Mixed Praise and Blame Is the Fate of a Doctor

When I decided to study medicine, I talked it over with an elder fellow apprentice who was already working as a doctor. He earnestly advised me not to study medicine or become a doctor; after so many years in the profession he was thoroughly tired of it. One of his reasons for opposing my choice was that doctors get scolded a lot, because patients and their families are often unreasonable, doctors suffer many grievances, and the occupational risk is high. That is why a saying is popular on the Internet these days: whoever persuades someone to study medicine deserves to be struck by lightning.

And indeed it is so. Once, the family member of a late-stage colorectal cancer patient treated by the senior doctor Kong Sibo came to talk with me. This patient had already had widespread metastases when Dr. Kong took her on, yet Dr. Kong sustained her life for nearly seven years. Later Dr. Kong himself passed away, and to the end he had not cured this patient. The patient's daughter was deeply dissatisfied with Dr. Kong and complained to me: "If you don't have the skill, don't take on the job. If you couldn't cure us, you should have told us early on, so we could have gone to another doctor."

I could only stay silent. I greatly admire that Dr. Kong kept a late-stage colorectal cancer patient with distant metastases alive for six or seven years. I believe that more than 90% of Chinese practitioners of both Chinese and Western medicine would admire this result too—only a handful of arrogant, self-styled mystics might not. But it still fell short of what the patient's family had expected.

I believe that if this patient's daughter had made her attitude clear to the doctor at the outset, I am afraid no doctor on earth would have dared to take her mother on.

In the book The Emperor of All Maladies by the American doctor Siddhartha Mukherjee, the author says that patients and their families expect far more than doctors can actually deliver, which is why oncologists in the United States also carry enormous professional pressure. And it is probably not only cancer patients and their families who are like this; all kinds of patients and families are. If I had not studied medicine, I myself would have been the same. So I fully understand how ordinary people think.

For this reason, being scolded is unavoidable for doctors. A few years ago, when I went on a consulting trip to Guilin, a patient's daughter told me that she had seen many doctors online being roundly cursed, but hardly anyone had yet cursed me. I smiled and told her that only meant my reputation was not yet big enough and I had not treated enough patients; once my reputation grew large and I treated more patients, I would surely be scolded too.

My senior fellow apprentice has a thin skin and is deeply distressed by being scolded. I used to be a person who treasured his reputation as well, and being upset used to hurt me too. But over time I adapted. The people who scold me are countless; most of them are total strangers who have never even met me, and cursing people on the Internet takes hardly any effort. I should be content if I can get just a few fewer scoldings from the patients and families I have actually treated.

Doctors cannot solve every patient's problems. Mixed praise and blame is the fate of a doctor. So a doctor must have very strong psychological resilience. If you get angry the moment you are scolded, you really are not suited to be a doctor, because it will shorten your own life.

As physicians, how could our work and its outcomes ever fully satisfy everyone? We need only ask that our consciences are clear. If a physician has no intention of cheating people and does not say reckless, self-serving things that harm others, I think that is already quite good. Do not raise the standard of medical ethics too high, and do not brag that medical skill is omnipotent. Respecting human nature and the facts is the greatest fairness we can show doctors. As for those who are acrimonious, is being able to keep your distance from them not one of life's great blessings?

Many people impose moral demands on doctors, requiring them to possess great compassion, while setting no high standards for their own moral conduct. This is the typical pattern of "being strict with others and lenient with oneself." Because of the special nature of the profession, doctors mostly endure in silence. As to whether, during the course of treatment, a physician is willing to give his all for such petitioners, that is another matter.

In my early years I felt that a doctor's medical ethics were very important, even more important than medical skill. Nowadays I feel that medical ethics are a very hard standard to measure, and I no longer think ethics matter more than skill. I now believe that while medical ethics are important, medical skill matters more. Patients seek doctors because they want their problems solved. Having ethics alone, without solid skill, is ultimately nothing more than being smooth and agreeable.

So now I have grown used to being scolded and no longer treasure my reputation as much as before, but I study all kinds of medical knowledge with a voracious appetite. Many people not only do not scold me but, even when my treatment does not meet their expectations, they thank me for the devoted effort I put in to helping them. That makes me feel both ashamed and pressed, and fills me with an urgent drive to delve deeper into my craft and improve outcomes. These are good people, and I have an obligation and a responsibility to help them achieve better results, to save their lives or the lives of their family members.

Of course, foxes grow craftier with age, and the longer a doctor practices, the more experienced he becomes. This experience is not only about treating disease but also about reading people. Most senior doctors get scolded less and less. The reason is simple: the moment a patient or family member falls into their sight, they know what kind of person they are and how to deal with them. Troublesome ones are politely declined with a few evasive phrases, wrapped in humility and courtesy so watertight that nothing leaks through. This is called "escorting them out with courtesy," done so as not to invite trouble.

So anyone who harbors malicious thoughts will eventually pay a price. Lincoln said that after a person reaches a certain age, he is responsible for his own face. What this means is that one's psychology and habits shape one's appearance; many people's acrimony is written all over their faces, visible to anyone at a glance. Such people find that, at critical moments, hardly anyone dares to help them. Human beings are born with an ability to discern risk, determined by our instinct for survival. A doctor without this ability could not survive either.