NOWHERE on earth is the relationship between doctors and patients more murderously strained than in China.

A spate of deadly attacks on doctors by vengeful patients and their families has exacerbated tensions and prompted authorities to crack down on violence at hospitals.

The ministries of public security and health recently publicized a joint circular that makes seven acts of disturbance at hospitals liable to legal punishment.

These acts include, for instance, turning hospitals into mourning halls for dead patients, burning paper money supposed to be used by the dead in their afterlife and worst of all, putting on display the bodies of the deceased who their relatives believe have died as a result of erroneous prognosis, negligence and medical malpractice.

Oftentimes a patient's body is used as a bargaining chip to wring more cash compensation from hospitals, which are desperate to avoid the damage such stunts will do to their reputation and business.

The stakes are higher when yi nao, professional troublemakers, are paid to play the roles of angry relatives, thus intensifying doctor-patient strife for pecuniary gains.

Flawed litigation

CCTV reported early last week that the Ministry of Health reported 17,243 cases of major disturbance at the nation's hospitals in 2010, up 7,000 from five years before.

In many of these cases, triad-like gangs were involved in upping the ante, the state broadcaster said.

The Xinmin Evening News noted on Thursday that these extortionist machinations are driven in big part by the belief that "big rows bring big money, small rows less, no rows no compensation at all."

One of the main reasons patients have turned to yi nao rather than the law to seek redress in medical disputes is that they are deeply skeptical of the litigation process, which is extremely slow.

Some victims of possible medical error finally take revenge on doctors as they see no hope in righting the wrongs through the law. Scuffles are common.

The Southern Weekend newspaper opined in October that prolonged and ineffectual medical litigation often makes matters worse. It referred to the case of a cancer patient who, convinced that the doctor's botched surgery on his throat had made him mute, fatally stabbed her with a knife in Beijing Tongren Hospital on September 15. The man had sued the doctor and hospital for compensation but the case dragged on for four years without a ruling. Out of desperation, he raised the knife.

Such loopholes in our legal aid system, unless plugged, will inevitably be exploited by yi nao.

Chinese hospitals have over the years become troubled, even hateful, places where violence against doctors is sometimes applauded.

A young intern doctor was killed and three others seriously injured by a patient in the worst attack on medical workers in years on March 23 in a hospital in Harbin, capital of Heilongjiang Province. The assailant was said to be motivated by what he called the doctor's indifference to his spinal disease.

The online reaction to the tragedy has sent a chill down the spines of the authorities. A majority of Internet users who commented on the incident were supportive of inflicting violence on "greedy" doctors.

The popular venom is a grisly indicator of the magnitude of doctor-patient tensions.

The market reform of hospitals is mainly to blame for public distrust of doctors, many of whom regularly prescribe overpriced and unnecessary medicine for kickbacks, and order expensive unnecessary tests. Their salaries are linked to hospital profits.

But what the public often does not know is that doctors also over-prescribe antibiotics or tests to shield themselves from potential liability claims.

Creeping cynicism makes doctors wary of risks in treating patients. That attitude, however, arouses the suspicion that they are shirking responsibilities.

Even if doctors need to make amends for their mistakes, this doesn't justify lynching or humiliating them, as some patients and their relatives occasionally have done.

On March 16, a dozen doctors from a hospital in Hengshan County, Shaanxi Province, prostrated themselves and grieved at a mourning service held in honor of an old man they had treated for food poisoning. He had died a week ago of stomach perforation caused by staff malpractice.

Angry relatives made the doctors repeatedly kowtow to pay condolences. As if the public humiliation were not enough, they ordered the hospital closed until it cleaned up its acts, despite the fact that they had no right to do so. The hospital's chief said he complied because the family is well-connected.

Call to reason

The hospital reopened after local authorities intervened and mediated the row. Under the new joint circular released by the ministries, the family could have been punished for intimidation.

Tu Jianshe, deputy head of the Office of Mediation of Medical Disputes in Pudong New Area, was quoted in the Xinmin Evening News as saying that "we cannot conflate ordinary medical rows with those incited by yi nao.

"Medical altercations need to be legally addressed, but blackmail attempts are to be cracked hard down upon," he said.

It's worth asking how the relations between doctors and patients have got so tense, but it's obvious the reasons are too complex to invite easy conclusions on which party is more to blame.

Many Internet users complain that the new circular has weakened the patients' position, but as a matter of fact, it represents a timely call to reason.

And it's in the best interest of patients and their families to take their cases to court - even though litigation is currently flawed - instead of going on a knife rampage. Distrust works both ways. Medicine used to be a noble calling. But as the occupational risks are getting higher, young people are discouraged from practicing medicine.

When there aren't enough doctors around, it will be too late for society to repent its virulence.