Causes of medical disputes in China and Japan from physicians' perspectives: a qualitative study.

Background: Medical disputes and strained doctor-patient relationships (DPRs) remain pressing challenges in China. This comparative qualitative study examined Chinese and Japanese doctors' perspectives on the causes of medical disputes to identify context-specific factors, elucidate causal mechanisms, and inform strategies for improvement. Method: Using purposive sampling, 20 practicing physicians from each country were recruited primarily through the authors' personal networks. Semi-structured interviews were conducted, and qualitative descriptive analysis was used to identify categories and subcategories of perceived contributors to medical disputes. Result: Five categories and seventeen subcategories emerged. While both countries' doctors identified similar negative factors affecting DPRs, their manifestations differed, explaining divergence in dispute prevalence. In China, disputes were additionally influenced by inefficiencies in medical insurance and the medical dispute resolution system, poverty, healthcare consumerism, distrust, low social morality, and a "vicious cycle of disputes." In Japan, disputes largely reflected poor communication and mutual distrust rather than broader systemic issues. Discussion: The findings underscore that medical disputes arise from broader social, medical, legal, economic, cultural, and ethical structures. In China, resolving disputes and improving DPRs requires systemic reforms, including strengthened social security, refined healthcare and legal systems, and enhanced ethics and public education. Sustainable trust-building is thus a long-term, structural endeavor rather than a matter of isolated interactions.