How My Patients Should Communicate and Cooperate with Me to Improve the Success Rate of Fighting Cancer

Recently, the father of a neuroblastoma child asked me: he had seen the other children being treated alongside his own at a certain hospital undergo explosive relapse and death, which frightened him. He asked me how the probability of such relapse and death could be lowered.

This is a question many cancer patients want answered, and one I myself have long been exploring. Honestly, the way doctor and patient relate and communicate does affect outcomes to some extent. But medicine carries inherent uncertainty; even a doctor who does his utmost cannot guarantee a good result, and only some fortunate patients achieve one.

So how can doctor and patient work together to raise the probability of successful treatment?

First, doctor and patient must build a relationship of mutual trust and respect, communicate frankly and openly, and stay in close contact.

Among the cancer patients I have treated over the years, a few had almost no communication outside in-person consultations yet achieved surprisingly good results, but these are rare exceptions. Most patients' outcomes are safeguarded by frequent communication and close observation.

In The Silence of the Lambs, when the heroine Clarice Starling begins investigating Buffalo Bill, her superior tells her she should first get to know the victims, familiarize herself with the environments in which they grew up and lived, and develop a 'feel' for them, so as to help her solve the case.

A physician treating illness likewise needs to develop a 'feel' for the patient in order to serve them better and work out a personalized treatment plan. Objectively speaking, my more successful patients are mostly those with whom I have a close relationship.

I am ashamed to admit that, with an ever-growing patient load, I have not truly developed a 'feel' for every patient. Only those who make a strong impression stay on my mind as I keep thinking about how to solve their problems; many patients I have seen just once are basically forgotten.

I have some misgivings that I believe many colleagues share. Since ancient times medicine has had the rule that 'the physician does not knock on the patient's door.' Many patients see us once but may not trust us, and if we take the initiative to contact them it looks like we are 'pitching' to them, as if treating a visit were a 'transaction.' So we generally wait for patients and families to report back to us.

Meanwhile, some patients and families may hold back from reporting to the doctor for fear of disturbing or offending him, which makes communication less smooth. Add to that the doctor's genuinely busy schedule, and there are always people who want to chat, taking up precious time that should be used to save lives. The result is insufficient doctor-patient communication: the doctor cannot learn about each stage of the patient's change in time and misses the best moment to adjust the treatment plan.

I hope to reach some consensus with my patients and their families on this point: for patients whose condition is not yet stable, keep in touch with me at least once a week. I will not charge for such communication, but I hope patients and families take the initiative to contact me rather than my contacting you. For one thing, I genuinely cannot remember each patient's situation. For another, I do not know whether some patients have already lost confidence in me and gone elsewhere. After all, I am an ordinary person, not a god, and cannot make every treatment effective. If a patient has already changed doctors, it would not be proper for me to keep contacting them.

I will also try to reduce my patient load, limit the meaningless drain on my time from casual inquirers, and free up energy to meet the need of my long-term patients for frequent communication, so as to improve outcomes and do my best to save lives. After all, for a physician life comes first; only by taking one's work seriously and standing guard over the patient's life can one be a competent doctor.

A good memory is not as good as a jotting. From now on I will keep memos and logs of my work, carefully recording the dates and content of communications with each patient and family, noting which patients' problems I have not yet solved, and building better work habits. Whether a patient's family is poor or wealthy, as long as they sincerely trust and respect me, I will treat them all equally.

Medical geniuses may exist, but I am certainly not one; miracle doctors may exist, but I am certainly not one either. When it comes to treating illness, I personally believe that patience and meticulousness are more reliable than exceptional talent. In most cases, only by closely watching the patient and interacting frequently can outcomes improve.

I must do some self-criticism: in the last year or two I have taken on too many patients, and my work has begun to trend toward assembly-line processing. Once a patient leaves the clinic I often no longer recall what they look like. This is not the medical model I want, nor the way I used to serve patients. Going forward I will strictly control the growth of my caseload, take better care of those already under my care, and be more thorough in turning away patients for whom there is no hope.

But I also hope some patients and families know when to stop. Some problems are world-class medical challenges; especially certain problems of end-stage cancer patients are beyond medicine's reach. I will work hard to find solutions, but at the same time families need to remain rational and restrained, not growing resentful and dissatisfied because these problems cannot be solved.

I also hope for understanding from some general readers. Many readers want to talk with me about life, ideals, religion, and philosophy. I occasionally write reflections on life and reading in the hope of easing the tension of my patients and families, not of debating grand topics with anyone. If I were lost in grand talk, many people who pin their hopes on me would lose their lives. Some even harbor resentment because I refuse to engage them, and at worst hurl abuse to vent their anger; that goes too far.

Second, and equally important: patients and families should not pin all their hopes of recovery on medicine; they must also do their own homework.

For example: some neuroblastoma children are glued to electronic devices that harm their condition; some cancer patients keep smoking and drinking as before; some families of patients with primary or secondary liver tumors disobey medical advice and feed greasy, hard-to-digest foods; some obese cancer patients refuse to control diet or increase exercise to lose weight; some cancer patients and their families keep losing their temper and making the home environment a wreck. All such behaviors harmful to recovery must be corrected by patients and families themselves.

Many cancer patients and families think that as long as the doctor prescribes the right medicine, all their problems will be solved. That is not so. Recovery from cancer certainly needs the doctor's help, but it also requires the patient to follow medical advice, adjust dietary, exercise, and lifestyle habits, improve relationships, and adjust mindset. Only by improving themselves in all directions under the doctor's guidance can they defeat the cancer.

