Table 3 Rotated factor loading matrix of all items

 Incompatible functions between health system and insurance, medical expenses are overburdening patients.

 Government investment in healthcare industry is inadequate, while the reason for increasing medical expenses is often mistakenly attributed to Chinese physicians.

 Imperfect salary structure in public hospitals results in a low reward of Chinese physicians.

 The unclear boundary between the power and responsibility caused by a defective legal system result in increasing difficulty to maintain the interests of both physicians and patients in China.

 Chinese physicians are overloaded owing to consulting with an excessive number of patients.

 High-quality resources are concentrated in the big cities, resulting in overcrowding in large hospitals.

 Current social trust is generally lower in China, which in turn exacerbates the gap in trust between the physicians and patients.

 Information regarding the negative reputation of physicians diffuses quickly in an internet era of easy interconnection.

 Public and media platforms are prone to ideologies of conspiracies and lack recognition for medical profession and clinicians.

 During this social transformation period, wide-ranging inequity triggers public dissatisfaction with all Chinese industries.

 Physicians’ Communication skill with patients is poor.

 The service attitude of some physicians is not good.

 The professionalism of some physicians is absent.

 Busy physicians are without enough time to care for their patients.

 Alert physicians often distrust their patients or their relatives.

 Pursuing the economic interests of some physicians leads to occasionally excessive diagnosis and treatment.

 Professional ability and skill Some physicians are deficient.

 Some patients or their relatives are hot-tempered and fail to cooperate with their physicians.

 Some patients or their relatives are biased and show distrust toward Chinese physicians.

 Social media used to promote reproachful narration toward Chinese physicians without professional or medical judgment.

 Some patients or their relatives often raise unreasonable expectations of their physician.

 Social media used to pursue to sensational press or reports regarding physician-patient dispute event lead to magnified, distorted, and amplified results.

 The patients or their relatives believe that either the physician or hospitals generate the result of Chinese high medical expenses.

 Chinese public hate to seek laws to deal with a medical error or accident.

 Inadequate cooperation between different departments in Chinese public hospitals lends to low-efficiency management.

 Due to poor procedure (awaiting long queues during many operations and steps such as registration, complications with receiving a diagnosis and getting medicine) patients’ time in consultation and treatment services is shortened.

 Hospitals pay much attention to economic benefits, which in turn increase patients’ medical costs.

 Hospital management is not scientific and chaotic.

 Some hospitals’ medical equipment and hardware are inadequate.

 The setting, operation, and medical institutions in public hospital are user-friendly.