The Concept and Principles of Medical Professionalism in China’s Context: A China-US Comparative Perspective Linying Hu Ph.D Peking University Health Science Center

Proposal of Research 1. PROBLEM STATEMENTPROBLEM STATEMENT 2. AIMS OF RESEARCHAIMS OF RESEARCH 3. PROPOSED RESEARCHPROPOSED RESEARCH 4. METHODOLOGYMETHODOLOGY 5. WORK PLANWORK PLAN 6. BUDGETBUDGET

PROBLEM STATEMENT 1. On present, Chinese medical professional values remains vague if any Profit-seeking ethos in medical profession under market-oriented economic context Be tired of their career and indifferent to their patients Conflict of interests, kickback from drug company, Red envelope, and over prescription, etc. 2.Similar issues, but different implications of medical professionalism between China and the US. Institution-Oriented Vs Individual Virtue: virtue, social responsibility, professional self-regulation, etc. Incompatibility of two different languages 3.Medical Professionalism in the New Millennium: A Physician Charter was issued in 2002, which inspires further exploration on how to understand and practice medical professionalism in different cultural contexts.

AIMS OF RESEARCH 1. To define the basic conception of medical professionalism under Chinese and American social cultural contexts from a comparative perspective 2. To clarify how it is from Chinese traditional Yide (medical morality) to medical professionalism, explore the process and challenges of this transformation, illustrated with evidences and cases;

AIMS OF RESEARCH (cont.) 3. To identify the basic characteristics of medical professionalism in China through closely examining physicians’ understanding and attitudes towards its basic principles; 4. To provide initial input to appropriate ways or strategies to improve Chinese medical professionalism.

PROPOSED RESEARCH I. Traditional medical morality and professional values in China and the US II. Medicine as a profession: from yide to medical professionalism III. Understanding and practicing of basic principles of medical Professionalism Iv. Future development of Chinese medical professionalism: some suggestions

I. Traditional Medical Morality and Modern Medical Values Study core values of traditional Chinese medical ethics, such as “Jing Cheng”, “Yi Nai Ren Shu” ect., examine the main contents of traditional Chinese and western medical ethics and find out the internal similarities between them from a comparative perspective. Reconsider the long-term dominant doctrines of medical ethics in China, such as You Hong You Zhuan, Bethune Spirit, Healing the Wounded and Rescuing the Dying and Serving the People wholeheartedly, and analyze the challenges facing the transformation of traditional medical ethics to modern medical professionalism, and explore whether these values could form the base of contemporary medical professionalism in China;

II. Medicine as a Profession: from yide to medical professionalism This part will make a thorough comparative study between medical professionalism in the western, which is characterized by “institutional arrangement”, and China, which is centering on “individual virtue” 1) Retrace the historical development of medical profession in traditional China and the US, explore why medicine is a profession, how medicine became a profession, and what the implication of medicine as a profession is 2) Identify the differences on the connotation and implications of medical professionalism, and make historical, cultural, social-economic, even philosophical analysis of the deep reasons for the differences

III. Understanding and Practicing of Basic Principles of Medical Professionalism This part will identify the basic characteristics of medical professionalism based on the genuine and insightful understanding of the Chinese rationales and reality (guoqing). through closely examining physicians’ understanding and attitudes towards its basic principles. 1) Primacy of patient’s welfare 2) Respect patients’ autonomy 3) Social justice

IV. Future Development of Chinese Medical Professionalism: Some Suggestions Study Report 1) Reconsider the basic implications of medical professionalism in China; 2) Develop professional self-regulation in the future as a more efficient way to improve physicians’ professional behaviors; 3) Explore the functions, contents and methods of education of medical ethics.

Methodology Literature review-----basic theoretical study Over 20 related works and 40 articles have been collected. Questionnaire survey-----National investigation 1) Design questionnaire Chinese physicians’ understanding of basic principles of medical professionalism. (30 questions in the draft) 2) 480 informants will be enrolled from 3 different levels hospitals in 4 cities, Beijing, Dalian, Nanjing, Kunming (see below table1) 3) Send mail-in questionnaires with stamped envelopes to randomly selected physicians via our network, collect and analyze the questionnaires systematically 4) Analysis of questionnaires will be made by statisticians of the research group

Survey (Table 1) MemberNumberLevel of Institutions Place Physicians practicing in internal medicine, surgery, OB, and pediatrics. 20*63 (levels)*2 Beijing(Central China) 20*63(levels)*2 Dalian (Northeast of China) 20*63(levels)*2 Nanjing (Mid of China) 20*63(levels)*2 Kunming (SouthWest of China)

WORK PLAN This project will last for 24month, starting in Nov and finishing in Nov TIME TASK Months Assembling research team Literature review Writing interim report Sending questionnaires and collecting data Data analysis Writing final report

Budget NO.Budget CategoryRMB (YUAN) No.Budget CategoryRMB (YUAN) 1 Books, Printing & Phone call 15,0005Assistant’s Salary12,000 2Expenses for survey 38,0006Collaborator’ Salary 15,000 3Attendance of Conference 12,0007Publication Fee8000 4Consultant & advisory Fee 5,0008Administration Fee 15,000 Total 120,000

Appendix 1. References 2. Prior research support 3. Questionnaires for physicians

Limitation 1. This study did not refer to physicians’ behavior and activities much. What they think may be often different from what they do. 2. Questionnaire is self-answered, then how to ensure they are reliable and generalizable. 3. Hard to make cultural, historical, social-economical, even philosophical reasons for these attitudes, which reasons are crucial for us to understand medical professionalism in China.

Acknowlgement Dr. Yin Xiuyun as Co-PI Prof. Li Benfu Dr. Nie Jingbao Prof. Li Yan Prof. Liu Yu Ms. Shi Liying

Thank you!