Our Backward and Barbaric Medical Care Needs All of Us to Improve It

At noon on June 29, 2018, after I had seen the patients booked for the day, a sudden severe pain struck me. It was like a knife twisting inside, and it intensified rapidly.

I was in such pain that cold sweat streamed down, and I could no longer stand. I lay face down on the bed, without even the strength to get out of it.

As a medically trained person, the pain robbed me of my judgment and of my usual calm. I half wondered whether it was acute pancreatitis or cholecystitis, and whether it might be life-threatening.

I called my family for help, but they had gone for a walk in the park and left their phones at home. I had no choice but to wait and see; half an hour later, the pain intensified to a level I could not bear at all.

I am the kind of person who once dared to operate on his own hand without anesthetic to deal with a ganglion cyst. If a pain is more than I can bear, it is truly at the extreme.

Among my patients was an elderly Western doctor nearing eighty; we were in touch on WeChat, and together we tried to relieve my pain, but regrettably all our efforts failed.

I drank a lot of water; after a bowel movement the pain eased slightly, but it still hurt badly. Bearing the pain, I hurried straight to the nearest Grade-A tertiary hospital.

Where I live, the nearest hospital really happens to be a Grade-A tertiary hospital.

But at the time I had no cash and no bank card; my wallet did have a medical insurance card, and my phone had money in WeChat and Alipay. But this is a military hospital, and it astonishingly accepted only cash or bank cards.

I tried to ask other patients nearby for help, hoping someone could give me a hundred yuan in cash and I could pay them back via WeChat or Alipay, so I could first register and get a test to see what was causing the pain.

But the hospital signal was poor, and I could not transfer via WeChat or Alipay. Truly, a penny stumps a hero; I collapsed on the ground, utterly helpless.

The colic grew worse and worse; in that moment I felt this must be renal colic. I struggled to find a bench to lie on, but a hospital security guard came over and told me I was not allowed to lie there.

Tormented by the fierce pain, I almost rolled on the floor, yet I could not even register. At that moment I was in extreme panic; my family's phone kept going unanswered.

At the emergency registration desk, I asked the young nurse to register me, saying I would pay the registration fee to her by WeChat transfer.

The nurse agreed and showed her payment QR code, but I could not scan it. She looked hesitant, putting off registering me; one could see her struggling, perhaps wanting to help me but worried about losing ten yuan.

Bearing the pain, I rummaged through my pockets and finally found twenty yuan. Truly heaven leaves no person without a way out; with these ten yuan I registered.

I went to the emergency surgery clinic. The surgeon agreed with my judgment: he also thought it might be renal colic, possibly caused by a kidney stone. He wrote an ultrasound order and told me to go to the second floor.

In pain, I had barely walked out of the surgery clinic before I collapsed onto the floor. I certainly could not produce the money for the ultrasound. By then I really felt I was dying of pain, but because the location of the pain was becoming clearer and I could roughly guess the cause, my heart settled.

I slumped at the door of the surgery emergency room, at my wits' end. My WeChat messages to my family went unanswered, so I calmed my nerves, sat on the ground, rested my head on a bench in the hospital, and quietly waited for my family to bring money.

Over twenty minutes later, my father and wife finally both arrived at the hospital and found me in the emergency area. After paying, we did the ultrasound and urine test, which showed severe hydronephrosis.

Once the ultrasound found hydronephrosis and the cause was identified, I stopped panicking. I had my wife go to my study to get Zhuling Tang granules and buy Sanjin Pian from a pharmacy outside, while I waited with my father for the urine result.

Incidentally, urinary stones cause severe hydronephrosis; the stone itself generally causes only mild-to-moderate pain. The truly fierce colic is basically renal colic caused by hydronephrosis, and renal colic is an extremely severe pain.

Many hospitals use pethidine to stop the pain. In fact a more effective measure is to drink large amounts of water and take diuretics. The reason I had my wife buy Sanjin Pian and get Zhuling Tang granules is that both are damp-draining, strangury-relieving herbs that help urination. Once there is a large volume of urine, renal colic immediately eases or even disappears entirely.

By then I was lying on a waiting bench; the hospital security guard again said the benches were not for lying on. My father, seeing how miserable I was, almost roared at the guard. The guard was cowed and never said another word.