Sometimes certain patients and families leave me at a loss. For example, the family of a liver-cancer patient: I repeatedly told them not to let the patient eat too much greasy food or hard-to-digest meat, but they simply would not listen. After feeding the patient meat, he could not digest it at all and suffered terrible abdominal distension, and then they came asking me what was wrong. This leaves me utterly helpless.

There is a social tendency to ridicule medical advice, especially among the less educated. They will point to someone who ate and drank whatever and still lived to a great age. Such phenomena do objectively exist; some people have longevity genes and live long regardless of how they eat and drink. But few people are blessed with such good genes. The rules doctors derive come from big data and work for the overwhelming majority of ordinary people. To mock medicine because of a few individual cases ultimately harms only the patient.

Third, be sufficiently patient with the treatment and with the doctor.

I have an ovarian-cancer patient undergoing Western chemotherapy; her CA125 was falling, but the rate of decline was slowing. She grew anxious and impatient with the doctor's regimen, demanding a change. The doctor, helpless and under pressure, changed the plan. Afterward CA125 not only stopped falling but rose sharply, her liver function was wrecked, and she had to go to a specialized liver hospital for protective treatment.

Honestly, whether in Western or Chinese medicine, achieving any effect at all in middle-to-late cancer is no easy thing. Patients and families need a rational, clear-headed understanding of this: do not demand perfection, and do not be overeager. Once a treatment works, stick with it patiently; do not change the plan on a whim because you are impatient, or it will often end in tragedy.

Another ovarian-cancer patient of mine knows the one above. When she came to me for pure TCM treatment, her CA125 initially fell very sharply, then the rate slowed, but it kept falling steadily. This patient was calm and simply kept on treating; today she is improving day by day.

I have seen quite a lot and have read case records of all kinds of cancer patients. Many doctors write helplessly in their records, 'At the family's request, added drug X.' I also often meet such patients, who have limited patience and keep instructing me on how to treat them, which leaves me at a loss. Deep down I very much hope they will find someone else and stop making things difficult for me; treating them makes me especially cautious.

Safety and efficacy are the ultimate goals of medicine. Achieving results against cancer is extremely hard; the patient's and family's urgency, though understandable, often does harm. The doctor-patient relationship is sensitive; because human life is at stake, no one dares take full responsibility over another person's life. When patients and families turn aggressive, the doctor can only retreat, which often ends in tragedy.

Fourth, this may not sound pleasant, but it is a very real point: during treatment, patients and families should try not to overdo the pleading of poverty to win the doctor's sympathy.

I am not saying doctors should not sympathize with patients; in reality such sympathy often backfires. I am a person with great sympathy for poor patients, because I once lived a very hard life myself. So when some patients plead poverty before me, my heart goes out to them.

A big mistake I made over the past year was desperately trying to save treatment costs for patients and push cancer patients' medical bills down. My ideal standard was to reduce a child's monthly drug spending to around 1,000 yuan and an adult's to around 2,000 yuan. Ten years ago, when my mother was alive, I spent about 10,000-30,000 yuan a month on her medical care. Ten years have passed and prices have inflated, yet now I am striving to cut patients' spending to one-tenth of what I spent on my own mother.

When I spent my own money treating my mother, I felt no burden; when I spend patients' money treating them, I carry a heavy psychological burden. The result was that some patients who might have been saved ended up beyond help because I was afraid of spending their money. That is effectively giving up on the patient.

Several years ago I had an ovarian-cancer patient who responded well; the tumor shrank markedly under my treatment, but because her family was hard up, I considered cutting out the expensive Xihuang Wan she was taking. Her condition then rapidly rebounded.

Now there is a prejudice that Chinese medicine ought to be cheap. Some patients accept spending hundreds of thousands on Western treatment but feel pained at spending a few hundred yuan on TCM, even though many expensive herbs and patent medicines are not cheap. When certain patients and families plead poverty too often before me, it affects my mindset toward the whole patient group, making me afraid to readily prescribe any expensive herb or patent medicine.

I am now working hard to correct this. For patients whose families are not in genuine hardship, if an expensive herb or patent medicine is called for, it should be used. In treating cancer, bearing a degree of financial pressure is an objective reality; families should be prepared for it. When families plead poverty, few doctors dare risk being held responsible later by prescribing costlier medicine.

Doctor-patient communication is not that difficult; the key is that both sides can put themselves in the other's place and exchange heart for heart. If social prejudices, scheming, and mutual suspicion creep in, treatment becomes a defensive battle between doctor and patient that will delay the patient's condition.

Finally, a word from the heart: doctor and patient depend on each other. These years I have been rolling about on the knife's edge of cancer treatment; without the quiet support of my patients and families behind me, I could not have persisted. Lately I have been working hard to bring myself into the best possible state to fight one difficult battle after another.

That we were brought together in this lifetime by the bond of doctor and patient, and that fate paired us to stay by each other, is something I value. I hope to walk forward in friendship, harmony, and mutual support with my patients and families. Beating cancer is our shared wish; we should pool our strength and go forward together with hope and confidence.

Through this article I hope you will understand me better and know how to get along with someone like me who is not good at expressing himself orally. My speaking ability is indeed far below my writing, which is why I prefer to communicate more effectively with you through articles rather than speech.