Workplace violence and its aftermath in China’s health sector: implications from a cross-sectional survey across three tiers of the health system

Yang, Sheng; Wu, Dan; Wang, Nan; Hesketh, Thérèse; Sun, Kai Sing; Lu, Li; Zhou, Xudong

doi:10.1136/bmjopen-2019-031513

“…The risk aversion of doctors and a practice of defensive obstetrics has been documented in other studies [52]. The growing risk of violence for physicians at the hands of patients and their relatives is a growing phenomenon worldwide [53,54] and has been well documented in China [55,56]. The study agrees with many women and communities, health professional and health organization related factors identi ed by Betran et.al (2018) in their contribution to the Lancet series on CS [8].…”

Section: Discussionsupporting

confidence: 85%

Physician-patient communication in decision-making about Caesarean sections in eight district hospitals in Bangladesh: A mixed-method study

Doraiswamy

¹

,

Billah

²

,

Karim

³

et al. 2020

Preprint

0

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Background: Caesarean sections (CS) in Bangladesh have risen eight-fold in the last 15 years. Few studies have explored why. Anecdotally, physicians suggest maternal request for CS is a reason. Women and families suggest physicians influence their decision-making. The aim of this research was to understand more about the decision-making process surrounding CS by exploring physician-patient communication leading to informed-consent for the operation. Methods: We conducted a mixed-method study using structured observations with the Option Grid Collaborative’s OPTION5 tool and interviews with physicians and women between July and December 2018. Study participants were recruited from eight district public-sector hospitals. Eligibility criteria for facilities was ≥80 births every month; and for physicians, was that they had performed CSs. Women aged ≥18 years, providing consent, and delivering at a facility were included in the observation component; primigravid women delivering by CS were selected for the in-depth interviews. Quantitative data from observations were analysed using descriptive statistics. Following transcription and translation, a preliminary coding framework was devised for the qualitative data analysis. We combined both inductive and deductive approaches in our thematic analysis. Results: In total, 306 labour situations were observed, and interviews were conducted with 16 physicians and 32 women who delivered by CS (16 emergency CS; 16 elective CS). In 92.5% of observations of physician-patient communication in the context of labour situations, the OPTION5 mean scores were low (5-25 out of 100) for presenting options, patient partnership, describing pros/cons, eliciting patient preferences and integrating patient preferences. Interviews found that non-clinical factors prime both physicians and patients in favour of CS prior to the clinical encounter in which the decision to perform a CS is documented. These interactions were both minimal in content and limited in purpose, with consent being an artefact of a process involving little communication.Conclusions: Insufficient communication between physicians and patients is one of many factors driving increasing rates of caesarean section in Bangladesh. While this single clinical encounter provides an opportunity for practice improvement, interventions are unlikley to impact rates of CS without simultaneoulsy addressing physician, patient and health system contextual factors too.

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“…The risk aversion of doctors and a practice of defensive obstetrics has been documented in other studies [32]. The growing risk of violence for physicians at the hands of patients and their relatives is a growing phenomenon worldwide [33,34] and has been well documented in China [35,36]. The study agrees with many women and communities, health professional and health organization related factors identi ed by Betran et.al (2018) in their contribution to the Lancet series on CS [8].…”

supporting

confidence: 85%

Physician-Patient Communication in Decision-Making about Caesarean Sections in Eight District Hospitals in Bangladesh: A Mixed-Method Study

