In China's healthcare sector, a popular and socio-culturally distinctive phenomenon known as guanxi jiuyi, whereby patients draw on their guanxi with physicians when seeking healthcare, is thriving. Integrating anthropological investigation with normative inquiry, this paper examines medical guanxi through the lens of patient–physician trust and mistrust. The first-hand empirical data acquired – on the lived experiences and perspectives of both patients and physicians – is based on six months' fieldwork carried out in a county hospital in Guangdong, southern China, which (...) included in-depth interviews with 20 patients and 20 medical professionals. Patients who emphasized the positive effects of guanxi on patient–physician trust believed that it facilitates access to experienced medical specialists, enhances clinical communication, and reduces the financial and medical risks of over diagnosis and overtreatment by physicians. At the same time, these findings reveal patients' strong sense of mistrust, not only towards individual health professionals but also to the medical profession and China's commercialized healthcare industry. While some health professionals in the study responded favourably to medical guanxi, most were opposed to it on the grounds that it undermines professional standards and equitable healthcare. We found that the practice of medical guanxi is not morally justifiable, chiefly because it reinforces the present high levels of patient–physician mistrust and erodes trust between patients and the medical profession as a whole. In China, both the medical profession and the state need to promote patient–physician trust based on medical professionalism and institutional norms, rather than on guanxi or individual relationships. (shrink)
To investigate the phenomenon of patient–physician mistrust in China, a qualitative study involving 107 physicians, nurses and health officials in Guangdong Province, southern China, was conducted through semi-structured interviews and focus groups. In this paper we report the key findings of the empirical study and argue for the essential role of medical professionalism in rebuilding patient-physician trust. Health professionals are trapped in a vicious circle of mistrust. Mistrust leads to increased levels of fear and self-protection by doctors which exacerbate difficulties (...) in communication; in turn, this increases physician workloads, adding to a strong sense of injustice and victimization. These factors produce poorer healthcare outcomes and increasingly discontented and angry patients, escalate conflicts and disputes, and result in negative media coverage, all these ultimately contributing to even greater levels of mistrust. The vicious circle indicates not only the crisis of patient-physician relationship but the crisis of medicine as a profession and institution. Underlying the circle is the inherent conflict of interest in the healthcare system by which health professionals and hospitals have become profit-driven. This institutional conflict of interest seriously compromises the fundamental principle of medical professionalism—the primacy of patient welfare—as well as the traditional Chinese ideal of “medicine as the art of humanity”. Patient trust can be restored through rectifying this institutional conflict of interest and promoting medical professionalism via a series of recommended practical measures. (shrink)
We study a family of ultraproducts of finite fields with the Frobenius automorphism in this paper. Their theories have the strict order property and TP2. But the coarse pseudofinite dimension of the definable sets is definable and integer-valued. Moreover, we establish a partial connection between coarse dimension and transformal transcendence degree in these difference fields.
ABSTRACTResearch on the development of selective trust has shown that young children do not indiscriminately trust all potential informants. They are likely to seek and endorse information from individuals who have proven competent or benign in the past. However, research on trust among adults raises the possibility that children might also be influenced by the emotions expressed by potential informants. In particular, they might trust individuals expressing more positive emotion. Indeed, young children’s trust in particular informants based on their past (...) behaviour might be undermined by their currently expressed emotions. To examine this possibility, we tested the selective trust of fifty 4- and 5-year-olds in two steps. We first confirmed that children are likely to invest more trust in individuals expressing more positive emotion. We then showed that even if children have already formed an impression of two potential informants based on their behavioural record, their choices about whose claims to trus... (shrink)
The Yuanming Yuan of the Qing dynasty was a magnificent imperial garden in Chinese history. The garden consisted of three Chinese gardens and a “Western-like garden” designed by the EuropeanJesuits. The garden encounter in the Yuanming Yuan provides a valuable case for studying cultural fusion in early modernity. This article redraws the traditional line of Daoist cosmology in Chinese imperial gardens by analyzing the fengshui layout of the Yuanming Yuan. Based on the Qing emperors’ writings, imperial archives, and the garden (...) representations, the research interprets the design distinction and its cross-cultural accommodation. The article concludes that the exotic depth produced by the linear-perspective views in the European portion demonstrated the typical Daoist attempt of preserving full brightness in one’s mind through seeking the remotest garden scenery, as stated in the Daoist scripture Laozi that “whoever knows his brightness veils himself in his darkness.” This Daoist paradoxical idea, best embodied by the Yuanming Yuan, opens up a comparative understanding of Heidegger’s concept “paradoxa.”. (shrink)
There are at least five kinds of causative constructions in Chinese, the constructions of the collocation of verbs and prepositional phrases, verb-copying constructions, “ba” constructions with an object ahead, verb-copying constructions with their complements, and pivotal constructions with commands. But the current type-logical grammar has no tools representing the meanings of causative constructions. It would be neither intuitive nor simple to describe these constructions by means of the current type-logical grammar. So we intend to improve the type-logical grammar by adding (...) CAUSE as a logical constant, complementing the structure rules about the movement and addition or deletion of some components of causative constructions, assigning categories to Chinese nouns and prepositions; then we give an intuitive as well as simple analysis on these causative constructions. Based on this work we shall extend the multimodal system of type-logical grammar, increase structure postulates, make constraints on frame semantics, and then prove the soundness and completeness of that system. (shrink)