Thoughts and Behaviors of Chinese and Japanese Doctors when faced with the Death of a Patient: A Qualitative Descriptive Study of Doctors' Responses to a Hypothetical Scenario.

China and Japan have similar cultures but differing healthcare systems. In both countries, admissions of medical error and apologies by doctors continue to be an important but difficult issue. The present study aimed to examine and compare the thoughts and behaviors of Chinese and Japanese doctors when faced with the unexpected death of a patient. Qualitative descriptive analysis was performed to compare the responses of 20 doctors from each country to a hypothetical scenario involving the death of a patient. We found that almost all doctors in both countries considered the treatment process described in the hypothetical scenario to be inappropriate and most would feel regret when faced with the young patient's death. There was a disagreement concerning responsibility for the patient death among the doctors regardless of their nationality. Doctors decided how to behave facing the patient death after anticipating the bereaved family's reaction and their initial responses varied widely. Japanese doctors indicated that they would communicate with the patient's family after a patient died, whereas none of the Chinese doctors indicated they would do so due to a fear of physical violence from the bereaved family. Finally, the decision on whether to disclose the medical error and apology was made after careful and complex consideration. In conclusion, significant differences were observed between Chinese and Japanese doctors with respect to communicating with, and disclosing errors and apologizing to, the bereaved family. We discuss both the ethical and social implications of these differences.