Doctor-patient relationship is the core of medical interpersonal relationship and crucial to health-care delivery. It is regarded as the interaction between a care provider and a care user[1]. Medical disputes generally refer to dissent between patients or their families and medical care providers on medical results and reasons causing such results[2]. The doctor-patient relationship is generally harmonious in developed countries such as Britain and the United States as these countries own relatively comprehensive legal system and medical insurance system. However, there are still a high proportion of conflicts in medical institutions. Health professionals in the UK, especially general practitioners (GPs), are consistently at risk of work place violence, with around 10–11% of GPs reportedly experiencing assault, 5% threats with a weapon, and 25–59% verbal abuse. In addition, 63.7% of sampled Australian GPs had experienced some violence at work[3]. In 2005, a survey by Michigan Medicine on workplace violence targeted on emergency physicians revealed that 74.9% of physicians suffered verbal threats at least once a year, and 28.1% of physicians suffered physical violence within a year[4]; In developing countries and countries undergoing social transformation, survey on health department staff showed that more than half of the medical staff had experienced physical or psychological violence for at least one time[5]. Such facts indicate that conflict between doctor and patient has become a global issue[6].
In China, the number of medical disputes surges since the beginning of the 21st century due to the mismatch of supply and demand in health services and patients’ rising awareness of rights as well as imperfect legal system[7]. Since the implementation of Medical Malpractice Management Regulation in September 2002, medical disputes have increased by an annual rate of 22.9%[8], and even as high as 40% in some regions[9]. There have been many vicious killings targeted on doctors[10]. According to data released by National Health Commission of China, the number of outpatients in medical institutions nationwide was 73 million in 2015, of which about 70,000 people ended in medical disputes. In 2017, there were 12,734 cases of medical dispute, which decreased slightly to 12,249 in 2018 and bounced back to 18,112 in 2019[11]. In recent years, medical disputes caused by medical negligence are rising year by year. More remarkably, the cause is shifting from medical negligence to non-medical negligence. It becomes more difficult to predict and handle the disputes and the amount of compensation is getting higher and higher, resulting in a general mistrust crisis between doctors and patients[12]. The disharmony between doctors and patients should not merely be a simple medical issue but a social focus that needs keen concern[13].
Medical disputes must be greatly emphasized on as they damage medical practice environment and are not conducive to protecting patients' life and health and are discordant with the construction of harmonious society. Studying the influence factors of medical disputes to prevent and control disputes will help hospitals maintain stable operation, reduce expenditure, improve work efficiency and economic benefits, and alleviate medical personnel’s fear and anxiety on medical disputes to arouse their enthusiasm and creativity. Therefore, we must strengthen research on medical disputes in order to discover the potential or existing risks in medical services in time, provide basis for pre-control of medical risks, ensure sound operation of hospitals, maintain common interests between doctors and patients and improve the quality of medical services. Deepening the research on doctor-patient relationship can prevent conflicts and reduce possible negative consequences in the short term, and strengthen humanistic care and create a harmonious environment in the long term.
As an international financial center, Shanghai is one of the cities with the richest medical resources in China, with its number of medical disputes increasing at an annual rate of 11%[14]. Domestic scholars mainly study doctor-patient relationship in four aspects, namely doctor-patient relationship research from the perspective of different disciplines, research on the nature of doctor-patient relationship, investigation of doctor-patient relationship, research on influence factors of doctor-patient relationship, and research on countermeasures for building harmonious doctor-patient relationship. Foreign scholars, on the other hand, concentrate on discussing the modes of doctor-patient relationship[15]. Innovation of this paper is that taking hospital management as the cut-in point and based on the perspectives of doctors, patients and diseases, 561 cases of medical disputes occurred in Shanghai in recent three years were extracted by multistage sampling. High-risk factors of disputes were analyzed and the correlation test on influence factors that would further escalate medical disputes was undertaken. It will provide a basis for hospitals in Shanghai to prevent medical disputes and lay a foundation for further establishment of early intervention indicators for medical disputes.