When the urine result came out, it showed occult blood. My father supported me into the surgery emergency room; after looking at both results, the doctor said to us: "Kidney stone. Our hospital has already closed (it was past five p.m.); the doctor who treats kidney stones is gone. You need to go to the nearby XX hospital or XX hospital; they have a 24-hour lithotripsy center."

My father said to the doctor: "Then can you first relieve my son's pain a bit?" The doctor said he was not able, and told us to hurry by taxi to either of the two hospitals he named.

My wife arrived with the medicine, along with a liter of plain water; after taking the medicine I drank a lot. The two diuretics worked well, and before long I could urinate freely. After urinating two or three times in the hospital toilet, the renal colic eased considerably.

Then we sat in the hospital waiting for more urine to pass. Basically I went to the toilet every few minutes, each time passing a large volume. After seven or eight times, the renal colic completely resolved; there was only slight percussion pain in the flank.

Once the pain eased, I recovered my calm. Since I could judge it as a urinary stone, there was no need to panic and no need for a lithotripsy center; I could handle it myself. Drinking lots of water, taking diuretics moderately, plus more bouncing exercise can expel the stone.

I had had kidney stones once ten years ago and once twenty years ago, both passed naturally. Twenty years ago I passed it by playing basketball; ten years ago I passed it by sitting through an overnight, bumpy train ride.

So we went home, and thereafter I treated myself at home with medicine, water, and exercise. After that fierce pain, although there were a few moderate dull aches, it was never as severe again.

Because I knew the cause, thereafter whenever the first sign of pain appeared, I immediately doubled the dose of Sanjin Pian and Zhuling Tang, and urination soon cleared. So I never again had pain above moderate.

Why do I describe this visit in such detail?

I was in Beijing, the capital of China, at a military Grade-A tertiary hospital with impeccable hardware. But in terms of my personal experience of that visit, it was truly very bad.

Perhaps in a developed country, when a patient like me enters a hospital, the staff would at once wheel out a trolley, settle me on it, push me into the clinic for examination, quickly find the cause, and contact my family.

That would not only ease my physical suffering but also greatly comfort my heart. Of course such treatment would also be expensive, and we citizens of a developing country probably could not yet afford it.

But after I had entered the hospital in such pain, for over an hour, not one person—not the hospital security, not the staff, not the other visitors’came forward to help me. That is simply inexcusable no matter how you look at it.

Our society has grown this cold, and our medical care this frighteningly icy.

I feel a deep after-fear: if that had not been renal colic but a more serious disease, I might have spent that hour-plus struggling and dying in the hospital lobby.

As far as I know, the threshold for Beijing's Grade-A tertiary hospitals is not low; the staff who get to work there are mostly top graduates of medical schools. Professionally, their knowledge is solid.

But in them, the humanitarian spirit of healing the wounded and rescuing the dying is utterly gone.

I am myself a doctor. Facing such an icy medical environment, I feel genuine terror from the bottom of my heart.

If one day I am old, or fall seriously ill, and must rely on other staff for care, and my family entrusts me to such a group of staff, that will be a disaster.

Many of my patients beg me to treat them long-term and refuse to go to the famous authoritative hospitals I recommend. Asked why they refuse, the usual answer, after a long sigh, is: "You don't know how hard it is to see a doctor in a hospital these days."

Hearing such words makes my face burn. Once, being a doctor was a deeply respected calling. Today, the impression doctors give is so dreadful.

When we call for improving the doctor-patient relationship and for patients to understand doctors' hardships, should we not also put in real effort to change the present state of medical care?

During this visit, had I not held him back, my father might have made a scene in the hospital. Because he was so emotional, I bore the pain and urged him: "Think about it—your own son is in this line too. Why make things hard for the staff?"

Leaving the hospital, I even said thank you to the doctor, apologized to the security guard for my father's attitude, and reminded him to be kind to patients in future.

When my mother was treated for stomach cancer at another Beijing Grade-A tertiary hospital, I once took her for a follow-up; a whole day cost several thousand yuan. When the bill was delivered to the ward I was away; my parents saw it.

My mother said to the attending physician: "It's only one day, just a follow-up—why so much money?"

The attending physician retorted: "Isn't the money your son paid still not used up? Why the rush?"

