Objective   To examine differences in cognition on medical examination between doctors and patients and to explore causes of the differences for providing references to conduct rational medical examination.

  Methods   We conducted a questionnaire survey among 523 doctors and 1 384 patients selected with convenience sampling at outpatient clinics, emergency and inpatient departments of 8 grade A tertiary hospitals affiliated to universities in Shenzheng and Guangzhou city, Guangdong province between November and December 2016.

  Results   In terms of the connotation of the rational medical examination, 210 doctors (40.2%) and 412 patients (29.8%) selected multiple evaluation criteria, with a statistically significant difference (P < 0.001); 105 doctors (20.1%) and 446 patients (32.2%) considered only the needs of patients, also with a statistically significant difference (P < 0.001). The doctors and the patients had a similar understanding on the significance of rational medical examination and among both of them, more than a half (309 59.1% doctors and 768 patients 55.5%) considered that the most important significance for rational medical examination is for improving the relationship between doctors and patients. Among the doctors, 25.8 % (135/523) and 39.18% (208/523) considered the cost of medical examination being too high or slightly high; while among the patients, 33.3% (461/1 384) and 39.1% (541/1 384) regarded the cost as too or slightly high. There were 340 patients (24.6%) reporting difficulties in paying their medical expenses and 59 patients (4.3%) stating that it was too difficult for them to cover the cost. As to factors that should be taken into consideration in promoting rational medical examination, significantly higher proportion of doctors (56.2%, 294) than that of patients (50.4%, 698) chose medical safety (P = 0.024) and hospital management (35.0% 183 vs. 7.3% 396) (P = 0.007). The majority of the doctors (62.5%) and patients (63.9%) expressed that diagnosis and treatment should be considered first in medical examination. About one third of the doctors (33.7%) and patients (30.1%) considered that the primary reason for irrational medical examination is related to ethical issues.

  Conclusion   Correct cognition on rational medical examination should be established and the connotation and standard for multi-dimensional reasonable medical examination should be clarified among both doctors and patients. A pricing mechanism with third-party supervision is needed to control the cost of rational examination and education on medical ethics needs to be strengthened to enhance the patients' trust in medical examination.