Bai Yansong: Doctors Take the Blame for a Distorted System. What Right Do We Have to Demand That Medical Staff Remain Noble in Such an Environment?
Introduction This is an excellent speech given by CCTV anchor Bai Yansong at the "Peking University Health Science Center Medical and Health Management Forum and the 100th-Session Alumni Gathering of the PKUHSC Hospital Management Advanced Training Program." Addressing hundreds of hospital administrators, Bai Yansong vividly set out the fivefold value of the medical profession in society: the value of life, the value of social solace, emotional value, the value of confidence, and the value of popular science.
Seven years ago, because of a fracture from playing soccer, I had fracture surgery at Peking University Third Hospital. On the operating table the surgeon asked, "Do you have any requests?"
My answer at the time was: "I will be a model patient. This is your specialty; I will leave everything to you." The surgery was very successful. Half a year later I returned to the PKU campus to play a soccer match, and the surgeon who operated on me was there.
In fact, when you trust the other party, the other party gives you more in return. When you start with a suspicious look, you yourself may be the biggest victim. In today's China, doctors and society at large are in exactly such a mismatched relationship. This profession stands between God, the Buddha, and an ordinary occupation Today I want to talk with you mainly about three levels of questions. First, how should we view doctors? What kind of group are doctors?
When people speak of doctors, two words always come up: one is medical ethics (yide), the other is the benevolent heart of the healer (yizhe renxin).
In our society, which occupations have the character "de" (virtue) attached to them? Only teachers and doctors — teacherly virtue and medical virtue. Our predecessors were clever enough to put "de" after these two professions because they uphold the two most important health domains of life: one is mental health, the other is physical health. That is why society demands so much of these two professions. Many doctors today feel wronged: I am doing this virtuous work, guarding everyone's health, yet I still face suspicion. Never doubt, never feel wronged. I must stress again: the closer you draw to the Buddha, the more trials and grievances you endure. Because your responsibility is great, everyone's expectations are higher, and everyone's needs of you are greater.
Why must the healer have a benevolent heart? The medical profession stands between God, the Buddha, and an ordinary occupation. People come to doctors usually bearing pain and despair. In the final analysis, it is less that they come to doctors to treat illness than that they come to doctors seeking hope. We often say doctors treat disease and save lives. Actually treating disease alone would suffice — why add "saving lives"? Treating disease is only treating symptoms, but saving lives is a comprehensive concept. When we face this profession, we overemphasize the factor of life while neglecting the factor of the heart. This is also the underlying reason why many social demands rub against this profession.
In the medical profession, what you see is always one pained heart after another, one pained face after another. Of course, the greatest happiness of a doctor is that patients arrive with pained expressions and, after your treatment, leave with smiles some time later. Therefore, spiritual solace and support were originally an extremely important aspect of this profession, not merely the medical techniques learned over five or six years. Only by combining physiological treatment skills with psychological solace do the eight characters "benevolent healer, treating disease and saving lives" acquire their full meaning. The medical profession possesses fivefold value The value of doctors is reflected in many ways. For example, Chinese people sum up a lifetime in four words: birth, old age, illness, death. I ask you: of these four stages, which one can do without doctors? Tell me, who can be certain that they will never become a patient in their lifetime? If you can be certain you will never be a patient, then go ahead and scold doctors! No one can make that guarantee.
From medical virtue to the benevolent healer, to treating disease and saving lives, all embody the doctor's first and most important value — the value of life.
Is the doctor's only value the value of life? I think doctors also have the value of social solace. Patients have much pain and much torment; relief often comes from the doctor's consolation. Therefore, the mark of a good doctor is not only curing disease but also letting many people feel hope and warmth. That was originally another kind of medical skill. The doctor's second value is to solace society as a whole.
I think the doctor's third value is emotional value, and the fourth is society's value of confidence. By emotional value, I mean that hostility and complaining are almost everywhere in society; if everyone can have a healthy mindset and a healthy state of life, doctor-patient conflict will decrease. By confidence value, I mean that China now lacks nothing, but what it most lacks is trust and confidence. The core of the imbalance in doctor-patient relations is the loss of trust. If reform of this profession can be carried out more thoroughly and trust restored, it will create enormous value for society.
And the doctor's last value? That is the value of popular science. Writing one paper relates to a doctor's promotion, but writing ten popular-science articles has no effect on promotion. How many doctors are willing to do such laborious work? Unless they have an overwhelming moral pursuit and sense of responsibility. Yet every doctor knows that the guidance of scientific common sense helps a great many people avoid illness, fall ill later, or develop only minor illness, and keeps acute illness from turning chronic.
