Seven Rules I Follow to Protect Myself in Medical Practice

Some talented young people in Chinese medicine have asked me to share my experience of self-protection in medical practice. I am a practitioner who took up Chinese medicine late, essentially self-taught. I have practiced Chinese medicine for more than ten years; my virtue is thin and my ability meager, and I have accomplished little, but in my work I have lived through some things and accumulated some lessons. Because of my limited ability, I am not qualified to speak of experience, only of the lessons I have learned, for the reference of my colleagues. I have summed up some truths I worked out from these lessons into seven self-protection rules, written out here; where I am wrong, I hope experts will correct me.

1. Hide your light and do not sing a high tune.

That this rule comes from my mouth is truly ironic: over the years I have written many articles with a large readership, and I personally have been anything but low-profile. But precisely because I once was high-profile, I have deeply come to feel that what a physician needs most is to "hide his light and not sing a high tune." Being high-profile has brought me no end of trouble. My ability and my fame are mismatched; people constantly hear my name through various channels and set their hopes very high, and I often have to belittle myself to them, telling them I am not as capable as they imagine, in an overcorrection.

Now I have withdrawn from many online platforms, keeping only one official account and a self-built personal website, wishing to limit the spread of my writings as much as possible to my patients and their relatives and friends. I do not wish to create more disturbance in society, still less to court the crowd for attention—based on my own experience, attention-grabbing articles often bring the author endless trouble. When I was young I too wrote attention-grabbing articles and paid the price. In truth these thoughts of mine are now wishful thinking; it is already hard for me not to affect others, because so many people spread my articles on various platforms that it is beyond my control.

I have always treated writing as a way of communicating with my patients, and the reason my writings are so varied is related to this. My patients have not only illness but also family problems and personal psychological issues; sometimes an article I write is simply psychological counseling for one of them. But another great lesson I have learned while living in this society is that one may discuss oneself but must not discuss others, for discussing others offends people. So in the end these articles, originally meant to console patients, all turned into self-reflective ones. It is not that I am so fond of reflecting; it is that I do not want to offend others, and only dare to offend myself.

But occasionally one or two articles still get forwarded by influential people and become popular. In the early days of the COVID-19 pandemic, the reach of my series of articles on my official account often exceeded 100,000 views, and my personal website's server repeatedly crashed from too many visitors. This brought me much trouble; for a while there was a lot of online harassment directed at me. I do not want other colleagues to walk this same road.

The medical profession seems glamorous to outsiders, but I believe the firsthand experience of most practitioners is otherwise; we actually live a bedraggled life. Medical problems are the most complex problems in the world; the problems we cannot solve always far outnumber those we can. The higher-profile a physician is, the faster he comes to grief. Not long ago a lymphoma patient of mine told me that while hospitalized she had witnessed a patient's family member chasing and beating a doctor in the hospital corridor. Hearing this, I felt a deep resonance. The public's understanding of medicine and physicians' understanding of medicine diverge greatly. Physicians should not walk to the center of the stage, still less onto an altar; being low-profile is safer.

Occasionally a patient compliments me, saying I are a modern-day Hua Tuo. I feel not the slightest pride but instinctively a sense of pressure. Did not Hua Tuo himself come to a violent death precisely because he was too high-profile? There was a famous Qing-dynasty physician named Xu Lingtai who wrote an essay titled "On Why One Should Not Become a Famous Physician," which details the various hardships high-profile physicians endure. It was words from the bottom of his heart; though he himself was a famous physician whose reputation shook the court and the countryside, he lived his whole life trembling as if treading on thin ice.

2. Taking a loss is a blessing; do not contend with others.

Many of the people physicians deal with have emotional problems—repressed or agitated—and cannot be measured by ordinary reason. I used to think a physician should not swallow an injustice, and sometimes wanted to reason with patients and their families, only to invite much trouble. Now I realize that taking a loss is a blessing and one must not contend with others.

Do not understand a physician's "taking a loss" as acting like a doormat; that interpretation makes it hard to calm the heart. Rather, understand deeply that one of the basic tasks of our work is to learn tolerance, understanding, and forbearance. Those we serve are in a state where they cannot possibly feel happy. Although we repeatedly urge patients to relax, as it benefits their recovery, we should also understand that people tormented by illness and threatened by death are unlikely to truly relax. Moreover, many patients have all sorts of other problems—financial, emotional, children's education, and so on—that may weigh them down; at any time they may vent their emotions on those around them, including medical staff. We can only sympathize with and understand them as much as possible.

It was only after many trials, and not until early this year, that I truly began to achieve this. As a result, in the most recent half year there have been no quarrels on my part. At least no patients or families have come to my face to complain, and I have had no friction with them. I think I have indeed matured a great deal in this respect; in the past there were some minor frictions. Although none of the minor frictions ever developed into a doctor-patient dispute, they more or less brought unpleasantness to myself and to others.

3. Seek truth from facts and stir up as little trouble as possible.

Whether in explaining the patient's condition or the expected efficacy and medical risks, one must follow the principle of seeking truth from facts. This is extremely important. If we are not expert in a patient's particular disease, we must say so frankly and ask them to seek another skilled physician. I particularly dislike the claim that one Chinese-medicine physician is equivalent to a whole general-practice hospital; that claim is pure nonsense. Statistics show there are 20,000 to 25,000 kinds of disease in the world; every physician has limited energy and cannot understand every disease. Infinitely exaggerating the powers of medicine, or infinitely exaggerating one's own ability, only brings trouble to the physician, and may even invite a fatal disaster.