My parents had scrimped and saved all their lives; over this remark they flew into a rage, considering what the doctor said worse than an animal's words. From then on, my mother refused, even at the cost of her life, to go back for follow-up, finally missing the best time to detect a recurrence.

When I took her seeking treatment, I tasted every bitterness of this cold medical care. Because my mother hated hospitals and refused to cooperate, I had to kneel down and beg her to cooperate with the doctors.

This unforgettable experience gave me deep sympathy for patients. I once swore that, after entering the medical system, I would strive to change China's medical situation.

In a blink, more than ten years passed; I have become someone with a little influence among cancer patients, and a group of tumor patients rely on my insignificant skill to ease pain and prolong survival.

In over ten years of practice, having tasted every bitterness, I have understood patients and their families, and understood doctors, and know how hard it is to be a doctor in a developing country.

At noon, as I write this, the family of a patient—who had a fungal infection after brain-tumor surgery and was not satisfied with Western treatment—contacted me.

Because the condition was critical and treatment would likely leave the family with neither money nor the patient, I tried talking my way out politely and failed, so I directly told them to seek a better doctor. The family still would not give up, and I used a price barrier to decline her.

This is probably a common, polite way many colleagues decline patients they dare not or do not want to treat; we may do this every day.

After declining this family, I went to my designated medical-insurance hospital to get some medicine. A patient nearing fifty, but looking about thirty years older than me, was being seen ahead of me (of course I look about ten years younger than my real age, which widens the gap).

His results showed emphysema, plus hypertension (systolic around 220), and heart problems.

He was a migrant worker in Beijing. The doctor seeing us was a woman of about fifty, with real compassion. Seeing the patient's shabby clothes and knowing his financial situation was poor, her face showed sympathy and distress.

The doctor asked the patient whether he was a migrant worker from out of town; he said yes. She told him he needed further tests to confirm the diagnosis, and those tests were expensive, and asked him to think about it and find a way.

She prescribed some medicine; the patient asked roughly how much it would cost. She said two hundred-plus yuan. The patient took out what money he had—not a single hundred-yuan note, probably only a few dozen yuan total—and said he could not afford medicine costing two hundred-plus. The doctor had to prescribe only some antihypertensive drugs.

The patient obviously did not realize he was at high risk of an imminent cardiovascular accident or sudden stroke. Resentful that the hospital had made him do tests and spent much money without giving a clear diagnosis, he was unhappy.

The patient kept telling the doctor he only had chest pain and only wanted to solve that. The doctor explained that chest pain might mean the heart was already blocked and that he needed further tests to see the actual situation before treating.

Helpless, the patient took the order the doctor had written and was leaving. Out of professional habit, I could not help saying to him: don't strain at stool, to avoid a stroke. I was about to explain how to prevent stroke, and what side effects his aspirin might have and what to do if side effects appeared.

This is my usual practice when seeing patients. Seeing that woman doctor had not explained any of it, without considering whether it was appropriate, I explained it for her.

Had I been the one seeing this patient, I would also have explained in detail his cause and what behaviors might bring him major risk.

The patient seemed to hear, and seemed not to want my chatter. He took the prescription and left.

The next patient was me; I was there to get medicine, so it was simple.

As the doctor wrote my prescription I kept thinking of the previous patient, regretting that I had not pulled out two hundred yuan and given it to him for medicine; that would at least have lowered his near-term risk of stroke or sudden death.

Had this been ten years ago, I might have helped him without a second thought.

Ten years ago, when my mother was hospitalized, a patient in the same ward lacked money for platelets; I asked my senior fellow working in the hospital to put the bill on me, to pay for her treatment and immediately transfuse platelets to save her.

Ten years ago, a patient I treated had major hemorrhage, came to me for a formula, and could not pay the consultation fee; I waived it. The next day I asked whether her bleeding had stopped; she said she was waiting for a friend to repay her so she could buy medicine. Without thinking, I gave her five hundred yuan to buy medicine first.

Such warm-hearted acts I used to do without a second thought, ten years ago. But now I did not react in the first instant.

After the doctor wrote my prescription, I hurried out to find the patient, ready to give him two hundred yuan. After all, helping him with two hundred was no great loss to me, but regrettably I could not find him.

