Constantly Shuttling Between Two Systems

The first night home on every break, I can hardly sleep well. There are many reasons. On every holiday I usually rush home by high-speed rail after finishing seven or eight classes, so it is already very late by the time I arrive; getting home before ten counts as good, and after washing up it is always past eleven.

Once everything is ready and I get into bed, I have to readjust. It sounds a bit funny, but it is no exaggeration. Since starting school I spend most of my time on campus, so when I return home the bed feels somewhat unfamiliar and I need a period of readjustment.

Spending two days at home on a weekend and then going back, I also need a little readjustment on returning to school. After a long break, school feels a bit unfamiliar too, and I need another readjustment. Middle-aged people are not as good as the young at adapting to such environmental changes.

It is not only the environment that needs adapting to, but also the jumps in medical thinking, which are another major challenge.

For various reasons I studied Chinese medicine first, and I was probably fairly good at it; my clinical diagnostic and treatment level was a bit above the social average—at least that is the feedback from most patients I have seen, though some may have been flattering me to save face. After all, in China everyone is used to polite niceties.

Now I am studying Western medicine, and my Western-theory foundation is fairly solid. This has an objective standard: my professional-course scores each semester have basically stayed above 90 (out of 100), some close to full marks. Many students cheat on exams, but I never do; and the knowledge chains across the various clinical-medicine subjects connect fairly well.

This has left me now doubting both Chinese and Western medicine, often plunged into self-doubt. When I face a patient and am about to apply a TCM method, many Western-medicine notions pop into my head and I question the TCM method I am about to use; likewise, if I am about to use a Western approach, I question it from the TCM angle. In the end I even question medicine as a whole, wondering whether studying it actually helps patients.

Many diseases look fearsome and sound serious, yet these patients' life expectancy is no lower than that of normal people; treatment may relieve suffering, but not treating is no disaster either—for example, our family's chronic enteritis. Other diseases do shorten lifespan, but medicine is helpless against them anyway.

I know my current state is only a phase, one that anyone crossing two medical systems must go through to grow further as a physician. Perhaps after crossing this phase, my clinical skill will take a big leap. But at the present stage there is real discomfort, and it is genuine.

What occasionally pulls me back from this self-doubt is the feedback from patients and their families; when they tell me their symptoms have improved, I feel a little better. After all, being in long-term doubt about one's own value is also very uncomfortable.

When I take my family to hospital, this feeling surfaces again. Doctors at Grade-A tertiary hospitals are usually rushed, and the history-taking is extremely perfunctory. I am sure these doctors are competent, but I cannot help questioning their diagnostic procedures. They received surely the same educational philosophy I did, yet in practice few follow it. In taking a history, omitting past medical history, family history, and allergy history is routine.

To anyone who has studied medicine, this immediately strikes a thorn, because such carelessness usually means missed and wrong diagnoses, and treatment plans built on that basis usually carry risk. Let alone serving patients by shuttling between Chinese and Western thinking—even within their own patch, many doctors fail to farm their field carefully.

But put myself in their place: if I had to see that many patients a day, I might find it hard to be meticulous too. Yet we are different from ordinary patients and families; we understand these diagnostic risks and what iatrogenic harm means, so how dare we risk our own and our family's lives and health?

A teacher of mine recently chatted with me about the diagnostic process of a close relative, and specifically mentioned many regrettable details that were not handled properly, leaving the relative a vegetative patient.

Medicine is such a subject that concerns human life; the more a doctor learns and understands, the more cautious they become, never letting down their guard. In ignorance, people are usually fearless—but that fearlessness is not courage, it is recklessness.

Choosing for the patient the safest, most effective, most economical, most standardized, and least side-effect treatment is always doctors' ultimate pursuit. But achieving that goal is easier said than done!