Chapter 1: The Dignity of the Healer From the cradle to the grave, no one can live without a doctor. When a person is born, the first person he or she sees is a doctor; before he or she dies, the last person he or she sees is also a doctor. Theoretically speaking, the doctor-patient relationship is one of the most intimate relationships in the world. Doctors and patients are close to each other, and it is difficult to part with them, so they are friends in life and death, and friends in distress. However, in China during the transition period, the doctor-patient relationship has lost its former purity and warmth and has become increasingly tense and indifferent. Although the world is warming up, but the doctor-patient relationship is in the “ice age”. A “high wall” of trust crisis is straddling between doctors and patients. Patients love and hate doctors, and doctors are wary of patients. Conflicts between doctors and patients are escalating, blood splattering white incidents occur repeatedly, the survival environment of Chinese doctors is deteriorating day by day. In the past, doctors used to describe their caution about their conditions as “being on the brink of an abyss, walking on thin ice”, but now they are worried about their safety. If two words are used to describe the current mentality of doctors and patients, one is “apprehensive” and the other is “torn”. The conflict between doctors and patients has become a lose-lose confrontation, a war without a winner. There is a phenomenon that seems unexplainable: in times of national crisis such as earthquake relief, doctors as a group brave the hardships, saving lives and helping the injured, worthy of the title of “white angel”. However, once back to normal times, many doctors have become “white-clothed businessmen”. In fact, this is the complexity and multi-faceted nature of human beings. Generally speaking, the harsher the environment, the easier it is to reveal the light of human nature; the milder the environment, the easier it is to grow the ugliness of human nature. For example, many people can resist the gunfire in times of war, but can not resist the sugar-coated shells in times of peace. In the same way, in the market economy, doctors, like ordinary people, are facing the pressure of high prices, high housing prices and high tuition fees, so many of them wander and struggle at the crossroads of reality and ideals, and eventually turn their backs on professional ethics for the sake of family livelihood. So, what is the root cause of doctor-patient conflict? We can certainly attribute it to the crisis of faith and moral decline, but this is a common phenomenon in society, not only between doctors and patients. In addition to moral factors, there seem to be deeper economic and social factors. Mark said, “Everything that people fight for has to do with their interests.” Adam Smith, the father of Western economics, also noted that “everything that people fight for is related to their interests. Smith also pointed out, “We are able to obtain our dinner, not from the benevolence of the butcher, the brewer and the baker, but from their concern for their own interests.” It can be seen that the relationship of interest is the most essential relationship in social relations, and the root of all social contradictions and social conflicts exists in people’s interest relationship. Under the current medical system in China, doctors and patients are a pair of contradictory bodies, with the common purpose of curing diseases, restoring health and saving lives, and the opposition of economic interests. Under the premise of ensuring the effectiveness of treatment, patients want to maximize the cost savings, while doctors want to maximize the economic benefits. If we turned back the clock 30 years, doctors would still be one of the “most glorious professions under the sun”. At that time, patients were so devout to doctors that they would repay each other with a drop of water, and disputes between doctors and patients rarely occurred. However, as public hospitals were pushed into the market, the strong feelings between doctors and patients became increasingly diluted. The government, with insufficient investment, encouraged hospitals to rely on self-generated income to maintain survival and development. Since then, the train of public hospitals has quietly left the track of public welfare, doctors from the “saint” to “businessmen”, large prescriptions, indiscriminate testing and other phenomena then proliferated, the bridge of mutual trust between doctors and patients began to break and disintegrate. Medical consumption is different from other consumption in that patients are passive consumers. For example, in restaurants, consumers can order food according to their own economic conditions, noodles for those who can’t afford it, shark fins for those who can afford it, and the abundance and frugality is up to them. However, in hospitals, patients cannot bargain, and they have to spend as much as the doctor tells them to. As a result, many patients want to order an affordable bowl of beef noodles, but the doctor has to recommend the expensive shark’s fin rice. The patient’s heart is unhappy and forced to endure, the gas is not smooth and strong swallow. Therefore, once a medical dispute occurs, it is easy to trigger the heart of the old grievances and social conflicts, and even into a mass incident. It is clear that the root cause of the disintegration of trust between doctors and patients lies in the deformed medical system. In the western developed countries, doctors mainly rely on technology, so they can follow the principle of “reasonable diagnosis, reasonable treatment”. However, the value of doctors’ labor in China is seriously undervalued, and they do not make money by prescribing and performing surgery. Due to the high level of out-of-pocket expenses for medical treatment, doctors over-treatment is equivalent to directly depriving patients of their wealth, thus leading to serious economic confrontation between doctors and patients, which is the root cause of doctor-patient conflict. From the perspective of health economics, doctors are both “moral people” and “economic people”. In the past, we often emphasized only the moral side and neglected the economic side. In fact, the composition of any group is “olive-shaped”. Doctors are no exception, the moral level is very high and very low are a minority, the majority of people in the middle level. We do not need to call them either “angels” or “devils”. The point is that if there is a system that encourages goodness, most people will tend to be good, and vice versa. Generally speaking, there are four types of people in society: the first is the gentleman who benefits himself; the second is the villain who harms himself; the third is the saint who sacrifices himself to benefit others; and the fourth is the fool who harms himself. The first two categories are the majority, and the last two categories are the minority. A society can promote the spirit of saints, but it cannot put its hope on saints, because saints are rare after all. The best way is to use the system to reward the gentleman and punish the villain, so that more villains can become gentlemen. In fact, any kind of system is, in the end, a system of income distribution. That is, the way in which members of society receive income and wealth. Because income and wealth are always goals that people pursue, the income distribution system is essentially an incentive system as well. Economists like to use win-lose argument. In fact, the relationship between doctors and patients is also a game. All games, there must be several forms: one is you lose and I win “zero-sum game”, the second is a double loss “negative and game”, the third is a win-win “positive and game”. At present, the doctor-patient relationship in China is basically antagonistic, belonging to the “zero-sum game” or “negative-sum game”. In an unreasonable medical system, doctors get more revenue by increasing patients’ medical expenses, which is a “zero-sum game” or “negative-sum game”; while in a reasonable medical system, the interests of doctors and patients are the same, and the lower the cost of patients’ treatment, the more medical expenses of society. The lower the cost of treatment for patients, the less the medical expenditure of society, the more the doctor gets rewarded, which is a “positive sum game”. It is clear that in order to eliminate the crisis of trust between doctors and patients at the root, we must reform the medical system that feeds doctors with drugs and medical equipment, so that doctors can eat with technology instead of selling drugs. At the same time, the establishment of an incentive-compatible system, that is, doctors in the pursuit of maximum personal interests at the same time, it also happens to maximize the social value, so that the medical cunning parties become a community of interest. Of course, doctors are both “economic people” and “social people”. A doctor has to pursue the realization of self-worth in addition to food and clothing, and they are eager to have a sense of dignity and achievement, and to obtain positive social evaluation. Therefore, creating a good practice environment is also an important factor to encourage doctors to be good. Between doctors and patients, harmony is beneficial, while injury is harmful. The conflict between doctors and patients is both a moral and institutional issue. The acquaintance society can rely on moral restraint, the stranger society is to rely on institutional restraint. Morality is a flexible constraint, the system is a rigid constraint; morality requires long-term construction, the system can be short-term results. Therefore, to solve the conflict between doctors and patients, the fundamental way out is to eradicate the ills of the medical system, with “reform” to pry “change the heart”.