Doctors Who Refuse to Treat Without a Definitive Diagnosis Are Responsible, Good Doctors

I have had low-back and leg pain for three or four years. During these years I have treated myself and sought doctors everywhere. After all, I am not an orthopedic surgeon and am not expert in this kind of pain; a doctor does not treat himself. So, drawn by reputation or searching online, I sought help everywhere.

My patients care about me, and several recommended local, non-establishment orthopedic doctors. Using manipulation, acupuncture, or plasters—various treatments, not without some effect, but none could effect a cure. In all these years, my back and legs have never been pain-free for more than ten consecutive days.

Not long ago I went to a Beijing top-tier (Grade-3 Class-A) integrated Chinese-Western hospital famous for orthopedics and got an ordinary ticket (expert tickets were simply too hard to get). A young doctor received me. After reviewing my earlier tests and listening to my symptoms, he firmly concluded my problem lay in the lumbar spine.

Although I had already had an MRI of the lumbosacral spine at their hospital showing a normal lumbar spine, and the same test at another hospital also showed no problem, he still insisted I have an MRI of the lumbosacral spine.

Frankly, his attitude was hard for me to accept at the time; after all, I had already had two MRIs, one at their own hospital, both normal. But to continue the consultation I had to obey and have the MRI. Their hospital had a long MRI queue, so, reluctantly, I went to their affiliated hospital for the scan.

The result showed my epidural fat thickness reached 8 mm, exceeding the 7 mm upper limit; the overly thick fat was compressing nerves and causing the back and leg pain. With this diagnosis I looked things up myself, stopped going to the hospital, and knew how to manage my condition.

Over the last month, through dieting and exercise, I have lost seven jin, focusing on strengthening my back and waist muscles. The back and leg pain is gone; it has not hurt for about three weeks now, and there are no adverse reactions to cold.

This is the best my back-and-leg problem has ever been resolved in the last three or four years. I am very grateful to this young doctor—he was not worldly-wise and held firmly to principles when handling my case. Precisely because of his insistence, my third lumbosacral MRI finally revealed my overly thick epidural fat.

At the same time, I experienced China's clinical misdiagnosis rate firsthand: along the way, several hospitals failed to give the correct diagnosis. The folk masters my patients found for me confidently declared my problem could be easily solved, but none of their promises came true.

I am deeply grateful to every doctor who treated my back and leg pain along the way. Because in my own practice I, like them, am often puzzled by a patient's condition and cannot solve it despite every effort. So I know how hard medicine is.

But the one I admire most is this young doctor I recently saw—he refused firmly to treat me without the correct diagnosis, insisting I first undergo a repeat examination.

Frankly, in this age of frequent medical disputes, a doctor ordering a patient to undergo a pricey repeat examination carries some risk. If my patients told me they were unwilling to do such a repeat test, I might not dare insist as he did, for fear of retaliation.

This also shows that whether the results of ostensibly high-end, advanced medical equipment are correct depends on the specific technician; missed and misdiagnoses are far too common. Encounter a technically weak or less responsible operator, and the test is wasted.

From my own experience I saw clearly the crucial role of a definitive diagnosis in treating disease, and the difficulty of clinical medicine. For a medical worker to practice well, he needs this rigorous work ethic: no treatment plan without a clear diagnosis.

Minutes before writing this article, I saw a report that a 39-year-old oncology specialist at Fudan University in Shanghai had just died young from overwork. His loss deeply saddened me. Because China lacks medical resources, today's clinicians work very hard, few without overload. I truly hope no other colleague suffers such misfortune.

This incident also reflects, from another angle, shortcomings in China's health cause: owing to talent shortages and insufficient resources, the overall level of Chinese medicine is objectively held back. Every link of our health enterprise is coarse; the quality both of lab personnel and of clinicians needs improvement, so the overall level is unsatisfactory. A patient's outcome depends on the skill of the clinician and lab staff he happens to encounter.

Doctors die of exhaustion, and patients' illnesses are not well treated; medical staff and patients are both overwhelmed. It seems China's health enterprise still has a long way to go before it reaches a level that satisfies and makes happy both patients and medical workers.

In future I will learn from this young doctor I met, and hope more colleagues will be more patient and careful with patients. I also hope patients will understand the hardship of most Chinese medical workers and the inherent difficulty of medicine. If both sides think more from the other's perspective, we can improve medical quality and the doctor-patient relationship alike.