Doctors Need Medical Virtue; Patients Also Need Patient Virtue

A patient once said to me that doctors need medical virtue, and patients also need "patient virtue." It is a fine saying. In our cancer circle, an old brother known as "Shengdi Mei Ya" once wrote an article titled, I believe, "Being a Good Patient."

Today I will write on this theme, sharing my feelings on how patient and doctor should get along to achieve better outcomes.

This morning I rose at four, read and looked up references until six, and after breakfast helped an old patient prepare medicine until eight forty. Then I hurriedly tidied up and began seeing today's patients before nine.

When clinic ended it was half past eleven. I rushed my son to a training center on Zhichun Road for an elective course mandated by the Beijing Municipal Education Commission.

We arrived at twelve thirty, grabbed a fast meal and hurried into the classroom. The child had only eaten half his food, with an egg tart left unfinished, so he had to pocket it for after class.

After rushing about like this, I finally made it to his one o'clock class. Once free, I opened WeChat and saw that an unknown patient's family member, having messaged me and not received a prompt reply, had indignantly cursed me for poor medical virtue and for being dismissive of people.

Another said I lacked compassion and generosity for refusing to prescribe online to treat his illness (I have a principle that I do not prescribe without seeing the patient in person, and I politely decline such requests).

These two have never met me and never paid me a cent, yet they demand my "healer's benevolent heart" to help them.

I understand their feelings, but I have been working nonstop for two weeks without rest; I receive no fewer than two hundred such online pleas a week, and my own daily work is already fully scheduled. I think anyone in my position could not satisfy so many people.

After my son's class today I still have to rush home to prepare tomorrow's lessons, because tomorrow I will teach my students for a full day. This is my weekend. And once the weekend is over, I immediately plunge into the next intense work week.

Nowadays people are quick to use "medical virtue" to coerce doctors; I think this is truly irrational. Most of the time, I help patients wherever I can, because I know patients and their families have it very hard. But when I encounter patients or family members who lack self-restraint in words and deeds, I feel helpless too.

Frankly, when I detect problems with a patient or family member, I have already mentally blacklisted them. After so many years of practice, with patients referring patients until I have too many, this is the only way I can filter some out; otherwise I could never see everyone who comes.

All my patients come by appointment, not by registration. Now I turn away or block those who show up without appointments, those who only vent their emotions without considering others' feelings, those who make an appointment and then no-show, leaving me waiting without even a word of notice, and those who pester me endlessly over trivial little matters. I believe that when patients make demands of doctors, it is necessary for them to examine and reflect on themselves.

I am deeply dedicated to my work and examine patients extremely carefully; no patient is seen for less than half an hour. After each day's clinic I still have to look up many references, research the regimens for critically ill or uncertain cases, and write articles to educate my patient community. Time is truly tight.

The teacher I most admire is also my patient. But seeing how exhausted I am, he often endures his own ailments rather than disturb me.

I often write articles at four or five in the morning and publish them on my own self-media channels. To avoid attracting too much attention and being overwhelmed by patients, I rarely write eye-catching articles to drive traffic, do not publish everywhere, do not buy traffic or ads, and do no publicity. I publish only on my own self-media for my patients to read. Over ninety percent of my patients are referred by patients I have already treated.

Originally I only saw patients on weekday mornings, but there are always people who can only come on rest days; most of the time I accommodate them, understanding how hard life is for everyone. When prescribing I also try my best to save patients money; for the very poor I reduce or waive the consultation fee, because I come from a farming family and know how bitter it is to be poor and ill together.

But I also hope everyone will put themselves in my shoes and not demand too much of me. I am a shy person; however others treat me, I cannot bring myself to rebuke them outright, and even when they curse me I do not fire back a single word.

One reason is that I have no energy to be angry with people; another is that our profession is sensitive—any conflict with a patient or inquirer can easily trigger a doctor-patient dispute. But I have my principles: I filter out those lacking self-restraint and spend my limited time helping people of better quality and kinder hearts.

Also, I earnestly ask every patient who has my phone number never to give it to anyone else.

I have many seriously ill patients, and my phone is basically on day and night. It is on so that if an emergency arises among these critically ill patients, they can reach me at any time.

Yet from time to time strangers call me in the middle of the night to ask about their condition or to come here first to "get a sense of things" before deciding whether to seek my treatment. I am already so busy that I often cannot eat or sleep; when I finally fall asleep and a call wakes me, I cannot rest again.

So henceforth, any patient who gives my mobile number to others without my consent—no matter how close we are—I will no longer treat. Some old classmates, not considering my feelings and troubling me too much, I have already blacklisted several of their numbers, let alone others.

What I need is not more patients but more rest. After all, I am not made of iron, and my body has its limits.

I am by no means the busiest doctor, yet even I have reached such a state of physical and mental exhaustion. Those with even more patients must be far more depleted.

So as a patient, too many unreasonable behaviors and demands are simply irrational. Most doctors, upon encountering such thorny patients, inwardly become wary. In fact, in the end such patients' treatment is the one that gets delayed.

I admit that now I pick and choose the patients I treat. My first criterion is that the patient must trust me sufficiently.

Sometimes patients or family members talk to me about a doctor's benevolent heart. I think that benevolence must first rest on mutual trust; if doctor and patient do not trust each other, how can we speak of benevolence? If the patient doubts the doctor and questions his ability, the doctor treads on thin ice treating him—how then can there be benevolence? Must the doctor, like an old woman selling melons, boast and self-praise to talk the patient into treatment?

Once I went to Weifang, Shandong, for a house call, invited by the patient's daughter. After I arrived, the patient's son, misunderstanding something, came to doubt me and treated me outright with gangster thuggery. To my face he said he would find people to make things difficult for me, that my personal safety would not be guaranteed, and that I would not leave Weifang safely.

I quickly left that family and stopped treating their mother. No matter how much they later begged me, I refused.

Such incidents are common in medicine. Patients or families often gather a crowd to surround a doctor, threatening to beat or kill him. It is entirely normal for doctors to be on guard.

So without trust, a doctor-patient relationship should not be formed. Many doctors within the system are pitiful; whether a relationship is formed is not up to them. Any patient who registers at a hospital must be seen, so conflicts easily arise. I worked in a hospital myself, so I know this firsthand.

Regarding China's healthcare reform, I hope one day it will reach the point where doctors have the right to choose their patients, achieving a two-way choice between doctor and patient—not only should patients have the right to choose doctors, but doctors should also have the right to choose patients. If that were so, I believe doctor-patient disputes would be far fewer.

I also care a great deal about the character of patients and their families. I believe patients and families judge doctors the same way; they watch the doctor's every word and deed. In fact, doctors watch the patient and family's words and deeds closely too.

Most doctors and patients, before forming a relationship, lack deep understanding, so it is normal for each to read the other through small details.

A doctor must decide what treatment plan to offer based on the patient and family's conduct. If the patient or family is mean and difficult, most doctors will respond by deflecting, to ensure their own safety.

So bullying, aggressive people are the ones doctors fear. Medicine is already a matter of saving life amid high risk; once a doctor feels fear, the patient's chance of being saved drops sharply.

Then there are patients or families who demand guarantees from the doctor; such people also put doctors on guard. Medicine is inherently uncertain. When a patient or family's expectations are too high, the doctor's pressure mounts.

Positive doctor-patient interaction builds mutual trust and eases the doctor's anxieties. Before a patient is cured, whether treatment will work is unknown to the doctor too.

Once a doctor decides to treat a patient, he is already racking his brains for a way to solve the problem. Patients and families should give the doctor a measure of understanding and tolerance. Without that, treatment cannot achieve ideal results.