Chinese Bioethics of Trust and Autonomy: How Doctors Make Patient Referrals After the Introduction of a Two-Way Referral System.

Based on 24 semi-structured interviews with secondary hospital doctors, we empirically investigate how a new two-way referral system in China influences the alignment between referring doctors, patients, and doctors who receive referrals. In particular, we focus on how this system addresses the challenges of trust, autonomy, and bioethics during the shared decision-making process. Our research shows that the two-way referral system has spawned new acquaintance networks, therefore improving communication and collaboration between doctors. Especially during upward referrals, benefits associated with care continuity have been made possible. However, doctors still tend to adopt defensive patient-centered strategies in referral communication. They consult patients' desires and play an information provider role. This is influenced by both procedural requirements imposed by managerial rules and uncertainty caused by medical consumerism. Thus, we argue that the Chinese bioethical issue of doctor-patient relationships has gradually turned to a mismatch of concerns between doctors and patients.