Ou Lizhi, a doctor in southeastern China, was making her morning rounds last week when a patient approached and demanded treatment. When she could not immediately help, he pulled a knife.
In an online petition started in the wake of the bloody ordeal, some 600,000 Chinese physicians called for an end to what has become a familiar occurrence in the country's underfunded and overcrowded hospitals: attacks on doctors.
Reports of disgruntled patients wreaking havoc on hospital floors are alarmingly common in China, from the story of the ear, nose and throat specialist stabbed to death on duty, to photographs of mob scenes at clinic gates.
Though violence against medical staff is not new, several studies suggest the problem is widespread — and may be getting worse.
In May, the Chinese Medical Doctors' Association reported that 13 percent of 12,600 doctors surveyed said they were physically assaulted in the last year. Chinese state media reported 12 incidents in June.
A report by the China Hospital Management Association found that, between 2002 and 2012, attacks on medical personnel jumped an average of 23 percent each year. In 2012, that meant an estimated 27 assaults per hospital.
Patient-on-doctor violence is a symptom of health system in crisis, experts say.
Thanks to an ambitious set of reforms launched in 2009, most Chinese have some form of public health insurance. But coverage is spotty, and hospitals still struggle to meet the demand for decent care at an affordable price; patients complain about days-long waits, shoddy service and bills that bankrupt entire families.
Doctors are also aggrieved. While American physicians are generally well-compensated, Chinese doctors are considered civil servants and often paid a pittance compared to private sector wages. With lines snaking through hospital hallways, the pressure to treat ever-greater numbers is enormous.
If things go wrong — or when patients think they do — there is little protection. Absent malpractice insurance and fair courts, disputes between doctors and patients are all too often settled informally, or not at all. Some families take matters into their own hands, striking out at those who they believe made a mistake — or just the first person in a lab coat.
Morale could hardly be worse. The proportion of Chinese doctors who hoped their child would enter the profession dropped from 11 percent in 2002 to 7 percent in 2011, according to a survey conducted by the Chinese Medical Doctors' Association. In a 2012 letter to The Lancet, a medical journal, a Chinese student expressed "regret" about choosing medicine as his career.
"The new generation of Chinese doctors feels lost," he wrote. "They do not know whether to continue to study medicine or not, and how to face the complex and uneasy relationship with their patients."
They also wonder how to stay safe. After a 46-year-old specialist was stabbed to death at a hospital outside Shanghai last year, a nearby hospital started holding kung fu classes, where medical staffers practiced using things like folding chairs to thwart attacks.
Officials in Guangdong Province, where Ou worked, are now calling for in-hospital police stations, alarm systems and more patrols — a move that may quell fear in the short term but seems unlikely to create an atmosphere of calm and trust.
In a pointed editorial, the Lancet urged Chinese officials to look beyond policing. "Although turning hospitals into high-security institutions may be a necessary step, it is a short-term solution to this disturbing and desperate situation," it said.
Instead, the journal argued, "China needs to make medicine an attractive, respected, rewarding, and safe profession again" by tackling issues such as funding, pay and patient knowledge.
That could go a long way to protecting people like Ou, who is recovering from surgery. Her surgeon told the South China Morning Post that she may or may not regain the use of her hand.