The son of a hospital patient was shot dead by police after injuring two medical personnel and holding a nurse at knifepoint in northeastern China on Tuesday, bringing the country’s health care violence crisis back into focus.

The man, surnamed Yang, was in his early 50s and had reportedly been dissatisfied with treatment his elderly mother received after she had a stroke.

The same day, three government bureaus, including the national health and safety authorities, issued a joint guideline calling for tighter control over violent crimes in hospitals at the district level and up, and for better protection of medical staff.

Specifically, the new measures aim to ensure that intoxicated, mentally ill, or otherwise dangerous patients be monitored by guards, require comprehensive surveillance, increase security patrols, assemble emergency security teams, strictly enforce visitor registration, establish complaint departments, and increase cooperation with law enforcement.

The guideline will also require hospitals to have a dedicated media liaison and a set plan for disseminating information about hospital crime in order to guide public sentiment. Though medical professionals in general have a good reputation in China, cases of breached patient privacy, accidental HIV transmission, and price-gouging on medication have made them less honorable in the eyes of some.

According to state news agency Xinhua, there were 115,000 disputes surrounding medical treatment in 2014, resulting in 4,599 “security incidents” and 1,425 arrests. A 2015 report from the Chinese Medical Doctor Association found that 60 percent of medical staff have been verbally abused in their work and that 13 percent have been physically attacked. Officially, however, hospital-related violence has declined every year for the past five years — most recently, by 16 percent in 2016.

Despite the downward trend, academic research suggests that yinao, or violence against doctors, may be deterring young people from pursuing careers in medicine — which is worrying, given China’s shortage of doctors in rural areas and in primary care fields such as pediatrics.

A 26-year-old nurse surnamed Chen who works at a hospital in Shanghai’s Pudong New Area spoke to Sixth Tone about a dispute she had with a patient last year who threatened to report her to a health care disciplinary hotline over a routine chicken pox vaccination. She declined to give her full name for fear of professional repercussions.

“I explained to the mother that children are generally required to be vaccinated for chicken pox before they can enter kindergarten, but she was playing on her phone the whole time,” Chen said. “Then when I asked her to make an appointment, she said I was forcing her daughter to get an injection to get a kickback. I was speechless — my base salary is just 15 yuan [$2.20] for a half-day’s work, during which time I might serve over 100 patients.”

In the end, hospital administrators were called in, Chen explained the situation, and — after her superiors reviewed the surveillance footage — she was found to have done nothing wrong.

This incident occurred during a storm of media coverage surrounding the arrests of 300 individuals involved in an illegal vaccination ring, so Chen said she understands the patient’s skepticism. “Some people are bad, but not everyone,” she said. “Because misunderstandings and biases are so common, they often lead to disputes at Chinese hospitals.”

In May 2016, a retired oral surgeon was followed home and stabbed to death by a former patient in Guangzhou, in southern China’s Guangdong province. The following month, another disgruntled patient stabbed the 10-year-old son of a medical worker 12 times on a public bus. And in October, an outraged father stabbed a pediatrician to death when his daughter died shortly after birth.

To bridge the understanding gap between patients and medical staff, hospitals and local governments have taken a variety of approaches, from making a documentary series about the vital role medical workers play in society to establishing conflict mediation panels.

“We have the feeling that doctor-patient relations are changing for the better,” said the nurse, Chen, in response to the new guidelines. “But there’s still a long way to go.”

Contributions: David Paulk; editor: David Paulk.

(Header image: A security guard stands at the door of a hospital ward in Shenzhen, Guangdong province, March 1, 2015. Huo Jianbin/VCG)