A Doctor-Patient Relationship Built on Candour, Mutual Understanding and Empathy Is a Key Guarantee of Efficacy

Once, when invited to see an out-of-town patient, I met a family member over seventy. During our conversation, the older man told me: "My only hope is to ease my wife's suffering. Her cancer is already at an advanced stage; to demand that doctors cure her would only make things hard on them."

Hearing his words, I was deeply moved. It was one of the most considerate things I have ever heard. Because of his attitude, I dared to treat his wife boldly, and the results were decent. The dignified bearing of such a patient's family is a great comfort to me.

Other family members ask questions I simply cannot answer. They want to know whether I have a way to eliminate the patient's suffering, and if so, how long it will take. Given medicine's inherent uncertainty, I think both Chinese and Western physicians, young and old, encountering such patients or families can only smile bitterly to themselves.

Still other families conceal the true condition from the patient. For example, families of cancer patients often, for various reasons, fear telling the patient the truth. They not only demand that doctors solve their loved one's problems, but when the patient—unaware—becomes angry and distrustful at a relapse, they pour all that anger onto the doctor.

I once went to Nanjing to see a patient with cancerous ascites in her own home. Her two daughters had told her only that she had a common "bloated belly." Right in front of me, the old lady cursed every local Nanjing doctor who had treated her, complaining that they could not even cure a simple belly bloating.

My prescription caused a minor adverse effect, and the old lady flew into a rage; her daughters joined in, hurling every kind of acid remark at me. Helpless, I refunded the pathetically small consultation fee the family had paid, and have since blocked every member of that family, wishing them well in finding someone better.

Because of my modest reputation, when I worked at a hospital, a patient came to register; the front-desk nurse required registration before consultation. The family insisted on first "inspecting the goods"—seeing me in person—before paying. The triage nurse refused to escort them to my office, and the family member actually threw a fit, kicking the door hard.

There are also patients who, without a word of notice, burst into my private residence to see what I look like. As a young TCM physician I do not take it personally; I simply list such families in a special category in my mind, and avoid seeing them if I can. I take no money from such families; since I cannot afford to provoke these lords, I can at least avoid them.

Doctor and patient share an extraordinary cooperative relationship. While the patient entrusts his life and health to the doctor, the doctor entrusts his own and his family's safety to the patient and family. Since ancient times, medical disputes have never ceased.

A teacher I once studied with told me, the first time she supervised me clinically, that two things matter greatly in being a doctor: first, ensure the patient's safety; second, ensure the doctor's own safety. She went on to say that during her medical education, she had read a foreign medical textbook describing how the consulting room door should open and how to escape quickly if attacked by a patient.

Another elderly physician I once hoped to study with, at our first meeting, showed me the court judgment by which he had been imprisoned after a medical accident, warning me that if I chose this path I must be mentally prepared and act with extreme caution.

US medical statistics show that difficult patients make up about 15% of all patients. These difficult patients, for various reasons, treat doctors very roughly. That is, no matter how well a doctor performs, he cannot satisfy these patients.

Doctor-patient disputes are a global phenomenon; in countries with good legal systems like the US, they are usually settled in court. America sees a flood of medical malpractice lawsuits every year, and some lawyers specialize in them.

To be honest, most medical workers, myself included, should first think of protecting ourselves and our families, and only then of treating the patient. I now often directly or indirectly refuse many requests for help—partly because I genuinely cannot fit them into my schedule, and partly because, for some, I decline out of personal safety concerns.

Chinese residents' understanding of medical efficacy often comes from fictional TV dramas. Some god-making dramas make curing disease look absurdly simple, like the hit "Divine Healer Xi Lai Le." As a result, many people believe that if only they find the right doctor, even the most hopeless disease can be cured.

Once a patient's daughter told me she believed that as long as she found the right doctor, her mother—with advanced gastric cancer and liver metastases—could definitely be saved, and that I was the kind of doctor who could save her. On the spot I denied being that miraculous.