Obviously he did not trust the doctor and left without even taking the antihypertensives. If he had taken them, he could not have left the hospital so fast; he would still be by the payment window and the Western pharmacy.

I walked out of the hospital melancholy and distressed.

In this one day: the first patient I politely declined for fear of treating a critical condition; this second patient, whom I could have helped with a little money, I let die through shameful callousness. Both people may be at risk to their lives.

Why have I become less warm-hearted than before? Is it that, having seen so much life and death, I've gone numb? Or that, since becoming a doctor, my income is lower and I've grown stingy? Or that, after more medical disputes, I've grown afraid?

We chose medicine, chose the humanitarian cause of healing the wounded; why so many scruples? Is a human life more important, or personal interest and safety?

These questions knock on my own conscience and make my heart ache. I seem to be forgetting my original purpose in medicine, turning from an ardent youth into someone growing numb.

For a spell recently I even thought of fleeing the medical profession and taking an easier job.

I have written many essays that seem very wise, but no matter how wise the thinking, it cannot replace what Mencius called the heart of compassion—a child's heart that everyone should by nature possess.

So hard it is to stay true to the original intention, and harder still to keep a child's heart. I feel deep shame and guilt at my so-called emotional maturity.

I have repeatedly told myself that in practice I should not withhold good because it is small, nor commit evil because it is small, and not forget the original heart of medicine. But in practice I have not managed it.

Of course, from a realistic angle, I did nothing wrong; self-protection is excusable.

The first patient I could not treat, so I could only decline. Patients like the second I encounter every day, perhaps many a day. What can I do? Pull out money for every one of them? Do I still get to survive?

When that patient left, the compassionate-looking woman doctor too looked pained. I knew that inside she might feel as I did, keenly aware of her limited ability to help such patients. Most doctors' incomes are not generous; they cannot be generous even if they want to.

Medical problems have seriously affected everyone's sense of well-being; both doctors and patients suffer in the medical system.

Many opinion leaders who lack deep understanding of these issues love to write emotional articles that worsen this medical environment.

In my social feed I see piles of such articles almost every day. Some of the authors hide their own interests and stir up readers' emotions.

Nowadays, unless you write something that stirs people's emotions, an article can hardly get 100,000-plus views.

Many authors live off heavy readership, so they think no further. To succeed, keep it simple and charge ahead.

In 2012, an elderly Western-medicine expert in his eighties almost pleaded with me: "You must find a way to reduce China's cancer incidence at the source, not just bury yourself treating disease. Stand up and do something more meaningful for Chinese medicine, not just be a doctor."

I have remembered his words ever since, though I have not until now been ready to act on them.

In the past I used my lowly voice as an excuse to shirk this responsibility.

Now I know that even in the humblest position, if one truly wants to do something to improve China's medical environment and lower China's cancer incidence, it is not impossible.

Another old doctor, whose name I have forgotten, issued this appeal: today's medical-education model neglects the cultivation of humanistic literacy and humanitarian spirit, turning out a generation of fearsome doctors. We ourselves are old and dare not seek treatment from our own students.

Doctors in developed countries like the US have diverse undergraduate educations—some studied philosophy, some literature, some chemistry; before medical school their horizons were already broad, and they are more than just doctors.

Professor Atul Gawande of Harvard Medical School was named one of the top ten thinkers of our time for writing many pieces that seem unrelated to medical expertise yet genuinely inspire the medical field.

The Japanese doctor Junichi Watanabe won a Nobel Prize—not the Nobel Prize in Medicine, but the Nobel Prize in Literature.

The American doctor Tom—he pioneered a new kind of care: he brought chickens, ducks, parrots, dogs, and the hospital staff's children into the nursing home he ran; as a result prescription drug use dropped by more than half while outcomes rose steeply.

Of course our country also has many versatile doctors. But more common are the rigid, rule-bound graduates of medical schools. With respect, the minds of the great majority of our doctors are very barren.

The old doctor I mentioned earlier, who called for Chinese medical education to value students' humanistic literacy, once urged doctors to read a few books in the humanities and social sciences every month to improve themselves.

But I believe that, however respected he is, this appeal has fallen on deaf ears, with few to respond. Many doctors I meet in real life would rather play a round of mahjong than read a book.

