Core Viewpoint - The article discusses the tragic case of Dr. Shao, a gynecologist who committed suicide after enduring severe online harassment stemming from medical disputes, highlighting the systemic issues in doctor-patient relationships and the pressures faced by medical professionals in high-stakes situations [3][6][31]. Group 1: Medical Disputes and Online Harassment - Dr. Shao faced three significant medical disputes that led to online harassment, with the most notable case involving a patient who suffered from amniotic fluid embolism, resulting in a hysterectomy [5][11]. - The online harassment included false accusations and coordinated attacks from the families involved in the disputes, leading to over a million views on related videos [5][12]. - The systemic failure to protect medical professionals from such harassment raises questions about the responsibilities of hospitals and the healthcare system [6][31]. Group 2: Clinical Decision-Making Under Pressure - The decision to perform a hysterectomy during an amniotic fluid embolism is complex and depends on the severity of the condition, with the primary goal being to save the patient's life [12][14]. - Amniotic fluid embolism has a high mortality rate, and timely intervention is critical, often requiring the mobilization of extensive medical resources [14][15]. - The unpredictability of childbirth and the potential for rapid deterioration in patient conditions create immense pressure on healthcare providers [19][20]. Group 3: Systemic Issues in Doctor-Patient Relationships - The article highlights the increasing tension in doctor-patient relationships, particularly since the early 2000s, exacerbated by the COVID-19 pandemic [26]. - Medical disputes often lead to a perception of doctors as solely responsible for negative outcomes, creating a sense of isolation among healthcare professionals [26][28]. - The current system places a heavy burden on doctors to prove their lack of fault in disputes, which can lead to defensive medical practices and increased healthcare costs [30][31]. Group 4: Hospital Responsibilities and Preventive Measures - Hospitals are expected to have mechanisms in place to address medical disputes and protect their staff, including the establishment of grievance offices [31][32]. - Effective communication before procedures, such as recording risk discussions, can help mitigate misunderstandings and reduce the likelihood of disputes [33]. - The article emphasizes the need for hospitals to actively manage online reputations and intervene in cases of online harassment to protect their staff [32][33].

Core Points - The tragic case of Dr. Shao, a gynecologist who committed suicide after enduring seven months of online harassment, highlights the severe impact of medical disputes and the challenges faced by healthcare professionals in China [1][4][5] - The online violence against Dr. Shao stemmed from three medical disputes, raising questions about the healthcare system's ability to protect its practitioners [3][4][29] - The incident has reignited discussions about the doctor-patient relationship, the pressures on medical professionals, and the systemic failures in addressing medical disputes [5][34][36] Group 1: Medical Disputes and Online Harassment - Dr. Shao had over 30 years of experience and delivered more than 30,000 babies, yet faced severe online harassment due to three medical disputes [3][4] - The first dispute involved a patient who suffered from amniotic fluid embolism, leading to a hysterectomy, with the family demanding 1 million yuan in compensation [3][10] - The second dispute arose from a patient who insisted on a natural birth, resulting in a uterine rupture and fetal death, despite signing a risk acknowledgment [3][10] - The third case involved a newborn diagnosed with cerebral palsy after two days, with the family blaming the hospital for alleged malpractice [3][10] Group 2: Systemic Issues in Healthcare - The healthcare system's failure to protect Dr. Shao during the online harassment and medical disputes raises concerns about institutional support for medical professionals [4][29] - The current medical dispute resolution system tends to place the burden of responsibility on individual doctors, leading to feelings of isolation and helplessness among practitioners [29][30] - Hospitals often lack effective measures to manage online harassment and disputes, with varying responses to such incidents across different institutions [34][35] Group 3: Doctor-Patient Relationship - The relationship between doctors and patients has become increasingly strained, with a history of tension exacerbated by recent events [27][33] - Effective communication and understanding of risks between doctors and patients are crucial in preventing disputes and misunderstandings [36] - The need for hospitals to implement proactive measures, such as recording pre-surgery discussions, is emphasized to bridge the knowledge gap between doctors and patients [36]

Core Viewpoint - Amniotic fluid embolism (AFE) is unpredictable and lacks screening methods, making preventive measures difficult. In critical situations, the priority is to save the mother, then the child, and finally consider the uterus [1][4]. Group 1: Medical Understanding of AFE - AFE typically occurs during childbirth when components from the amniotic fluid enter the maternal circulation, causing severe immune reactions that can lead to respiratory and cardiac arrest, massive bleeding, and multi-organ failure within minutes [3][4]. - Approximately 70% of AFE cases occur around the time of delivery, particularly within two hours before or half an hour after the fetus is born [3]. - The decision to perform a hysterectomy during AFE management is complex and often necessary to control life-threatening bleeding, especially in cases of disseminated intravascular coagulation (DIC) [3][4]. Group 2: Emergency Response and Treatment - Effective management of AFE relies not only on technical skills but also on timely blood transfusions and multidisciplinary collaboration among experienced medical professionals [4]. - The decision to perform a hysterectomy is a last resort, only considered when other bleeding control methods fail and life-threatening uterine hemorrhage persists [4]. Group 3: Risk Factors and Considerations - The risk of AFE is slightly higher during cesarean sections due to increased surgical manipulation and exposure of blood vessels to amniotic fluid [5]. - Despite the higher risk associated with cesarean delivery, the overall incidence of AFE remains very low, estimated at several thousandths to tens of thousands of a percent in the general population [6].