Oncologists Have It Hard; It Is Only Natural to Choose One's Patients

Treating cancer is one of the hardest things in this world, and being a doctor who treats cancer is very far from easy.

Every doctor wants to achieve good results for the patient, but for an oncologist this beautiful wish is often shattered by cruel reality.

To this day I dare not claim publicly that I have cured any cancer patient. If a patient or family member asks me what the cure rate is and insists that I tell the truth, I will answer: zero.

Because even among the patients I am currently treating relatively well, I cannot guarantee that one day the disease will not recur. Whether a cancer patient is cured can only be judged when the coffin is closed. Many patients recur after twenty or thirty years.

So I often tell my long-term patients: once you have cancer, you are fighting cancer for life; you must not let your guard down just because you are now in complete remission. The cancer cells are merely dormant; they may be awakened at any time.

But such blunt words are sometimes hard to say to certain patients, because they will crush those with weak psychological endurance. They count on a lifesaver's straw, but being the lifesaver's straw for patients whose expectations are too high is exhausting to body and mind. Oncologists are generally in a sub-health state; the more long-term patients an oncologist has, the greater the pressure.

Oncologists need to spend a long time with patients and their families; it cannot be completed in a single consultation. So if you encounter a patient or family member with an extreme or suspicious personality, that is a disaster. Even if offered a consultation fee a hundred times higher, I would not want to encounter such a patient or relative; joy, health and happiness cannot be bought with money.

I don't know how other doctors think or act, but I myself am quite choosy about patients and their families. I believe a doctor has the right to choose patients, just as patients have the right to choose doctors. To ask a doctor to set aside his own risk and feelings, to respond to every request and accept everyone, is neither fair nor realistic to the doctor; it is naked moral coercion.

I am just an ordinary student of medicine, not a god or a sage; there may be many disgusting flaws in me of which I am unaware. But I am who I am: I must first ensure that my own physical and mental health and safety are not harmed, and only then can I serve society.

As Mr. Wang Xiaobo said, every individual must first be responsible for himself, and only then can he be responsible for the public.

So all my life I will spare no effort to increase my own freedom and ability—if possible, I hope that in the years ahead I can, ever more precisely and freely, choose my patients. I take no pride in this, but I feel no shame about it either; it is a realistic choice.

People often scold me. Apart from telling myself to be on guard against such people in future, I have no reaction; I can't even be bothered to explain. Not answering back when scolded, but returning a blow if struck—this is my bottom line. As long as it does not rise to the level of threatening my personal safety, I can ignore it.

I calmly look at everything in this world, myself included, through an ecological lens. We all live within a self-contained social ecosystem; everything has its function, and even things that damage my reputation have great positive value.

For every patient or relative who takes a questioning attitude toward me, if these negative evaluations of me only reinforce their negative impression of me, that is a good thing for me. A forcibly twisted melon is not sweet; if there is pus, it should be squeezed out early, rather than building a doctor-patient relationship and then making each other miserable.

I advise my readers, before coming to me in future, to look up all sorts of negative evaluations about me through various channels; only those who still have confidence in me after that are the ones truly likely to build a deep, long-term relationship of mutual trust and respect with me. And only with such patients can I possibly achieve good results. As for mutual lack of trust, it is 100% impossible to achieve good results.

I will choose, among patients and relatives, those who are rational, calm and able to accept reality to deal with; I will do so all my life. I know that many TCM and Western-medicine colleagues do the same, only more discreetly. Of course, though I put it bluntly, in practice I too am discreet.

For patients with whom I mesh well, I will spare no effort to think of ways. Though it is hard to cure them, there is still hope of controlling the condition in some of these patients and giving them a very long survival. Strive to let them survive three, five, ten years, or longer. Some may even live out their natural lives like normal people.

But a person who views the doctor through tinted glasses will never have this blessing.

There is a story in the Buddhist canon: a fisherman lived every day with white cranes, and the cranes did not fly away when he approached. Suddenly one day the fisherman conceived the intention to kill and hunt the cranes; before he could approach, the cranes flew away, because they had sensed his murderous intent.

A person may think himself clever, believing he can hide his deepest secrets, but body language—the eyes, the face, the speed and tone of voice—betrays him mercilessly.

Doctors are truly well-traveled people; in a few minutes of contact they can judge the state of mind of a patient and family, and accordingly decide how much risk to take for the patient and how to guard against their own risks—otherwise they cannot be good doctors.

The great majority of my new patients now are referred by patients I have treated effectively (effective treatment does not equal cure) or by their families, so these patients have no trust problem with me at all, and treating them I am relaxed and at my best.

But there really are a few patients who come to me after reading my articles, and among these some are not very trusting. Some are completely skeptical; some half-skeptical.

Honestly, if they told me directly that they are half-skeptical or completely skeptical of me, I would quite bluntly refuse them and ask them to find someone better. It is just that sometimes they disguise their suspicion and want to take a chance with me.

I can understand this state of mind, but I will also guard against such help-seekers. In medicine, from antiquity to the present, there has been a clear maxim: "Do not treat those who do not trust you." So patients who do not trust, or half-trust, a given doctor—I advise you to go to the doctor you trust; do not seek care with a suspicious attitude. Doctors, tempered over their careers, have long mastered the ability to judge the inner world of the person consulting from details.

Deep in my heart I am unwilling to face death. All who practice medicine want only to see the patient's problem resolved and leave with a beaming face. No one wants to watch patients die in agony and see their relatives stricken with grief. So within the medical profession, oncologists who can face death directly are greatly respected by their peers, because they bear the heaviest and most painful responsibility in medicine, accumulating a great deal of negative energy within.

Some patients and relatives of high quality deeply sympathize with this professional trait of oncologists. Relatives often tell me that merely bearing the pressure of one loved one with cancer has almost broken them down, so they can hardly imagine how I calm my own mood every day facing so many cancer patients.

Other relatives or patients, however, think the doctor should bear this pressure for them. Modern people mostly do not want their family members to die at home, because the emotional impact of death is too great; they treat the hospital as their final spiritual comfort.

But how many people realize that medical staff, like ordinary people, are beings with normal emotions? Who wants to be struck every day by the painful thing called death?

I have quite a few oncologists on WeChat, both Western-medicine and TCM; we watch over and comfort one another. Many of the articles I write have resonated with them. Most doctors are not good writers; they may not be skilled at expressing themselves through words, but what is in their hearts is much like mine.

The reason I write such articles is also to promote greater understanding between doctors and patients, less scheming, and less resentment. Disease is our common enemy; only through mutual trust and understanding between doctor and patient can we, to the greatest possible extent, defeat disease.