In China, violence against doctors and other healthcare professionals has become a worrisome trend. Much as Americans have gotten depressingly used to the expression “school shooting,” Chinese citizens are now familiar with “hospital stabbings.” While still quite rare events relative to China’s enormous population, these incidents are both troubling in themselves and indicative of larger problems, including distrust and anger toward medical professionals and the healthcare establishment.

Could this distrust and anger have something to do with the rhetoric that has accompanied some of China’s high-profile anticorruption campaigns? It is hard, perhaps impossible, to prove a direct link, but consider the following suggestive evidence:

• In early 2006, corruption in the healthcare sector received a great deal of Chinese media coverage thanks to two events: First, an exposé of a pediatrician accepting kickbacks at a major hospital in northern China went viral online. Second, shortly afterwards, the minister of the Chinese National Medical Products Administration was sentenced to death for another incident of grand corruption leading to the mass distribution of counterfeit medicine, marking the first death sentence for a Chinese official at the ministerial level. The way the state-sponsored Chinese media covered these events suggested that corruption among doctors was widespread. Stories on the topic (which it’s safe to assume the Chinese government approved) had sensationalized headlines like Hospital Dean Took the Lead in Corruption and 70% of Doctors Received Kickbacks and The Three Traps of Crooked Gynecologists to Rob Patients. The year 2006 also saw a surge in violence against healthcare providers, with over 200 cases of assault, including 21 documented incidents of significant physical violence against medical professionals. By comparison, in 2005 there was only one well-known incident of physical violence against a doctor.
• In 2013, the British pharmaceutical company GlaxoSmithKline (GSK) was reported to be bribing Chinese government officials overseeing pharmaceutical sales and medical professionals, and in 2014 Chinese courts fined GSK $489 million for bribery. The GSK scandal prompted widespread reporting on corruption in the medical field in the mainstream Chinese media. As in 2006, a great deal of the coverage was quite sensational, with headlines like All 73 Hospitals in a City are Corrupt, How Does Corruption Markup Drug Prices, We Are Speechless that 90% of Doctors are Corrupt in a City. And 2014 was again a notably bad year for physical assaults on healthcare providers. While reliable numbers for the year are hard to find, it appears that in a period of barely over a month (from February 7 to March 23, 2014) hospitals across China saw an unprecedented 17 incidents of physical assaults on medical professionals. 

Is this a coincidence? Possibly. But perhaps this suggestive evidence is a sign that anticorruption campaigners and media platforms—not only in China, but everywhere—should reflect on the narratives they use to frame corruption problems. This is not to say that we shouldn’t raise awareness of corruption scandals, or that we shouldn’t use vivid incidents to capture people’s attention and mobilize them. But as an earlier post on this blog cautioned, we need to be careful about exaggerated and inaccurate “everyone-is-corrupt” rhetoric; violent episodes against physicians in China may be a particularly alarming consequence of such rhetoric.

While it is not possible to prove a direct causal link between media rhetoric about pervasive healthcare corruption and actual violence against doctors, such a connection is plausible in light of how such rhetoric could affect how people interpret the underlying reasons for their bad experiences with the healthcare system. When patients are dissatisfied with the treatment they receive and the cost of their medical care, it’s natural for them to want to assign blame. Without minimizing the adverse effects of corruption on the Chinese health system, media and public rhetoric suggesting that corruption is widespread among individual doctors primes patients to blame their bad experiences on their doctor, who they may see as a greedy, dishonest traitor in part because the media coverage of medical corruption has spread the message that many ordinary doctors are corrupt.

Are there ways to call attention to the genuine and important problems of corruption in the Chinese healthcare system without sending the message that patients cannot trust their lying, cheating, stealing doctors? China’s most recent crackdown on corruption in the health sector suggests that there is. The most recent campaign, launched last year, does not seem to have been accompanied by an increase in physical assaults on medical professionals across China. What is different this time? Notably, all 155 healthcare professionals who have been implicated in the current crackdown are hospital administrators; none is a patient-facing doctor. And in discussing these cases, mainstream Chinese media (which, again, we can assume is giving the official government line) consistently describes the malefactors being targeted as a “key minority” of the healthcare sector (see also here, here, and here). The government has made abundantly clear that healthcare providers who see patients daily are not targeted in this campaign, and they are not the principal culprits for the corruption in the Chinese medical system. It is at least plausible that this change in rhetoric and framing helped avoid the surge in violent incidents against doctors that accompanied the last couple of Chinese crackdowns on health sector corruption. Corruption is such an emotionally charged word, especially in an industry that people rely on during the most vulnerable moments of their lives. The crafting of narratives in anticorruption campaigns is often overlooked, but the Chinese trajectory in clamping down on healthcare corruption in the past two decades suggests that rhetorical choices can have quite significant consequences.