I once worked at a hospital; a colleague of mine, a chief physician, was deeply moved after seeing how diligently I read and wrote, and went home to dig out her own books. She laughed and said those books had gathered dust for over twenty years.

Without humanistic literacy and humanitarian spirit, how can one be a doctor? And how can we change this dissatisfying medical state trapped in a vicious cycle?

Will doctors and patients shouting at each other solve the problem?

A while back, reports on the problem vaccines came out. I had been watching, not wanting to comment. I myself am a victim of vaccination; it has ruined my life, and I deeply regret this backward public-health enterprise.

But though backward, it has truly benefited many people; many infectious diseases that once killed legions of children have indeed been contained.

Moreover, vaccination and the eradication of infectious diseases touch on far too broad an area.

Reading Professor Atul Gawande, I saw his account of a polio-eradication vaccination campaign he took part in, and understood how hard this work is—not something you can do just by talking.

So I do not plan to issue any extreme, emotion-stirring statements on it.

Moreover, a bad medical environment has a great deal to do with a bad overall social environment.

In his memoir, Mr. Huang Renyu spoke of what he saw during the War of Resistance. He said that at the time, on the streets of Changsha, after Japanese warplanes bombed, some Changsha residents fought over branches blown down by Japanese shells beside the corpses of their own countrymen, to take home as firewood.

After enlisting and living through the war, Mr. Huang reflected bitterly and finally realized that the civilized progress of an entire nation can only be a slow process. It can no longer be solved by shouting kill and kill, but only by universal education—which may take many generations.

Last year I went to Japan and saw that every car on the road automatically yielded to pedestrians. The first day back in Beijing, a rich kid gunned a sports car and nearly blew my son and me into the air.

This summer I went back to Hubei and was hit once in Wuhan and once in my hometown Huanggang.

Walking by East Lake in Wuhan, a large milk bottle suddenly fell from the sky, nearly hitting me; turning around, I saw it had been thrown from a speeding car whose driver looked rather pleased with himself.

Last time I went out on an emergency call in Beijing it was pouring rain; a car sped by and sprayed me all over with mud. The emergency could not wait, and I had to go and give resuscitative treatment to the patient soaking wet.

These small incidents show me that our big environment makes these heartbreaking phenomena in medicine utterly commonplace.

A while back my son's class teacher was calling for volunteers to welcome new students' parents at the school; she asked for a long time and not one child volunteered, because there were no grade points in it.

In the end my son, feeling awkward at everyone's lack of enthusiasm, stood up and volunteered.

Usually, whenever there is an activity with grade points, his classmates break down the door to join. This is today's education: everything is so calculating.

That first-year junior-high students at a key middle school in Beijing's Haidian district have become this calculating and selfish makes me deeply grieved. Our education is a failure! A group of teenagers have already lost their child's heart—lamentable.

Yet the parents here feel reassured that their children study here, because the university-admission rate will be relatively high.

If we want to avoid incidents like the vaccine fraud, there may be no hope in my son's generation, because we, the future citizens, have already become unlovable.

Every one of us is actually responsible for this state of affairs, yet many angrily pursue others' blame without reflecting on their own faults.

We can't keep unrealistically hoping that some great figure will appear and save the whole world through heroics, can we?

We are selfish ourselves, and still teach our children to be selfish. When a whole society is selfish, law and morality become empty words.

I understand why Sun Yat-sen and Lu Xun abandoned medicine for literature and strove to change society. Though, from my reading of history, I know they did not succeed.

I hope that after several, even a dozen generations, our family, school, and social education will raise large numbers of qualified citizens.

Perhaps only then will such disgusting incidents stop cropping up in numbers.

On the popularization of medical knowledge, we too are deficient.

This year I read a great many works by European, American, and Japanese doctors; after finishing each one I would close the book with a long sigh.

Our health management is in a very rough state, and the blunders in our medical care are simply unbearable to look at.

Take one example: after routine treatment of gastric cancer, eradicating Helicobacter pylori in gastric-cancer patients has become a medical consensus; it lowers recurrence and the chance of residual gastritis.

But when my mother had her stomach-cancer treatment at one of Beijing's best cancer hospitals, the attending physician never mentioned this to us. The reason is none other than that his medical knowledge had not been updated fast enough.

