A Physician Needs Three Hearts: Conscience, Carefulness, and Resolve
I believe that a TCM physician treating patients needs three kinds of heart: a conscience, carefulness, and resolve.
A physician without a conscience is a disaster for patients. Doctor-patient relations in China are currently very tense; in the final analysis, this is because corruption in the medical field is too severe. Public hospitals take kickbacks, and private hospitals, especially the Putian-system hospitals, resort to every trick of fraud and deception. All of this stems from physicians' lack of basic professional conscience.
Nearly every physician in China is like a wonder-working immortal, and this is especially true in TCM. Some TCM practitioners love to talk grandly; in their eyes there is simply no such thing as an incurable disease in this world. Yet when patients actually come to them for treatment, the results are often far from satisfactory. A physician's conscience should first of all be reflected in seeking truth from facts: when informing patients, one must be clear, one's words must be grounded in fact, and one must not use tricks to fabricate facts or use sleight of hand to confuse patients, exaggerating one's own skill and efficacy—because such conduct brings only financial return to the physician and does not help patients make the most correct choice.
A physician's conscience should also be reflected in compassion for the suffering. A physician saves the dying and heals the wounded; one should have the heart of a parent toward patients, sympathize with their ordeal, and do one's utmost to consider for them, using the smallest cost to obtain the best therapeutic effect. Lacking compassion, a physician cannot feel the enormous physical, mental, and financial pressure patients bear. To be honest, in the current social environment, even physicians who truly lack compassion may be constrained by their hospitals: hospitals need to generate revenue, and to make a living physicians often have to yield to management systems built on profit, ending up as people who exploit patients. For patients, that is no blessing. Perhaps only when physicians can practice independently will this problem in China have hope of being resolved.
Besides conscience, a physician must also be sufficiently careful. One cannot be careless about a patient's condition. The allocation of medical resources in our country is irrational, and patients tend to worship authority; as a result, some experts carry such an enormous outpatient load that they simply cannot be careful. A patient is usually seen for less than two minutes before a prescription is written. Before the patient has even finished stating the chief complaint, the physician has already reached a conclusion. This sloppy attitude produces a strange phenomenon in China's medical world: the curative effects of many famous professors are sometimes inferior to those of a rural barefoot doctor. Are they really unable to treat disease? I think that if these physicians saw only one-tenth to one-fifth of the patients they actually see each day, their outcomes would improve greatly. Seeing patients is like fighting a battle; with long queues of patients waiting behind, it is truly too difficult to examine each person carefully.
I have indeed seen some older physicians whose thinking is purer than the younger generation's and who examine very carefully. They also have many outpatients, but often, although they hold clinic only in the morning, they drag on until the afternoon or evening before finishing—and as a result the outcomes are relatively good. To judge a patient's condition, a physician must have enough time to understand and think. If this time is too short, one can only skim the surface, and the therapeutic result naturally suffers. Physicians in developed countries may see only two or three patients in a morning, and naturally the outcomes are better.
The last point is resolve. This is especially important in TCM physicians. The ancients said: “If the medicine does not cause a dizzying, mirror-like reaction, the stubborn disease will not be cured.” For major and difficult diseases, medication must be somewhat one-sided, and patients often experience all kinds of undesirable side effects. Some side effects can be anticipated; others cannot. If the moment a patient has a side effect he cries out to the physician, and the physician panics at once and insists on writing a prescription after which the patient feels comfortable everywhere—that is not treating disease, but merely handling symptoms.
A TCM physician treating disease must be bold. After understanding the patient's condition in detail, one must use the medicine resolutely. When undesirable side effects appear, do not panic; as long as the reasoning is correct, resolutely let the patient endure the suffering brought by treatment. Grasp the patient's main ailment and do not let go; resolve the problem that would disable or kill the patient—and that is enough.
I myself focus on treating tumors, and most of the prescriptions I write have side effects. The first lesson I give new patients now is to give them fair warning: I tell them that all kinds of side effects will occur during treatment, and some may be very painful. When this happens, they must endure it; everything should be judged by whether the tumor shrinks or disappears. As long as the tumor shrinks or disappears, a little suffering is nothing.
When a patient complains, if the physician judges from experience that the condition is likely to improve, then upon hearing such complaints one must harden one's heart. A soft-hearted physician, one who loses his head at the patient's laments, is very likely not a truly good physician.