I have taken on several students who began learning medicine with me from primary school, and I repeatedly tell them that when they practice in future they must not exaggerate or distort the facts but must seek truth from facts. We must have a heart of reverence; without it one easily comes to a violent end. Ever since Hua Tuo, physicians have come to violent ends. Hua Tuo was a failed physician; he could not even keep his own life and did not hold the bottom line of medical safety, and he is not worth emulating.

Occasionally I have cured a few non-tumor diseases, but I never dare claim to be very expert in them. I have always treated every seeker cautiously, frankly admitting my lack of expertise in their particular illness. Even so, in the past a few patients with other diseases, after treatment that did not help, cursed me; fortunately their reaction stopped at cursing. This lesson is deeply etched: we never know whether the person we encounter may be someone with a strong vengeful streak; if so, we will suffer. So I prefer to belittle myself rather than exaggerate myself; this is what I now do constantly. Am I someone who likes to defame and mock himself? It is only the unavoidable price of self-protection.

4. Be kind to others, but do not be pedantically naive.

Treat patients and their families as kindly as possible, but do not be so naive as to believe you are a saint. When I teach my students on Sun Simiao's "On the Absolute Sincerity of Great Physicians," I tell them that the spirit of absolute sincerity that Sun Simiao advocated is worth learning and that we should strive toward it all our lives, but we must not become so pedantically devoted as to believe that in reality practicing it eliminates all professional risk.

Being a physician, one must maintain a high level of vigilance; while helping others, one must also be on guard. When you hear compliments from patients and their families, do not get carried away. When they need something from the physician, they will say all kinds of pleasing things, but when they turn against you without mercy, they are capable of anything. If a physician lacks this string in his heart, it is hard to guarantee that no accident will occur.

Love can dissolve hatred, but we must add a qualifier: love can dissolve most hatred, not all. In the real world, there are many people whose inner anger cannot be dissolved by others' caring. Birth, old age, illness, and death are critical junctures at which both the good and the evil in human nature are magnified. Without sound vigilance, do not be a clinician.

5. Act within your means; do not crave great merit.

For some diseases we can only relieve the patient's suffering and cannot eradicate the disease. We should communicate as much as possible with the family, tell them this fact, and not force ourselves to try to cure the patient. Taking one step further often slides from the smooth road into the abyss. In practice I have repeatedly encountered patients whose condition had improved but who, impatient for further results and hoping for more, pushed on with more aggressive efforts and lost their lives. For example, when a patient's pain lessens and appetite improves, they should continue to recuperate for a while and let the body recover before other treatment; but the family, impatient for success, often forces through some risky treatment plan, and all previous effort is wasted.

As clinicians, we should do our best to avoid pushing patients into such situations. There is a classic saying in medicine: sometimes doing nothing is more beneficial than doing anything. Physicians who crave merit and press forward recklessly are the ones most likely to cause medical accidents. If patients and their families are craving merit and pushing forward, we must promptly tell them that we do not have the ability they want. When I was young I may have resisted a conservative approach, but now I feel that moderate conservatism brings patients more benefit than harm, because I have seen too many tragedies caused by aggressive medicine. Always remember: only when the patient is safe can the physician be safe.

6. Speak and act cautiously; hold firmly to the bottom line.

A physician must not sexually harass patients or their families; best of all, do not casually joke with those you serve, especially jokes about sexual relations. A physician must not demand property beyond reasonable medical fees from patients or their families, and should politely decline gifts or red envelopes. A physician must not casually criticize peers, lest, through not understanding their line of thinking, he bring them the trouble of doctor-patient disputes. These bottom lines must be held firm.

Human hearts change easily, and different people interpret the same words or the same event very differently, so we never know whether a joke we once made will become a handle with which they accuse us. I am a very lively, mischievous person; in earlier years I often joked with fellow patients in group chats. Now I have quit every group and try to be rigorous when speaking with those I serve. On several occasions I saw others screenshot my chat and post it online to scold me for speaking casually. I used not to understand why older physicians mostly wear a stern, proper face; now I am becoming such a person myself. The profession requires us to be serious and circumspect in our words and deeds, so we must speak and act cautiously.

Experienced physicians are forged by being scolded—scolded by seniors in the hospital, scolded by patients, scolded by patients' families. After many scoldings, the corners are naturally worn smooth. So be it, then, the scolding! Do not be too precious about your own reputation. The medical vocation is destined to be an imperfect one; no physician in history or today has ever been a perfect person. Do not set your own demands too high, or you may have a breakdown.

Take off the professional garb, return to life, and laugh and talk freely with your relatives and friends! In the working state, your sense of humor must be used in the right place; when speaking with patients and their families, mind your sense of proportion.

7. Stay calm and rational; adapt to changing circumstances.

Medical work is full of variables. The patient's condition may change at any moment, and the emotions of patients and their families may erupt at any time. A physician must stay calm and rational and have good adaptive ability. At the same time, alternate work with rest; when a person is over-fatigued, reaction speed slows considerably.

Do not feel that talking about self-protection is shameful, nor truly believe that the public respects physicians from the bottom of their hearts. Looking at today's online comments, the unfavorable ones toward physicians far outnumber the favorable ones. This social environment has very complex causes, which cannot be explained in a sentence or two, and cannot be changed by one or two people. Never think you are wiser and luckier than other physicians, beloved and not envied; if you think that way, you are not far from a fall.

Since society has already become what it is, we must learn to adapt to it rather than complain. Do not let loud slogans cloud your head; after the blood boils, the mind must sober up quickly, and you must always remain calm, rational, and vigilant. Every practitioner should strive to ensure that medical accidents and doctor-patient disputes do not happen to them. While curing diseases and saving lives, you must also live safely yourselves. Do not just shout lofty slogans; apart from ourselves, no one can truly protect us.