Date of Award

January 2018

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)



First Advisor

E. J. Edelman

Second Advisor

Kaveh Khoshnood


Problems facing the doctor-patient-family relationship (DPFR) in China, including violence against doctors, have received international attention. Possible contributors to tension in the medical relationship include systems-level challenges such as imbalances between provider and patient populations and a biased media. Yet, there has been limited empiric prior work examining how interpersonal dynamics, particularly communication, between patients, their family members, and providers contribute to satisfaction or tension. This study aims to identify actionable communication factors contributing to tension in the Chinese doctor-patient-family relationship among breast surgeons, surgical patients, and their family members in an urban, tertiary-level teaching in Hunan Province, China. We conducted a qualitative study between June and August 2015. We recruited a convenience sample of 29 participants, including 11 breast lumpectomy inpatients, 9 corresponding family members, and 9 surgeons. In-depth, semi-structured interviews were conducted perioperatively in Mandarin and English. Interviews were transcribed and translated into English. Transcripts were coded and thematic analysis was applied. We identified three emergent themes regarding tension: 1) Trust degradation occurred before and during the healthcare experience; 2) The healthcare-seeking experience for patients and family members was marked by unmet expectations for achieving a basic understanding as well as powerlessness; and 3) Societal pressures on doctors contributed to a state of learned helplessness. Findings from this study suggest that tension between doctors, patients, and family members is associated with both interpersonal and structural challenges with communication playing an important role. Reforms at all levels are needed to promote empowerment by providing a more patient-centered experience for patients and family members while ensuring the well-being and security of providers.


This is an Open Access Thesis.

Open Access

This Article is Open Access