To Become a Competent Oncologist, I Still Need More Than Ten Years

Recently I bought many Western-medicine monographs on oncology. As I read, I felt deeply ashamed, because reading these works showed me how very thin my own professional knowledge of oncology still is.

I once saw a survey saying that among practicing oncologists in the United States, more than half are unqualified. These oncologists not only do not know the latest oncology research, they are weak even on the basics.

That figure is not exaggerated; I believe we in China are no better. The professional knowledge involved in oncology is simply too vast and complex. Even the complications of a single type of tumor come in many forms. When we meet a patient clinically, if we are not even sure which complication a given symptom belongs to, the intervention we choose may well do more harm than good.

In the past I focused on TCM anticancer work and rarely studied Western oncology. Now, forced to, I have had to study broadly all the Chinese- and Western-medicine knowledge of tumors. This study has shown me what a frog at the bottom of a well I was.

Our TCM circle is also overly conservative, even arrogant. Large numbers of TCM physicians write exaggerated articles, belittling modern medicine, deifying TCM, and sealing themselves off. So many TCM practitioners, over time, end up as charlatans.

To be objective, cancer is not a disease that TCM alone can usually treat to especially good effect. I often meet self-important TCM doctors who boast of treating tumors as if they were colds, vehemently belittling modern oncology, elevating themselves and misleading patients. But when one actually tracks their results, one is usually disappointed—and that is most undesirable.

TCM treatment of tumors should learn more from modern medicine, drawing on its research, combining it with TCM theory, and exploring new approaches. The known common TCM anticancer strategies—activating blood and resolving stasis, using poison to attack poison, softening hard masses, clearing heat and detoxifying—are still insufficient to resolve tumors and their many complications.

There are many problems I cannot solve. Sometimes I turn to TCM colleagues; most of the time they cannot solve them either, and often cannot even identify the cause. For many tumor complications—cancer pain, cachexia, superior vena cava syndrome—when we apply TCM's pattern differentiation and disease differentiation to seek solutions, the success rate is not high.

Now too many patients come to me for help, and many are already in the advanced or terminal stage where all doctors are helpless. The patients still have a strong will to live, and the families often have very high expectations.

Some patients openly say they regard me as the last stop in their search for care. Yet even at this stage they still clutch at the last straw. So the pressure on me is also great; at the end of last year I began to develop alopecia areata.

Some patients, tormented by cancer pain or cachexia, urgently hope I can solve their problems and relieve their suffering, yet in practice I often end in failure.

I think on the one hand the patients are indeed too advanced, but on the other hand my own medical knowledge is still not broad enough. Improving my knowledge structure would help raise clinical efficacy.

So entering this year I set aside many unnecessary administrative tasks and, rationally, turned away patients already too advanced to treat, freeing time to read oncology monographs and consolidate my Chinese- and Western-medicine foundations. I must admit that to become a competent oncologist there is still far too much I need to learn.

Treating too many patients and doing too much social activity both make one superficial. Having chosen to study oncology, one should devote oneself wholly. Not seeking quick success, but seeking a solid foundation.

A doctor cannot become a master overnight. Reading the literature, practicing carefully, accumulating over time—a small step each year, a small accomplishment in five, a big step in ten—that is closer to the truth. However gifted a person, learning medicine demands its due blood, sweat and time.

After practicing for a while, the elder physician Yue Meizhong felt his own foundations were inadequate; he set everything aside, studied seriously for several years, and solidly consolidated his basics, after which his results improved dramatically.

You regret the lack of books only when you need them. Every doctor, after clinical practice, finds large shortcomings and wants to bury himself in study again. But under the pressure of life and work, or driven by inertia, few can settle down to read and consolidate the basics.

The elder Yue Meizhong wrote an essay, "On Cultivating the Basic Skills of TCM," in which he said: "The so-called basic skills are those, from nothing to something, from near to far, from shallow to deep, progressing step by step from clumsy unfamiliarity to mature mastery. They are important for beginners. But for colleagues who already have a certain foundation in TCM scholarship, they are also important. Does this mean most must start over from the beginning? I believe it does. The reasons are many, chiefly that the basic skills must be practiced until they are fluent. Read a book a hundred times and its meaning reveals itself; each reading brings gains of a different depth."

I now feel Dr. Yue's words deeply. I have read many books myself, yet with age I find I have forgotten much. Sometimes, sitting on the toilet, I pick up a basic TCM textbook and, reading on, find some knowledge as unfamiliar as if I were learning it for the first time.

Moreover, after more clinical practice, one finds that actually solving patients' real problems is not about mastering how much novel medical knowledge; better clinical results depend on solid basic skills. The most basic things are the most practical and effective.

So a person studying and practicing medicine should allocate time more sensibly. In my current stage, at least half my time should go to reading literature and learning and consolidating my Chinese- and Western-medicine foundations.

In treating patients, one must not bite off more than one can chew. A doctor who is too busy is not a good thing, because being too busy means he no longer has time to read the literature.

I was far too busy over the last few years, and my clinical results were actually not as good as when I had fewer patients. My own experience is that results do not improve simply with more clinical experience; they improve only when one has enough time to study each patient's condition.

Most doctors in our country are now overwhelmingly busy. Many not only have no time to read, but working alone has broken their health; reports of doctors dropping dead from overwork are common.

These past few years my own health has also declined from overwork. Last lunar December, my physical and mental stamina were both at the breaking point; I developed many symptoms and my hair began to fall in patches. Then I made a decision: no matter what, I would take a break for a while. I traveled to Huangshan, Hangzhou and Wuzhen, then went home for the Spring Festival, taking a long holiday. During this time I settled myself and reflected on many things.

I feel that many of the patients I treated in those years would have done better had I followed my old model of treating while researching; but because I was too busy to study each case carefully as before, I, like many famous doctors with a reputation but no substance, achieved only mediocre results. With so many treatment failures, I was also full of frustration and could not feel the sunshine in life.

So I was silent for a long time, settling down to buy and read books, and adjust my rhythm of work and life. After this period of adjustment, the hair I lost has slowly begun to grow back, and my heart is no longer as anxious and pessimistic as last year.

In this life I do not want to fall back into the busyness of those years, nor be crushed under a mountain of work. I want from now on to focus on improving outcomes and lengthening and improving patients' survival. I no longer want to treat diseases outside oncology; life is too short to spread oneself so wide and truly do anything well.

In the past I overestimated my ideals and my ability. Now I only hope to settle down steadily and reach a "competent" level in oncology. In the years to come, I will slowly improve myself.