Honestly, every apparently good result I achieve comes both from my own blood, sweat, and exhaustive effort, and from the patient's own luck.

I do not believe there are miraculous doctors in this world; I have, however, seen plenty of self-promoting "miracle-mongers." For a few years I took pleasure in exposing their lies. A few of them, having caused deaths under my nose and with their personal details in my hands, feared me greatly. But later I stopped this work, partly because such charlatans are multiplying, and partly out of concern for my own and my family's safety.

Every outstanding doctor relies on extensive reading of the literature, exchange of experience with peers, careful and deliberate clinical prescribing, and tireless follow-up of patients' responses—never on some magical, occult secret.

For a patient to get well, he must build firm trust with his doctor, and fully understand and accommodate the doctor's way of working, in order to receive careful treatment and long-term follow-up.

Even for a minor illness like the common cold, no doctor can promise a 100% cure, let alone guarantee results within a set time. The one thing I have been sure of since studying medicine is that medicine is inherently uncertain. With every prescription, the doctor himself walks on thin ice, only relaxing when he sees the patient improving.

As the ancients said, some fools, after three years of studying medicine, dare to think they know everything and believe no disease is incurable; only after three years of real clinical practice do they realize they know nothing—that too many diseases cannot be cured, and that the books they read are basically worthless.

A liver cancer patient once came to me, saying he had sought out every famous liver-cancer specialist in China, spending about a week with each; when his tumor did not obviously shrink, he called each a fraud. After listening to his rant, I decided not to make a fool of myself, because I knew I would be the next he cursed. So after a few pleasantries, I told him my experience and learning were shallow and asked him to seek someone better.

A patient once told me that doctors need medical ethics, and patients need "patient ethics." It was the first time I had heard the word "patient ethics," but on reflection she had a point. A contentious, unreasonable patient is practically committing suicide; few doctors dare to risk treating such a person.

Treating yourself and your family as God when seeking a doctor is surely wrong. Some patients and families engage in extreme self-protection, wantonly trampling on the doctor's dignity and personal safety. The result is that they become, in the doctor's eyes, troublesome clients to be handled cautiously, with risks avoided whenever possible—effectively resulting in slack, substandard care.

For the patient, this is absolutely the worst outcome. In doctor-patient confrontation, the doctor appears to hold the strong position, but in China is actually in an absolutely weak position.

There are naturally more patients than doctors; and a sick person is essentially a person in misfortune, easily arousing cheap sympathy from all of society. This cheap sympathy means the public likes to stand on the moral high ground and pity the patient, while not helping the patient medically or financially, and instead expecting doctors to act like philanthropists.

That makes it easy to understand public opinion when medical disputes arise.

We should understand from birth that some things in life are essentially cruel. Being ravaged by disease is one of them; even parents cannot relieve us of our illness. A doctor's heart should be as a parent's, but that does not mean a doctor can solve the patient's problems 100%. When ravaged by disease, one should avoid complaining about others.

Recently, while in Shandong, I saw a cancer patient under thirty. He asked me why he had cancer. I told him that cancer at his age is largely due to the law of natural selection operating as the human species evolved: his genes were not the optimal genes, so elimination in the evolutionary process was all but inevitable.

Such an explanation may seem cruel, but it helps the patient see reality clearly, set a proper attitude, stop blaming heaven and others, and thus respond better to treatment.

Another patient I saw, with colorectal cancer and liver metastases, searched for her own cause, attributing her illness to the harm done by her husband and mother-in-law. She had been married little over a year; from what I know, colorectal cancer takes many years of chronic progression to reach liver metastases.

Before me, this woman tearfully denounced how her husband and mother-in-law had bullied her. As an onlooker, what I saw was her own acid, bitter side. I had to point it out, not too politely, telling her she should first learn to treat others well before she could earn their respect and love.