Correspondence

744 www.thelancet.com Vol 384 August 30, 2014

communication, bypassing geographic boundaries and enhancing disciplinary development. However, in China, roughly 4 billion patient-visits annually are undertaken by grassroots medical staff,2 and Chinese medical journals are their main source of medical information. And worryingly, some unreliable and low-quality Chinese medical journals hinder medical skill improvement in these personnel. Hence, to improve the overall quality of Chinese medical journals, and to narrow the disparity between Chinese medical journals and international medical journals is not only benefi cial for grassroots medical staff but also extremely important to improve the quality of health care in China. Rebuilding a scientifi c and reasonable assessment system for medical research would be an essential step for the Chinese Government.We declare no competing interests.

Jun-Song Yang, *Ding-Jun Haodingjun.hao@qq.com

Department of Spinal Surgery, Hong-Hui Hospital, Medical College of Xi’an Jiaotong University, Xi’an 710054, China

1 Tong D, Wang L, Jiang J. Publications from China in The Lancet, NEJM, and JAMA. Lancet 2013; 381: 1983.

2 National Health and Family Planning Commission of China. China Health Statistics Yearbook 2013. http://www.nhfpc.gov.cn/mohwsbwstjxxzx/s7967/201404/f3306223b 40e4f18a43cb68797942d2d.shtml (accessed May 24, 2014).

Violence against doctors in ChinaUndoubtedly, the doctor–patient relationship has worsened in China.1 In the past two decades, there has been a lot of violence against doctors, with serious eff ects on the medical community and prospects for the future.2

To tackle medical disputes, a new initiative was launched on April 24, 2014, to establish that such attacks on doctors will bring severe punishment. The Supreme People’s Court, the Supreme

Violence against doctors in China is an important issue, previously covered in The Lancet.1–4 One reason to explain this issue is the inadequate mechanisms for handling patient’s complaints in China.3 We studied the process of regulation for handling patients’ complaints and noted some important systemic constraints.

First, conflicts can arise from the discrepancies between the legal system for handling complaints and the processes used and solutions determined by the hospitals. The absence of unified laws or guidelines results in inconsistency and uncertainty about how to apply diff erent regulations.

Second, hospitals have the main responsibility for hand ling com-plaints, including comp ensation for medical injuries. Hospitals prefer to compensate patients to minimise problems and to keep their reputation; but this strategy can also induce some patients to complain even more.

Third, patient complaints are generally not linked to improved quality of care. Most complaints are solved on a case-by-case basis, without sufficient concern for the improvement of health services overall.

Finally, in some cases, incon-venience or unexpected medical injuries experienced by patients are due to the organisation of the health and social welfare systems rather than caused by doctors or hospitals. To a certain extent, doctors and hospitals have become easy scapegoats for broader problems in the stewardship of the health and social welfare systems in China.We declare no competing interests.

People’s Procuratorate, the Ministry of Public Security, the Ministry of Justice, and the National Health and Family Planning Commission jointly issued guidelines that aim to bring strong punishments for violence involving medical staff.3 With the new guidelines, violence such as intentionally hurting or killing medical staff, or damaging public or private property in medical institutions will be punished. Any behaviours that can disrupt medical practice, such as insulting or threatening medical staff or illegally carrying weapons in a medical institution, will result in punishment. And extremely serious crimes shall be subject to the death penalty.3

We believe that this latest guideline can help restrain violence against doctors. However, punishment is not an end in itself. We need not only to strengthen punishment by law but also to solve the problem, taking measures to prevent and reduce medical malpractice.

On the one hand, the government should optimise the allocation of medical resources, improve current social insurance systems, continue to rein back drug prices, protect patients’ rights, improve medical technology and the quality of service, and take eff ective measures to guide patients to use adequate channels for complaint. On the other hand, medical knowledge should be made available to the community to improve people’s understanding of the risks of medical practice. Chinese media should assume their social responsibility.

With eff ective measures and prompt actions, we believe that we will be able to rebuild confi dence between doctors and patients.We declare no competing interests.

Lin Zhao, Xin-Yu Zhang, Gao-Yuan Bai, *Yao-Gang Wangwyg@tmu.edu.cn

School of Public Health, Tianjin Medical University, 300070 Tianjin, China

1 The Lancet. Ending violence against doctors in China. Lancet 2012; 379: 1764.

2 The Lancet. Which future for doctors in China? Lancet 2013; 382: 936.

3 Xinhuanet. China to punish crimes in doctor-patient fl are-ups. http://news.xinhuanet.com/english/china/2014-04/24/c_133287654.htm (accessed April 25, 2014).