As doctors, reading the Editorial “Chinese doctors are under threat” (Aug 28, p 657) was such a consolation. The Chinese media certainly has an important role in the demon isation of doctors and nurses. However, there is a saying in China: “you can never make applause with one palm”. The reasons are not always from the outside; some originate from the doctors and nurses themselves. The low quality of medical service in China is universal. The access qualifi cation for a physician is not as strict as in western countries. One can apply for a physician’s licence even without formal college education, and this is granted if that person can pass the qualifi cation examination, which is not actually diffi cult. For a nurse, the education period is shorter and the qualifi cation examination easier. In previous years, a nurse, even one without a medical education back ground, could work as a doctor without the need for any qualifi cation examination. Many of these “doctors” are still working in their positions today. The Editorial cites a few Chinese media reports that have misled public opinion. Never theless, some reports highlight real cases of malpractice, and the most frequent reason is the doctor or nurse’s lack of professional ethics. Without the deserved salary and respect, deterioration of professional ethics is perhaps to be expected in other professions. But a medical worker’s lack of ethics directly harms patients. So it is no surprise that patients are usually treated as the victims in the public’s opinion when medical disputes occur. Moreover, for a patient subjected to malpractice, it is very hard in the current justice system to win a legal claim against a big hospital. If a patient cannot fi nd protection from the law, revenge via violence is conceivable. Although we agree that “China’s health-system reforms cannot be successful without reforming the social and economic status of doctors”, we believe that improve ment of the quality of medical workers and refi ning of medical practice laws are essential as well.