As the month for breast cancer awareness approaches, we are reminded that the disease is the most common cancer for women in China. The number of new cases is only expected to grow. But in a healthcare system with limited resources, tensions can run high for both patients and doctors.

Over the years, both sides have grown wary of the other when dealing with the uncertainties of life-threatening diseases such as cancer – the sick may doubt their doctors' abilities or think that they are being given unnecessary tests, while medical professionals have grown cautious for fear of being sued.

But patient concerns may contain a grain of truth.

A study reviewing over 1,500 cases of alleged medical malpractice in Beijing found instances of error for more than six out of 10 patients. The top error was mistakes in diagnosis, followed closely by improper performance of procedures.

Although research on malpractice in the country is scarce, long-term local studies on the living and the dead – such as one reviewing autopsies over a decade at the Wuhan University School of Medicine – have concluded that there is a strong link between malpractice and misdiagnosis.

Receiving an incorrect diagnosis can be a frightening thought, since a wrong or delayed assessment can mean the difference between life and death.

One reason for such high rates is that many Chinese physicians work up to 16 hours a day under heavy pressure, all while being underpaid, health policy expert He Jingwei told CGTN.

On top of that, tense relationships with distraught patients – some have even made headlines by attacking hospital staff – place a great burden on the mental health of doctors.

A grueling schedule may seem commonplace for medical professionals everywhere, but there are only 1.8 doctors for every 1,000 citizens in China compared with 2.8 in Britain, so many have to deal with high patient loads and short face-to-face times in the country's swarming hospitals.

Varying degrees of physician quality is another reason. In a Lancet article that looks at reforms to China's graduate medical education, the authors note that nearly half of the country's doctors have qualifications lower than a bachelor's degree, a relic of the Soviet era when medical training was expedited to meet high demand.

But a less obvious factor contributing to error-prone judgments is the "fragmented care" pervasive in the country's health sector, Zhu Jiming said in a CGTN interview with the author. Zhu is one of the co-authors of the Lancet article, and a research fellow at the China Medical Board (CMB), which once funded China's top medical college.

Chinese patients are more likely to visit specialists at large hospitals for their ailments instead of family doctors, unlike in the US and UK. Since a patient may see different specialists at the same hospital for a recurring problem, physicians often don't have the complete picture to make accurate diagnoses.

Overhauling a lumbering system

Overworked doctors could benefit from hiring more assistants and improving IT infrastructure, so that physicians can focus on diagnosis and treatment, says Li Wenkai, CMB's Beijing office director and another co-author of the Lancet article. Meanwhile, the healthcare sector is looking to the burgeoning field of AI for help with complex tasks such as identifying cancer or assisting in surgery.

The human touch is something that often gets lost when doctors are under pressure to process an unending line of restless patients outside of their office doors. Zhu proposes simulating patient interactions in teaching clinics to help physicians not only improve their technical skills, but also how to better communicate and deal with the sick.

Healthcare professionals could be more mindful of patients by adhering to best practices based on scientific evidence. For example, local doctors and nurses should be proactive in getting flu shots in order to prevent transmitting the disease, says Li. Zhu adds that this mindset should be more commonly applied when diagnosing and treating patients.

The central government is doing its part to alleviate the burden on large hospitals by encouraging people to visit family doctors earlier this year. The transition to getting basic medical services within local communities will take time, as most patients still consider hospital-based specialists to be the first line of care.

Patients, doctors, and the broader healthcare system are all undergoing rapid changes, along with everything else in the country, but whether this process produces positive outcomes still depends on the agency of the parties involved.