Beyond Medical Skill, Within Duty, According to Reason and Humanity

Over ten years ago, my mother was treated for gastric cancer at a Grade-A tertiary hospital in Beijing. Her attending physician was an associate professor specializing in medical oncology of the digestive tract, a medical doctor around forty. When my mother returned to the hospital after surgery for inpatient workup, my parents reviewed the daily bills. In the first week, before treatment even began, daily costs ran above five thousand yuan.

My mother asked the attending why the costs were so high. The doctor, impatient and rude, snapped back at my parents: "Hasn't your son's deposit run out yet? Why the hurry? Just cooperate quietly." My parents were furious at his attitude, especially my mother, who felt the doctor spoke almost without humanity.

Not wanting me to spend money so hard-earned, my mother left the hospital that same day against all advice, refusing any further check-ups or treatment. Helpless, I had to bite the bullet and give her follow-up care myself. In fact, for gastric cancer not as advanced as my mother's, integrated Chinese-Western treatment would have worked better. But that doctor's communication skills had left my mother so deeply disillusioned that she refused to cooperate further.

While writing this article, I looked up that doctor. He is now a full professor and doctoral supervisor. I do not know whether his communication with patients has improved over the years, nor whether the students he trains will inherit his bedside manner. Frankly, he has left me deeply disappointed in the doctor-patient communication skills of specialists in our medical system.

He was not the only doctor poor at talking to patients. When I took my mother to see an academician specializing in gastric cancer at a Grade-A tertiary hospital in Wuhan, his attitude was even worse. My mother had only just had her endoscopy report; after glancing at it, he flatly declared that this was already very advanced gastric cancer and she would not live long. When my parents and I, in his office, hoped for more guidance, he barked us out with great impatience.

If I had come to him for free, I could understand that attitude. But I had paid a high price for a special-needs expert appointment, already showing my trust and respect, and he was still like that—it cut me deeply. In fact, the postoperative surgical pathology showed that this academician's reputation was hollow; his judgment was wildly wrong.

Both doctors I encountered are still alive and still work in medical institutions. I am now a doctor myself and can partly understand them, but I still cannot agree with their ways. Perhaps there are simply too many patients and they are frantic with work, so patience runs thin. But such wretched doctor-patient communication shows they are seriously unfit; that they occupy posts as academicians and doctoral supervisors makes one worry about the future of medical education.

I have long hoped that our medical staff would be gentler with patients, with more humanistic care. That hope led me to leave business for medicine, and once I caught the eye of the head of a medical institution, who—kindly enough—made me one of its principal leaders.

What drew me to join that institution was that its head approved of my idea of "practicing warm medicine." But in fact that approval was just the lord of Ye who loved dragons. When I was ready to put my idea into practice there, I realized I had been fooled, and I left.

Yesterday, a long-time reader consulted me because her father had been diagnosed with colorectal cancer. She is from Shanghai, and her father is hospitalized at a Grade-A tertiary hospital there. As soon as we were on the phone she broke down in tears. Her father's attending physician was communicating with her as bluntly and crudely as my mother's attending had with my parents years ago. She felt helpless, frightened, anxious, angry and pained all at once.

A cancer diagnosis in a close relative is a bolt from the blue for any family. Every relative desperately wants more information from the doctor. But many clinicians have no sense of the family's feelings; they will not even show them the basic test reports. This daughter asked to see her father's reports, or to ask whether integrated Chinese-Western treatment might be considered. The attending, somewhat angry, demanded whether she had studied medicine—did she know more than the doctor?—and cut her off.

I explained her father's condition to her in as much detail as I could, told her the current plan was reasonable and that she need not worry too much. I also asked her to bear with the doctor, who was busy and lacked communication experience. I told her the treatment plan was correct. I walked her through the disease's features, her father's current state and prognosis, and how best to care for him and talk with his attending. By the end of the call, the reader's fear, grief and unease had eased considerably.

If we open the official textbooks on doctor-patient communication in China, we find startling numbers: medical disputes are rising explosively, and violent assaults on doctors appear frequently in the news. After each such report, I see many online voices cheering.

I studied medicine out of love for it and am now part of the medical profession; seeing this phenomenon weighs heavily on me. We cannot lay all the blame for the high rate of disputes on patient irrationality—though patient irrationality and non-payment for care do exist. There is also, I fear, a serious communication deficit on the part of some medical staff.

Reading When Breath Becomes Air, I was deeply moved by one line: when the scalpel can no longer help, the doctor must know how to use words to treat the patient. For many patients whose disease is beyond what medical technology can solve, when they turn to us, a compassionate heart—patiently explaining to the patient and family, soothing their emotions as much as possible, and then providing appropriate palliative care—is far more bearable for everyone.

We now one-sidedly equate medicine with scalpel and drugs, treating it purely as a technology and ignoring that medicine's objects are living, flesh-and-blood human beings. Many doctors lack common human warmth and fail to care for the patient's psychology, which ultimately drives the doctor-patient relationship to a breaking point and sometimes produces tragic violence. This is deeply distressing.

Of course, in the course of seeking care for my own family, the great majority of doctors I met were excellent. Some—like the venerable, kindly Professor Huang Xizhen of Peking Union Medical College Hospital—even moved me deeply. She not only treated my relative but patiently answered my questions and guided my own medical study. In the two years my teacher's wife was treated by her, I was almost her half-student; she guided me through much new knowledge.

A good doctor like Professor Huang is surely loved and respected by her patients, but such doctors are increasingly rare. Before taking my medical exams, I read much prep material, often thinking as I read: if doctors were truly held to these licensing standards, I fear most clinicians would not qualify. Much of the medical ethics and communication knowledge people study, apart from exam time, is probably never used at all.

Soothing the emotions of patients and families and explaining disease prevention and treatment in detail is part of a doctor's duty. Treat patients as people, not as cold charts; handle matters with reason and humanity, and few patients will make things difficult for us.

Once I was invited to Qingyang, Gansu, to see a patient I had previously rescued from critical condition in Beijing. He had since returned home, and after a cold had again become critically ill. When I arrived, he was already in the ICU; his attending was busy getting the family to sign a series of legal documents. I understood that attending's position: the patient was about to die, and he feared future disputes. It was also clear that relations between him and the family were strained.

The family asked me to help. When I saw the patient, he could no longer breathe abdominally, only thoracically. A terminal cancer patient at this stage is beyond saving. So I spoke patiently with the family, told them the truth, and persuaded them to follow local customs and prepare for the patient's passing.

The family understood and accepted. They then paid me to escort the patient back to their old village home, so he would not die on the road. I agreed, and throughout did not sign any legal documents with the family.

This patient's family still keeps on very friendly terms with me; when their relatives fall ill, they still come to me. This taught me that in doctor-patient relations, reasonableness matters far more than legality—what legal document can fend off a distraught family member's blade in overwhelming grief? Only the doctor's compassion can both ease the patient and family's suffering and lower the doctor's own occupational risk.

I hope our healthcare system grows ever better, that patients receive ever better care, and that our medical staff find joy, safety and fulfillment in their work. But to achieve this, I fear our system needs a major uplift in humanistic spirit. Medical staff must not only master technical skills; improving communication is equally important.