How Doctor-Patient Mutual Alignment Influences Cancer Treatment Outcomes

The late renowned Shanghai physician Qiu Peiran once said that doctor-patient mutual alignment is an important guarantee of therapeutic effect, and he wrote a long article describing it in detail.

The Huangdi Neijing (Yellow Emperor's Inner Canon), the classic of TCM, also repeatedly stresses the influence of the doctor-patient relationship on efficacy, stating: "The patient is the root, the physician is the branch; when root and branch do not align, the pathogenic qi will not submit. This is what is meant."

This passage means that in treating disease, the patient himself is key, and the doctor plays only a supporting role. If a trusting relationship cannot be established between doctor and patient, and the patient does not actively confront his illness, the disease cannot be cured.

This is especially true of diseases like cancer. Cancer is a major illness; its treatment requires not only close cooperation between doctor and patient on a foundation of mutual trust, but also the involvement of the patient's family. If any of these three parties goes wrong, the outcome will be poor.

This is why I have always stressed that cancer patients should know their own condition: it is a critical guarantee of successfully fighting for survival.

Families often, for various reasons, hide the truth from cancer patients and refuse to tell them what they have. This is irrational. And honestly, no one values his own life more than the patient himself; only when patients know what disease they have can they defend their own lives.

Patients should not only be informed but should also clearly understand their prognosis. Only after being informed, and with the help of professional caregivers, can they build the confidence to overcome the disease and better cooperate with treatment.

From my experience with over ten thousand cancer patients, those who are informed will proactively seek to understand why they fell ill, learn about preventing recurrence, and actively change their lifestyles.

In my own observation, few informed patients are actually "scared to death" by their disease. Yet society is full of articles passing rumors about what proportion of cancer patients die of fear; such articles are very misleading.

On learning they have cancer, patients certainly suffer an initial psychological blow. But by the instinctive human will to live, most gradually calm down and become rational after the initial shock, actively studying anti-cancer knowledge and changing their habits—all of which greatly aids recovery.

The measures taken by the cancer patient himself account for the largest share of the recovery process. One might even say that without the patient's own cooperation and active pursuit of every recovery method, ideal results are impossible.

To date I have seen many cancer patients who survive long-term; some I treated myself, and many I know through various connections. Without exception, these patients know their own condition deeply; some were already at an advanced stage when diagnosed.

These patients share one trait: a deep understanding of their disease, and some know even more comprehensively than certain specialists. Doctors tend to be confined to their own specialties, but patients proactively learn about every field related to their disease.

For example, many Western doctors may never in their lives learn about TCM approaches to cancer, and most TCM physicians reject Western medicine; but most patients have no such "Chinese vs. Western" quarrel. Patients are pragmatists; as long as something helps their recovery, they accept it.

Many patients even actively learn, within cancer survivor communities, about recovery knowledge beyond narrow medicine—religion, psychology, and some branches of natural medicine.

All of this plays a supportive role in cancer treatment. Many clinicians may be reluctant to admit it, but from my own observation I can affirm that this broad learning of anti-cancer knowledge by patients is beneficial.

Cancer recovery also requires a good interpersonal environment, above all a warm family. Family members should get along with mutual affection and calm speech, and avoid frequent, fierce interpersonal conflict.

This requires, on one hand, that the patient regulate his own mindset, and on the other, that the family regulate theirs. Although medicine still debates whether cancer is related to emotion, a relaxed, cheerful spirit definitely helps during recovery.

Over half the patients I have treated live in fierce interpersonal conflict. There are always family members who complain to me behind the patient's back—how violent the patient's temper is, how bad his habits. They think the patient will listen to the doctor, and so hope that while treating the disease we will also persuade him to change.

Most of the time this is rather absurd. From my clinical observation, the complaining family members have no fewer character flaws than the patient themselves; one might even say they are worse. Their behavior and language are extreme, selfish, and inconsiderate of others.

One patient had four sisters who all came to see me during his treatment. Once they had my phone number and WeChat, they would call or video me at any time, regardless of whether I was busy.

Their conversations were basically mutual complaining and endless grievances; as for the consultation fee, they all passed the buck, not one willing to pay. After dealing with such patients and families, I learned that a physician who casually gives out his contact information is acting very unwisely.

