Rebuild a Trust Relationship Between Doctors and Patients--Informal Exchange in Chinese Health Sector

Trust lies at the heart of effective patient-doctor relationship. Chinese health sector is facing a trust crisis between patients and doctors as shown in the rising numbers of conflicts and dissensions. In seeking an accountable health care, patients widely employ informal exchange by giving gifts and red-packets to doctors, seeking connections and acquaintance relationship (guanxi) to get health care. The gift exchange and guanxi network involve the cultivation of emotion (renqing, ganqing, the emotional feelings of indebtedness and obligation), through which a trustworthy relationship is emergent and negotiated. However, in the changing moral context of China today, trust is very fragile amidst the inherent uncertainties of medical care. The individual efforts of gift-exchange and guanxi networking sometimes could not secure a trustworthy relationship, and patients frequently become the targets of defrauding, extortion and abuse of power. The paper, setting the context in the post-socialist China, shows how people try to counter the rising uncertainty in daily life and to secure a trustworthy doctor-patient relationship. It is about how trust is practiced, dismantled, and rebuilt in daily medical encounter. The paper recognizes the limits of individual informal exchange in building trust, and suggests more works to be done in building a trustworthy health system and improving the trust in society as a whole amid the wide mistrust.