Dr Chen Yuna had just eaten her lunch and was seated at her desk updating patients’ medical records when a masked man entered her office. He pulled out a dagger and stabbed her 28 times in her neck, chest, stomach and elsewhere. Then he left her to die in a pool of blood.

He knew the hospital well enough to slip out easily: Before he became Chen’s killer, the man had been her patient.

Chen’s murder in central Hunan province is one of thousands of violent attacks in recent years by patients that have crystallised public discontent with China’s health care system, the largest in the world.

Despite an injection of more than $240 billion in Government funding into healthcare over the past three years, the doctor-patient relationship has continued to break down.

Doctors are overworked and underpaid, and many push drug sales or charge extra for services such as deliveries to make more money. Patients are faced with high medical expenses, brief consultations and often poor quality care.

The Government’s attempts to fix the system may even have made some things worse. Its rapid expansion of insurance coverage means that more patients can pay for health services, which are mostly provided by public hospitals. But even as demand has gone up, doctors and funding are still in short supply. Hospitals are often scenes of disarray, with beds overflowing out of wards into corridors and shouting matches between patients and medical staff.

The anger built up over years is now exploding into violence, with doctors, nurses and interns around the country stabbed, punched or otherwise assaulted by patients or their relatives over the past year. A few have died. Although official data is unavailable, state media reports say there were more than 17,000 “violent incidents” at health care facilities nationwide in 2010, a 70 per cent increase from 2004.

In a top Beijing hospital in September last year, a 54-year-old cancer patient stabbed a doctor 17 times after a dispute. In the northeastern city of Harbin in March, a 17-year-old patient with a spinal disease attacked doctors with a fruit knife, leading to the death of an intern. One month later in Beijing, a man identified as a patient stabbed two doctors.

“China’s doctors are in crisis,” the British medical journal Lancet said in a May editorial urging a Government inquiry into the spate of violence and solutions to ending it.

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