People should be good at self-reflection. After a family member falls seriously ill like cancer, whether patient or family, if everyone can repent of their own faults, blame others less, and improve family relations, it greatly helps both the patient's recovery and the family's happiness.

Blaming others is the least rational course. When the body develops a problem, one must actively solve it.

A patient with colorectal cancer and liver metastases once, when she saw me, tearfully denounced how her husband and mother-in-law had psychologically abused her; she believed her illness, after a little over a year of marriage, was caused by their mental cruelty.

I had to tell her that colorectal cancer progressing to liver metastases like hers by no means takes only a year or two. I explained this medical common sense, hoping she would let go of her resentment, calm down, actively seek the true cause, and address it.

Such fiercely conflicted relationships are one hundred percent harmful to recovery. The patient and family should calm down and resolve the problem, creating a harmonious, relaxed interpersonal environment that lifts the patient's spirits and aids recovery.

Another thing that must be mentioned is how patients and families get along with their doctors.

The doctor is unquestionably central in cancer treatment. Once cancer is diagnosed and a doctor is chosen, the patient may work with that doctor for life, until either the patient or the doctor dies.

Most long-term survivors have one long-term treating doctor; frequently changing doctors is never a patient's blessing.

I once saw a liver cancer patient change several doctors a month. After diagnosis he searched everywhere for famous physicians; after a week with no effect he cursed each as a fraud and moved to the next. The result was rapid progression, and he soon died.

Does a doctor's fame matter? It does, and it does not. A doctor who works a lifetime on the medical front lines yet never wins patients' recognition is a sad case—it means his results are poor. But fame built on advertising and puffery is mostly hollow. When seeking care, patients or families should join a patient community and assess a doctor's reputation there; true fame should rest on word of mouth, not advertising.

Most long-term survivors I have seen, when they first presented, had treating doctors who were not famous at all—junior, low-prestige—but patient enough, and their results were better than those of the big names.

After choosing a doctor, the patient should respect him during interactions. Only genuine respect earns the doctor's bold, wholehearted treatment.

Myself, I usually do not readily take on patients who are strangers to me or who do not show respect. Some patients find me from somewhere and consult online without even knowing what I do, demanding my résumé or asking my profession. When I had more time I would reply; now I basically ignore them.

Because years of experience tell me that little trust and cooperation can grow between doctor and patient like that.

Other patients make appointments and then no-show without even telling me. If the doctor waits and the patient does not come, and the patient does arrive later, the doctor gets cursed; but if the doctor waits in vain, the patient and family not only offer no apology but usually do not even acknowledge him. This is a common flaw among us Chinese; I encounter it often. Now public opinion constantly berates doctors for lacking medical ethics, but few notice that seekers of care sometimes have no basic decency either.

I now blacklist such patients outright. Whatever the reason, basic politeness is expected. If even basic politeness is impossible, then our medical karmic affinity was simply too shallow.

Still other patients are overly suspicious and calculating toward their doctors; such patients too find it hard to build good cooperation.

I believe that in today's tense doctor-patient climate, not only I but most doctors take precautions against these types of patients. Except, of course, for Putian-style private hospitals that treat medicine as business.

Most of the doctors I have seen who truly pursue medicine as an ideal are not only responsible but compassionate: they reach out to poor patients when they can, and carefully respect the patient's dignity and self-esteem. But there is a precondition: the patient and family must also deeply respect and trust the doctor.

Cancer treatment is long, and doctor and patient spend a long time together. Treating cancer requires the doctor's utmost dedication; good results require the doctor to take the disease seriously. For the doctor, treating is his profession, but the family, in turn, must act reasonably. If words and deeds go too far, the doctor cannot sincerely pour his heart into treating a particular patient.

Before I had been through all this, I treated cancer patients with full passion. After more experience, I became more laissez-faire. Many patients and families who had never dealt with me thought, when first meeting me, that I was rather hard to talk to.

This, after more experience, is a last-resort measure I take to make better use of my time. I now pick and choose my patients; I do not agree to treat everyone who seeks care. I believe that declining patients with whom a good working relationship is unlikely is responsible both to the patient and to the doctor, and that for society at large it is the best way to avoid wasting medical resources.