It's war on the wards of China's hospitals

And not just at the entrance, but as deputy administrators. The goal: to keep disgruntled patients and their relatives from attacking the doctors.

Officials in this north-eastern industrial city of nearly eight million people have a point. Chinese hospitals are dangerous places to work. In 2006, the last year the Health Ministry published statistics on hospital violence, attacks by patients or their relatives injured more than 5,500 medical workers.

"The police should have a permanent base here," said a neurosurgeon at Shengjing Hospital. "I always feel this element of danger."

In June alone, a doctor was stabbed to death in Shandong Province by the son of a patient who had died of liver cancer.

Three doctors were severely burned in Shanxi Province when a patient set fire to a hospital office. A paediatrician in Fujian Province was also injured after leaping out a fifth-floor window to escape angry relatives of a newborn who had died under his care.

Over the past year, families of deceased patients have forced doctors to don mourning clothes as a sign of atonement for poor care, and organised protests to bar hospital entrances. Four years ago, 2,000 people rioted at a hospital after reports that a three-year-old boy was refused treatment because his grandfather could not pay 50 in upfront fees. The child died.

Doctors and nurses say the strains in the relations between them and patients' relatives are often the result of unrealistic expectations by poor families who, having travelled far and exhausted their savings on care, expect medical miracles.

But the violence also reflects much wider discontent with China's public health care system.

Although the government, under Communist leadership, once offered rudimentary health care at nominal prices, it pulled back in the 1990s, leaving hospitals largely to fend for themselves in the new market economy.

By 2000, the World Health Organisation ranked China's health system as one of the world's most inequitable, 188th among 191 nations. Nearly two of every five sick people went untreated. Only one in ten had health insurance.

Over the past seven years, the state has intervened anew, with notable results. It has narrowed the gap in public health care spending with other developing nations of similar income levels, health experts say, pouring tens of billions of dollars into government insurance plans and hospital construction.

But across much of China, the quality of care remains low.Almost half the nation's doctors have no better than a high school degree, according to the Organisation for Economic Cooperation and Development. Many village doctors did not make it past junior high school. Primary care is scarce, so public hospitals are typically patients' first stop in cities, even for minor ailments. One survey estimated that a fifth of hospital patients suffer from no more than a cold or flu. Chinese health experts estimate that a third to a half of patients are hospitalised for no good reason.

Once admitted, patients are at risk of needless surgery; for instance, one of every two Chinese newborns is delivered by Caesarean sections.

Patients appear to be even more likely to get useless prescriptions. Drug sales are hospitals' second biggest source of revenue, and many offer incentives that can lead doctors to overprescribe or link doctors' salaries to the money they generate from prescriptions and costly diagnostic tests.

Doctors seem as unhappy as patients. They say they are underpaid, undervalued and mistrusted. One in four suffers from depression, and fewer than two of every three believe their patients respect them. Like some other cities, Shenyang has been seeking ways to ward off disturbances, including setting up hospital mediation centres. Even so, the city reported 152 "severe conflicts" between patients and doctors last year.

At Hospital No 5, the memory of a January attack remains fresh. After a doctor referred a patient with a temperature to a fever clinic frustrated relatives beat the doctor and several nurses with a mop and sticks.

Now a banner strung across the hospital's main lobby states: "Everyone participate in the sorting out of the law and order problem!"