“After NATURE is LANCET, Chinese medical disgrace to the world” – someone’s signature. To use a popular phrase, LANCET is really powerful. In the context of the increasingly harsh domestic medical environment, it is said that this year’s college entrance exams medical colleges and universities recruiting underfill, Zhongshan Medical reduced the score, none of which is a warning to medical personnel in all aspects of the situation, the environment, work, life, income …… gradually entered a vicious circle. But no matter how the government, the media, the uninformed masses face, this issue has really gotten a lot of attention. I think, when things have gone so far, not in the silence of the outbreak, or in the silence of death. I believe that through everyone’s efforts, the medical environment can become better and better, and reach a new situation of harmony and win-win between doctors and patients. Chinese doctors under the dangerous wall! Institutional change was the theme of the World Cancer Congress held in Shenzhen from August 18 to 21, and was the central message conveyed by Chinese Health Minister Chen Zhu in describing the current Chinese healthcare reform. Leading the discussion on the architecture and actions for system change at the Congress were many international health policy-making experts and physicians outside of China, with little involvement from domestic Chinese physicians. To understand why so many Chinese physicians who are burdened with front-line clinical work are rarely represented at institutional reform conferences, you must first understand that for most Chinese physicians, personal safety is their primary concern. Chinese doctors are often subject to vicious and violent attacks. In June, a doctor and nurse in Shandong province were stabbed and seriously injured by the son of a patient who died of liver cancer 13 years ago, while in Fujian province a pediatrician was injured when he jumped from the fifth floor to escape the angry family of a newborn who had died after being admitted to his care. It would not be surprising then why 27 hospitals in Shenyang invited police station leaders to serve as vice presidents in July. Once hospitals become violent battlegrounds, being a doctor in China becomes a dangerous job. Much of the problem stems from the perception that many Chinese patients believe that doctors and hospitals are always conspiring to make money by charging more for unnecessary tests and treatments. Many patients blame doctors for the corruption in the health system, condemning them for their lack of medical ethics and skills. How is it that the image of Chinese doctors is in such decline when the ancient Chinese intellectual ideal was “to be a good doctor if you are not a good doctor” and in contemporary China doctors and nurses used to be known as “white angels”? The Chinese media has certainly played an important role in stirring up the urgent doctor-patient relationship. In newspapers, on television and on the Internet, there are overwhelming reports about how medical professionals cheat patients. Just a few weeks ago the Southern Metropolis Daily (Guangdong’s most popular newspaper) wrongly condemned a midwife who treated a woman who developed hemorrhoids after giving birth, saying she deliberately stitched the patient’s anus shut. And in November 2009 China’s largest official media outlet, CCAV, reported that the prestigious Peking University First Hospital had allowed medical students to participate in the illegal practice of medicine, resulting in the death of a patient. Although the hospital and the Ministry of Health affirmed that it was legal for the medical students in question to participate in clinical operations, including surgery, under the supervision of a qualified practitioner, the public’s trust in the hospital and the doctors was greatly damaged. It is difficult to determine whether the inaccurate reporting by Southern Metropolis Daily and CCAV was due to a lack of medical knowledge or an attempt to create a sensationalist story. But the public’s misunderstanding of the medical profession will certainly end up hurting both doctors and patients. Most Chinese hospitals, especially large-scale hospitals such as Peking Union Medical College Hospital and Fudan Hua Shan Hospital, are government-run, and while public hospitals in China enjoyed full government funding until 1985, government financial support for hospitals is now very limited after the reform and opening up, resulting in hospitals having to generate revenue to meet expenses. Since hospital revenues are primarily derived from treatment measures, there is a profit motive for excessive testing and treatment. In order to reduce undue conflicts of interest, the Chinese government has passed a decree to prevent hospitals from receiving kickbacks from pharmaceutical companies. Because the official salaries of Chinese doctors are modest even by Chinese income standards, many doctors in economically prosperous China have to struggle with the dilemma of balancing medical ethics with their families’ livelihoods. This pressure, combined with the feeling that their labor is undervalued by the government and society, has caused many doctors to leave the profession. China’s health reform will not succeed without improving the socio-economic status of doctors, and Chinese doctors should call for attention to their situation and contribute ideas to improve medical policy.