aware that not all patients are sympathetic of his cause. For example, I put it to him that many people we spoke to said that the solution to this conflict is for doctors to treat patients properly, i.e., cure their illness or injury.

"A doctor can’t heal every condition. All he can do is treat you using his professional skill and spirit. That’s to say, Cure Sometimes, Relieve Often, Comfort Always, as the famous doctor Edward Trudeau said," Dr Yu said.

Few hospitals have to face the prospect of death as often as specialist cancer hospitals like this one, the Beijing Cancer Hospital. Dr Zhang Xiaodong is Director of Gastroenterology here. She says few people think cancer can be cured, so tempers don’t fray as much as in other departments, such as paediatrics, ER and Obstetrics. But it does still happen.

"It’s a terrible feeling, not normal, but extreme, and brings utter misery. If you’re in a situation where you yourself think you’re doing well, but the patient doesn’t appreciate it and is aggressive, you feel extremely depressed, and this inevitably has a negative effect on your work," said Dr Zhang Xiaodong, director of Gastroenterology Dept, Beijing Cancer Hospital.

Dr Zhang says she has witnessed violence against doctors and has even been a victim herself.

"In my case, I wanted to quit, to give up my job as a doctor. That’s how bad I felt. Yes. But after thinking it over, I could understand. That’s how I feel. I’m sorry, but I really understand the victims’ feelings," Dr Zhang said.

The impact of the violence may be felt for years to come.

78% of Chinese Doctors don’t want their children to study medicine according to a survey of 6000 doctors conducted by the Chinese Medical Doctors’ Association. And in a separate survey conducted from 2012-2013 across 316 hospitals nationwide nearly 40% of medical personnel said they plan to give up their profession, citing the increased violence in hospitals as the main reason.

"I think we may lose departments like the emergency room, ICU, obstetrics and pediatrics, because of the shortage of doctors.
Some people may argue that there are plenty of graduate students at medical colleges. True, but there’s the question of ability.
Every year we recruit masters students. In recent years, the past 5 to 10 years, we’ve clearly felt that the quality of our masters students is declining," Dr Zhang said.

Like Yu Keyi, Dr Zhang has been driven by the crisis to make her voice heard on social media site Weibo. But this has got her into trouble. For example, after an incident in which a Doctor-friend was attacked with a knife, she called on all doctors to go on strike. For that Zhang was invited to have a chat with the police about her intentions.

Since then, at the request of her hospital superiors, she has toned down her rallying cries. But her online awareness work continues.

She also recognises that hospitals have work to do to improve their service.

To this end, her team have come up with an innovative solution.

"Most patients undergo treatment at the outpatients clinic, then go home. So, they experience the side effects at home. We wanted to create a communication channel regarding tests and so on, and the potential side effects of the drugs we prescribe. So we set up this Wechat group," said Dr Zhang.

There are now around 100 patients in the group. Doctors use this tool to respond to patient’s queries about test results and side effects. The feedback has been very positive, almost too positive in fact. Numbers are growing fast and to keep up, on-duty doctors must use their lunchtimes or evenings.

Another who has joined the campaign to end violence against hospital staff is Lawyer and Chinese Medical Doctor Association Committee member Li Huijuan. She has represented doctors and their families in many of the most high-profile recent cases, including Wang Hao’s.

"There was no warning or previous conflict. Murderer and victim had never met before. This case revealed one thing, that is, the person he killed was no one in particular, just someone wearing a white coat. The conflict was between different groups. It was collectivistic conflict," said Li Huijuan, committee member of China Medical Doctors Association.

Li travels the country delivering lectures to hospital managers on how best to handle incidents. Medical reform and increased investment are coming, but in the opinion of doctors and patients alike, nowhere near fast enough. And as long as patients are dissatisfied with the treatment they are receiving, there is always the possibility that they will take drastic action.
At the root of the problem, though, according to Li Huijuan and all the doctors we’ve spoken to, are two factors. One is a chronic lack of investment in health care and the other is related to a societal fear of death.

"We always think that doctors possess the medicine and skills capable of bringing people back to life. Doctors are expected to heal the sick, like an angel or a god. In Chinese tradition doctors are held in high regard, with often overly-high expectations. But from the perspective of science the limitations can be seen if we look at the job in a reasonable way," Li said.

8pm, and Dr Wang’s shift has finished.

He tells me he’s often concerned about his safety. Just two weeks ago he was very nearly assaulted by a patient. But he is comforted by the fact that his wife is safe because at Peking Union’s ICU she gets to work behind locked doors.