Over these years I have seen countless gastric-cancer patients; reading their records, not one has a record of subsequent H. pylori eradication.

Is it that the consensus of gastroenterology is not accepted by oncology colleagues, or that oncology doctors simply never received such training? Unknown.

Again, direct relatives of a gastric-cancer patient like me have a far higher risk of gastric cancer than the general population, yet within our medical system no one could possibly prevent me from getting gastric cancer. If I did not know a bit myself, I could only take no preventive measures at all.

Or take long-term PPI users (proton-pump inhibitors like omeprazole and lansoprazole, which suppress stomach acid and treat reflux). PPIs are high-risk carcinogens because they induce intestinal metaplasia, a precancerous lesion of the digestive tract; from intestinal metaplasia to a digestive-tract tumor is only one step.

But in China there is no such thing as a health record, and the long-term abuse of PPIs is widespread; that is to say, some cancer patients owe their cancer entirely to their doctors, who turned them into cancer patients. I have encountered several such patients.

Of course similar problems may exist in developed countries too. I once saw a report whose gist was that a survey showed about half of American oncologists hold unqualified professional knowledge. The proportion in China is certainly higher, and American standards are higher than ours.

Who is going to tell us these things?

We do have people doing medical science popularization. But our so-called popular science is very short-term and profit-driven; behind many authors' impassioned words lies huge commercial interest.

A small medical-popularization group I know: a few medical doctors attract fans through popular science and sell all kinds of expensive imported anticancer products, hiding their side effects and exaggerating efficacy, taking in over a hundred million yuan a year.

As for the more socially meaningful popularization of preventive medicine, they have no time for it. The unlovableness of profit-grabbing countrymen is evident from this.

Ten years from now my son will be grown, and my medical knowledge richer. I may withdraw from the clinical front line and become a patient preventive-medicine science writer, reducing cancer at the source—more socially meaningful than treating cancer and bankrupting patients' families.

Of course, even if I have not withdrawn, before and after this I will still do this work in my spare time.

Mr. Wang Xiaobo said that switching from computing to freelance writing was an anti-entropy act—investing much, gaining little.

In fact society needs us to be "anti-entropy" now and then. If everyone is this utilitarian, the result is very uncomfortable.

It goes without saying that, as a developing country, our medical care is still backward and barbaric. I was once a senior administrator at a hospital, but in 2016 I resigned. The reason was that my values conflicted with the hospital's philosophy.

When I resigned, my colleague said to me: "Zhiyuan, we didn't do anything wicked, did we?" From his standpoint, indeed they seemed to have done nothing wicked.

But in the hospital I did the president's job and knew the full picture. I truly could not bear the greedy, icy reality of our medical care. In that period I developed reflux esophagitis from the anxiety; after resigning, it healed without treatment.

Since I left, for over two years now, medical institutions have constantly invited me to join.

The head of a hospital built with a hundred million yuan in investment said to me: "You come, and half this hospital is yours." But in dealing with him I could feel how urgent his need to make money was.

I knew that if I agreed, I would become a certain kind of doctor; and that the reason he valued me was only my little influence among cancer patients. What he valued was the commercial value behind it, and the last thing I like is lending my personal image to endorse commercialized medicine.

So, different paths do not plot together; each year I turn down a dozen or so such invitations. I am past the age of short-term gain, and my life is past the stage of loving money like life.

A dermatology teacher I know once said to me: "Medicine can make money, but it cannot make fast money; fast money leads to trouble."

I fully agree with him. Over my years in Beijing I have made many colleagues in the medical industry; many doctors are very unhappy with the present medical environment but feel powerless and cannot change much.

But we can actually change ourselves: be kinder to patients, more patient, more caring—this we can do. In our spare time, offering the public genuinely valuable medical popular science is also within our power.

Little by little, the medical environment will improve day by day. If we do nothing, I fear we may one day see that scene Mr. Huang Renyu witnessed on the streets of Changsha replayed in our society.

And every Chinese should improve our social environment by reflecting on his own every word and deed. If we ourselves keep doing evil, what right do we have to accuse others of being icy?

WeChat public account: zhouzhiyuan360 (or search for "周志远")

Author's website: www.zhouzhiyuan.com

Author's WeChat: zhouzhiyuan1979 (or: 36641)