Doctor-Patient Relationships in China and the Mediating Role of Medical Social Work

Since its establishment in 1950s, China’s healthcare system has undergone three stages of reforms, resulting in the changes of doctor-patient relationships. Issues of ‘difficult access to healthcare’ and ‘high medical costs’ have become central concerns. Growing medical disputes threaten the quality of medical services and social stability. In response, the Chinese government in the early 21st century re-established medical social work (MSW) to help restore harmonious doctor-patient relationships. In this context, this research proposed four main questions: (1) How are doctor-patient relationships shaped in China? (2) How has the current healthcare system shifted responsibilities between doctors and patients? (3) How do medical social workers intervene in doctor-patient relationships? (4) What challenges do medical social workers face in fulfilling their roles?
This research employed institutional theory to analyse the formation and evolution of doctor-patient relationships in current healthcare system. Combining institutional theory with professional legitimacy theory, the research examined how medical social workers (MSWs) establish professional legitimacy within the current healthcare system, as well as the challenges they encountered. Semi-structured interviews with 57 participants were conducted; thematic analysis revealed four main findings.
First, four models of doctor-patient relationships were revealed: the doctor-dominant model, collaborative model, service-oriented model, and adaptive model. Second, a phenomenon of ‘privatised responsibility’ has been analysed, where institutional responsibilities were shifted onto individual doctors and patients. Third, MSW has established its legitimacy by intervening in the practical issues within doctors and patients. Fourth, as a newly established profession MSWs faced obstacles in building clear scope of professional responsibilities.
This research enriched our understanding of doctor-patient relationships and MSW in China. It provided a framework of using institutional norms for future research to analyse doctor-patient dynamics and the establishment of professional legitimacy for MSW’s roles in various institutional and cultural settings.