Doraiswamy

¹

,

Billah

²

,

Karim

³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Caesarean sections (CS) in Bangladesh have risen eight-fold in the last 15 years. Few studies have explored why. Anecdotally, physicians suggest maternal request for CS is a reason. Women and families suggest physicians influence their decision-making. The aim of this research was to understand more about the decision-making process surrounding CS by exploring physician-patient communication leading to informed-consent for the operation. Methods: We conducted a mixed-method study using structured observations with the Option Grid Collaborative’s OPTION5 tool and interviews with physicians and women between July and December 2018. Study participants were recruited from eight district public-sector hospitals. Eligibility criteria for facilities was ≥80 births every month; and for physicians, was that they had performed CSs. Women aged ≥18 years, providing consent, and delivering at a facility were included in the observation component; primigravid women delivering by CS were selected for the in-depth interviews. Quantitative data from observations were analysed using descriptive statistics. Following transcription and translation, a preliminary coding framework was devised for the qualitative data analysis. We combined both inductive and deductive approaches in our thematic analysis. Results: In total, 306 labour situations were observed, and interviews were conducted with 16 physicians and 32 women who delivered by CS (16 emergency CS; 16 elective CS). In 92.5% of observations of physician-patient communication in the context of labour situations, the OPTION5 mean scores were low (5-25 out of 100) for presenting options, patient partnership, describing pros/cons, eliciting patient preferences and integrating patient preferences. Interviews found that non-clinical factors prime both physicians and patients in favour of CS prior to the clinical encounter in which the decision to perform a CS is documented. These interactions were both minimal in content and limited in purpose, with consent being an artefact of a process involving little communication.Conclusions: Insufficient communication between physicians and patients is one of many factors driving increasing rates of caesarean section in Bangladesh. While this single clinical encounter provides an opportunity for practice improvement, interventions are unlikley to impact rates of CS without simultaneoulsy addressing physician, patient and health system contextual factors too.

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“…This difference may be due to a number of potential factors including differences in the level of supervision or training between the two systems and differences the definition of errors or willingness to admit errors. Violence by patient or patients' relatives against providers has recently been much discussed 10 , and fear of such violence was a significant predictor in the final model of depression during residency in China.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Predictors of Depression among Training Physicians in China: A Comparison to the United States

Zhuo

¹

,

Wang

²

,

Zhou³

et al. 2020

Preprint

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Resident physician training is associated with a substantial increase in depression in the United States, with rates increasing from about 4% before internship to 35% at least once during the first year of residency. Here, we sought to assess whether the rate of depression among residents in China are similar to their US counterparts and identify the common and differential predictors of depression in the two training systems. We assessed 1006 residents across three cohorts (2016-2019) at 16 affiliated hospitals of Shanghai Jiao Tong University and Peking Union Medical College. In parallel, we assessed three cohorts of 7028 residents at 100+ US institutions. At the Chinese institutions, similarly, the proportion of participants who met depression criteria increased from 9% prior to residency to 35% at least once during the first year of residency (P<0.0001), an increase similar in magnitude to residents during internship in US institutions. Among factors assessed before residency, prior history of depression and depressive symptom score at baseline were common factors associated with depression during residency in both China and the US. In contrast, neuroticism and early family environment were strongly associated with depression risk in the US but not in China. Young age was a predictor of depression in China but not in the US sample. Among residency training factors, long duty hours and reduced sleep duration emerged as predictors of depression in both China and the US. To gain insight into whether differences in personal predictors between the residents in China compared to the US residents were driven more by differences between cohorts, or by training system differences, we compared US residents of East Asian descent to other US and Chinese residents. We found that for most predictors (age, Neuroticism, early family environment), US residents of East Asian descent were more similar to other US residents than to the residents training in China. Overall, the magnitude of depression increase and work-related drivers of depression were similar between China and the US, suggesting a need for system reforms, and that the types of effective reforms may be similar across the two systems.

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Workplace violence and its aftermath in China’s health sector: implications from a cross-sectional survey across three tiers of the health system

Cited by 41 publications

References 42 publications

Physician-patient communication in decision-making about Caesarean sections in eight district hospitals in Bangladesh: A mixed-method study

Physician-patient communication in decision-making about Caesarean sections in eight district hospitals in Bangladesh: A mixed-method study

Physician-Patient Communication in Decision-Making about Caesarean Sections in Eight District Hospitals in Bangladesh: A Mixed-Method Study

Prevalence and Predictors of Depression among Training Physicians in China: A Comparison to the United States

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