Trust Between Doctor and Patient Is an Important Guarantee of Therapeutic Effect
There is a gentleman from Inner Mongolia who came to know me through an introduction by an acquaintance. When someone in his family fell ill, he came to me. The first patient he brought me was a lung cancer patient. In only a month or two of treatment, the tumor shrank by about half. After about a year of treatment, although resistance developed, after changing the medication regimen, I once again controlled the patient's condition very well.
Thereafter this gentleman successively brought me more than ten friends and relatives for treatment—a thyroid cancer, a gastric cancer, and two lung cancers. Of these patients I treated, not one failed to respond.
There was also his elderly mother with chronic obstructive pulmonary disease complicated by cardiopulmonary failure, her whole body already swollen; she too came to me. By the time they reached the hospital, doctors had already asked the family to sign the critical-illness notice. With no other choice, he asked me to prescribe.
Because we had dealt with each other long enough, I took the risk and wrote the prescription. Within an hour of taking the medicine, the patient began to urinate freely; after a few days the edema subsided, and she recovered well and was discharged home.
A few days ago, he again brought two relatives to me for severe pustular folliculitis and acne. I am not skilled in this kind of skin disease, but he trusted my medical skill immensely and insisted that I treat them.
These two patients had already seen many dermatology experts at Beijing's top hospitals. In front of the patients, I photographed the affected areas and sent the photos over WeChat to my friend Professor Li, a dermatologist at the General Hospital of the Armed Police. Professor Li guided me, telling me what the disease was in Western terms and how it should be treated.
Then, having learned the disease name, in front of the patients I pulled several monographs on TCM external medicine and skin diseases from the shelf, looked up the TCM treatment, and prescribed a TCM formula for the patients. After going home and taking the Chinese medicine for only a day or two, both patients' conditions improved greatly.
This gentleman was overjoyed and called me with the news, also telling me that the gastric cancer of a friend's father, whom he had recently referred, had seen basically all its clinical symptoms disappear after more than ten days of my treatment.
I myself like treating patients like him and their relatives; now ninety percent of my patients come referred by friends made through seeking treatment, like him.
The reason is simple: these patients have no problem of trust with me, so I can treat them boldly and freely, even consulting colleagues and looking up medical books in front of them, without fearing that patients will laugh at my poor skill. The end result is that patients benefit, and I gain still greater trust from patients and their relatives.
After practicing medicine for a long time, once a patient or patient's family exchanges three or five sentences with me, I know how much they trust me. Generally, when I intuitively sense a patient's skepticism, I gently refuse their request and tell them to seek care elsewhere.
Trust between doctor and patient is the foundation of medicine. Without this foundation, however much sympathy we doctors feel for patients, our hearts are uneasy; we do not know whether the patient we are trying to help will become a medical dispute. Although the Medicine King Sun Simiao said that in the great physician's utmost sincerity, when treating illness the doctor should set aside his own life and safety, in actual treatment I think no doctor truly dares be careless. More often, we are all cautious, as if treading on thin ice, as if facing an abyss.
In the current harsh practice environment, an experienced healer's seeking self-protection is natural. Once the heart seeks self-protection, medication will put safety first.
The core of medicine is really only four words: safe and effective. But sometimes safety and effectiveness cannot both be had; to achieve efficacy, a certain risk must be taken.
When a doctor takes a risk in medication, the patient may die. The frequent physician-violence incidents cannot have no effect on frontline clinicians. Most doctors first consider the patient's safety; after all, when the patient is safe, the doctor's safety is assured.
So today many seriously ill patients who are not entirely beyond hope of treatment are turned away by doctors everywhere. Doctors fear doctor-patient disputes and fear medical disturbances. If they must treat, they only dare prescribe mild, peace formulas, using lukewarm formulas and waiting for the condition to develop naturally—this mostly delays treatment timing.
Last year I was invited to make a house call somewhere. The patient's son, due to a misunderstanding, was very rude to me and almost physically attacked me on the spot. This consultation was very unpleasant, so I withdrew from it to avoid unnecessary future trouble. Later the patient's family sought treatment everywhere for over a year, and the condition worsened daily.
One day this summer, the patient's family suddenly came to my doorstep, weeping and apologizing, even using the most solemn Chinese rite—kneeling—to beg my forgiveness and ask me to continue treating the patient.
I told the family: you have come begging, and I have no reason to refuse; but the shadow in my heart has already formed, and I can no longer freely treat your relative. I can write a prescription, but it must be a thoroughly safe, peace formula; I dare not use any medicine, however slight the risk, that could cure the disease.
In the end, I referred two doctors I considered authoritative on the relative's disease, and sent them to see those two. Trust is gone, and treatment can no longer be meaningful. So not delaying their condition is the most beneficial thing I can do for them, even though the patient's family, seeing me refuse, is deeply hurt.
When I previously took my mother to other doctors, I was refused by several of them, and at the time I found it incomprehensible. But now, when I myself face countless supplicants, I also gently refuse many, who may also find it incomprehensible.
Why refuse? Because from their words and behavior I have already sniffed out thick distrust. Many come to me for consultation with a skeptical attitude; their every word and deed tells me that our medical affinity has not yet arrived. Rather than reluctantly treating them, it is better to gently refuse, to avoid future trouble.
I often meet patients who frequently change doctors, and I generally gently refuse them too, because such patients, by their character, are generally not good at trusting people. Since they cannot trust other colleagues, they probably will not trust me either; the earnest attitude when seeking care will not last long, and such consultations mostly end in failure.
I have been feeling out the boundaries of my own ability and the boundaries of dealing with patients. Some patients I dare treat boldly, even joking with them freely; some I dare only communicate with cautiously; still others I only dare escort to the door.
The Wudeng Huiyuan records an anecdote about Chan Master Zhaozhou Congshen. It is said that one day Wang Rong, the Jiedushi of Chengde Circuit enfeoffed as King of Zhao, came to Guanyin Yuan to visit Congshen. Congshen, seated on his meditation bed, asked Wang Rong: Does Your Majesty understand? Wang Rong answered: I do not. Congshen replied: Since childhood I have kept the fast and my body is already old; seeing people, I lack the strength to descend from the meditation bed. Hearing this, Wang Rong was greatly enlightened and treated Congshen with even greater respect.
The next day, a General from Zhending came, and Master Congshen descended from the bed to receive him. The attendant asked Master Congshen: When the King came, the monk did not descend from the meditation bed. Today the General came, why do you descend? Congshen said: It is not for you to know. When the highest type of person comes, I receive him on the meditation bed; when the middle type comes, I receive him descending from the meditation bed; when the lowest type comes, I receive him outside the three gates.
This anecdote is quite profound. When each of us receives and treats people, we inevitably differentiate. Some people have good cultivation, high quality, and self-discipline; however casually one treats them, it is fine. But others have mediocre cultivation and must be treated politely. Some who could be called rough need not even be polite—on the contrary, they must be treated with great deference.
Doctors treat patients the same way. The more polite and deferential, the more alert and fearful the doctor's heart. So anyone who usually pays attention to his own cultivation is doing no bad thing. At critical moments, what can truly help us is not our wealth or social connections, but the personal aura that radiates from our own cultivation.
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