The value of life, the value of social solace, emotional value, the value of confidence, and the value of popular science — I believe the medical profession possesses these five values. But now society has loaded doctors with too much emergency value: whenever an epidemic spreads, whenever a disaster like the Wenchuan earthquake strikes, doctors all become angels in white. Because at critical moments doctors are the stabilizer of social order. But once that period passes, everyone forgets. And then, once again, they start scolding doctors. The key is whether the environment activates the good or the evil in human nature A few days ago I also attended a meeting of the Medical Ethics Committee of the Chinese Medical Doctor Association on doctors' moral self-discipline. Moral issues need vigorous advocacy, but advocacy and self-discipline alone are not enough. Chinese human nature is no worse than it was a hundred years ago, and no better than it will be a hundred years hence; the key is whether the environment activates the good or the evil in human nature.
Today China's moral problems seem too large — for example, the elderly fall and no one helps them up. If an old person falls and you help him or her up, will he or she try to extort you? I believe eight or nine out of ten extortionist old people are Chinese people who have been kind and cautious all their lives. But in China, the elderly's greatest fear is becoming a burden to their children. The moment they fall and find they cannot move, they immediately worry about how much trouble they will cause their children, and their values are suddenly distorted. At that moment, whoever reaches out a hand, they will grab like a lifeline — and may extort them. Once our medical insurance and pension systems are sound, I think this will happen far less.
Therefore, moral problems are often problems of incomplete reform. Decades ago, when two cars collided in China, the drivers got out and fought; why? Because winning or losing determined the compensation. Today, when two cars collide, nobody throws a punch, because everyone is required by law to carry third-party liability insurance. It is clear that institutions can elevate civility.
If a doctor sees fifty or sixty patients in a morning, dares not drink water, and cannot even go to the toilet, how can he listen patiently to every patient? If doing one surgery earns only a hundred-some yuan while the profit on one stent may be several thousand, what do you think? If doing a surgery in one's own hospital pays only a hundred-some yuan, while moonlighting at another hospital may bring in over ten thousand, what right do we have to demand that human nature remain noble within such a distorted system? Frankly, a considerable proportion of today's doctor-patient conflicts are carrying the blame for the slow pace of healthcare reform. If healthcare reform cannot break through quickly, this blame will be borne for a long time.
In easing doctor-patient relations, pressure cannot all be pushed onto doctors and hospital directors.
Science by nature has successes and failures, exploration, and twists and turns. Because of doctor-patient risk and the institutional framework, many doctors dare not suggest risky treatment plans to patients.
So I believe that breaking through China's healthcare dilemma requires change in the whole system. We place all our hopes on every doctor treating patients gently, which is in fact impossible; we still have not entered a virtuous cycle. Lubricating mechanisms and buffer zones are very important. You hospital directors here could try setting up volunteers in the hospital and introducing NGOs (non-governmental organizations). They do not occupy your resources; with a certain amount of training they can provide long-term lubrication and buffering. Why do I feel this way about doctors? Finally, I want to tell a story, by way of closing. Why do I feel this way about doctors? My family once went through such an episode.
The night before I was to return to Beijing after graduating from university and going back to my hometown, my mother told me a story.
My hometown is Hailar in Inner Mongolia. That place is very remote. In the 1970s, my father was in his thirties, always coughing, sometimes with blood. One day he was on a business trip to Tianjin. My mother told him that after finishing his business he must go to the hospital to see his illness. My father went to Tianjin, and only on the last day did he go to the hospital. As a result, he was diagnosed with cancer. The doctor could not bring himself to tell him face to face; he only said, "I'm sorry, you cannot leave; you must be admitted."
My father refused: he had a pile of things to do and had to go back. He took out his ticket and said to the doctor, "This is my ticket back to Hailar today; I have to leave." The doctor said, "Please wait a moment; I will get our leader to talk with you." While the doctor went to fetch the leader, my father slipped away.
That evening, as my father waited for his train at Tianjin Station, the station loudspeaker crackled — someone was looking for him: "So-and-so from Hailar, please come to the station entrance." My father walked to the station entrance, and there in the doorway stood that afternoon's doctor, anxiously waiting for him. It turned out the doctor had remembered the evening train. My father was thus taken back to the hospital by ambulance.
Although my father still passed away two years later, my mother, telling this story, said quietly: "If you meet a doctor like that, plus modern technology, perhaps your father's illness could have been cured."
Fortunately we live now, when there is already enough technology to overcome disease. Fortunately we meet today's doctors, and need no longer wait at the head of every train station platform, but can contact them directly on WeChat. Thanks to the doctors willing to trust us, who even outside outpatient clinic stay in touch with us on our phones. It is precisely these doctors, standing between God, the Buddha, and an ordinary occupation, who help our illnesses be better cured.
(Source: Jiefang Daily)