During China’s COVID-19 outbreak, respect for the country’s medical professionals reached new heights. Both the government and media went out of their ways to depict doctors and nurses as the heroes of the crisis. “(They) have no regard for compensation or death, nor do they cower in the presence of danger or fear,” rhapsodized the People’s Daily at the epidemic’s peak in February. “Salute to the warriors in white!” Meanwhile, the paper’s coverage of doctor-patient disputes — a media standby in China — has almost halved in the last year, relative to the previous five years.

The attitude shift is welcome news to the country’s doctors. Prior to this year, the frequency of patient-on-physician attacks in China had risen steadily for two decades: One 2012 survey found that two-thirds of hospitals had reported physician assaults that year. Roughly 60% of physicians said they had experienced verbal abuse, and 13% said they had experienced physical attacks. Critically, these incidences occurred across the spectrum of clinical departments and hospitals, small and large, and at the provincial, municipal, and district levels.

Public health crises highlight the importance and devotion of doctors, but once they’re over, things have a way of returning to normal. If doctors truly want to reestablish their social prestige, they must first understand how and why the medical profession experienced such a dramatic fall from grace in the first place.

The decline of the medical profession’s reputation in China can be traced to the mid-1980s, when the marketization and privatization of public health care resources shifted professional norms away from serving the people and toward making a profit. As state funding dried up, public hospitals began establishing performance-based compensation systems that incentivized doctors to generate more revenue for their employers.

Interestingly, the ensuing epidemic of medical over-prescription largely flew under the radar. Instead, for a decade, Chinese media continued to portray the medical profession positively, and reports of doctor-patient disputes remained sporadic. This was partly because patients rarely footed the bill, as most prescriptions were still reimbursable through the public health insurance system.

Beginning in the 1990s, however, an increasing number of municipalities and provinces began setting up new health insurance schemes, which only partially covered these expenses. In other words, overprescribing now had direct financial implications for patients, who soon began expressing their dissatisfaction in evermore aggressive ways. In one well-known incident from last December, an emergency room doctor in Beijing had her throat slit by a man angry that his mother had not been cured quickly enough.

Around the same time, media outlets adopted a more critical tone in their reporting of physicians’ overprescribing and other unethical behaviours. These reports were typically sympathetic to patients, even those who acted violently.

As tensions between doctors and patients escalated, the government attempted to intervene, with mixed results. Officials sought to tamp down professional misconduct through public shaming, and portrayed doctors’ unethical behavior as an almost universal problem. In doing so, they unintentionally added fuel to the fire, giving impetus to already festering public discontent. Patients, in particular, were willing to inflict harsh and violent punishments, as they were the ones with the most at stake.

The COVID-19 pandemic has offered a temporary reprieve, but it may prove short-lived. A similar respite occurred after the 2003 SARS epidemic, which saw medical professionals widely praised by the government and media for their commitment to saving patients’ lives. Once the epidemic was over, however, the media quickly resumed its coverage of unethical physicians and their victims. If anything, SARS drew more attention to the contrast between physicians’ widespread misconduct and their supposed heroism.

Will the same pattern recur after the COVID-19 pandemic recedes? In the early days of this latest outbreak, both the government and media effusively praised medical professionals who volunteered on the “front lines.” These accolades have laid the groundwork for a potential rehabilitation of the profession, but as with SARS, they’re not enough on their own.

In particular, now would be a good time to deal with the root cause of all these problems by increasing public funding for medical care and overhauling hospitals’ incentive systems. A substantial shift is in order before the medical profession can resume what should be its primary purpose: serving the people.

In addition, rather than relying on media outlets and public-shaming campaigns, the government should empower professional associations to operate independently, allowing them to represent and supervise doctors. These organizations can not only protect medical professionals against vilification, but also help uphold ethical norms by punishing violators and promoting proper conduct.

Regulators, too, need to adopt stringent punishments for those who violate professional ethics, while avoiding the sort of shaming campaigns that brought the entire profession into disrepute. Instead of generalizing the problem, regulators should single out individual perpetrators and strip them of their qualifications.

The collapse of faith in China’s medical system is a serious problem, with implications not only for patients, but for the whole of society. Respect for physicians and their profession must be restored.

With contributions from Mia Raynard and Royston Greenwood.

Editors: Cai Yiwen and Kilian O’Donnell; portrait artist: Wang Zhenhao.

(Header image: A doctor talks to a patient’s relative in the emergency room of a hospital in Beijing, Sept. 9, 2020. People Visual)