Some Reflections on Therapeutic Efficacy

Lately I have been turning over a problem in my mind and reflecting on it: why is my own therapeutic result not satisfactory to me?

Many physicians have puzzled over efficacy in the course of their practice. As far as I know, the elder physician Pu Fuzhou, early in his career, once suspended his practice for three whole years because his results did not please him, and threw himself back into studying the medical classics in order to raise his level.

Twenty years ago I researched cough and asthma because I myself had asthma; more than ten years ago I began researching the after-effects of cerebral hemorrhage and the treatment of cancer because my mother suffered a cerebral hemorrhage and stomach cancer.

At first I treated only myself and my relatives and friends. Later, when seeking treatment for my mother, I joined many patient support groups. As we chatted, out of a warm-heartedness I wrote prescriptions for some fellow patients to relieve their symptoms.

Afterward, because I had some results, I gradually gained a little reputation among patient communities. In my early days, when I wrote prescriptions I was cautious and very meticulous; I promptly learned how patients reacted to the medicine and adjusted my approach on the fly, and my results were better than they are now.

Some patients I first treated out of simple fellow-suffering are still alive and well today; quite a few have survived over five years, and some nearly ten.

When I first began treating people I was only in my twenties, with far less experience than now, yet my results were better. Because back then I repeatedly looked up all sorts of references for my patients and would not rest until their symptoms and condition eased, I poured enormous effort into each one. Of the patients I treated for years, every time one passed away I felt deeply bereaved.

Later, a patient's relative from Wenzhou who worked as a reporter urged me to organize some of the medical material on cancer I had read, write it up, and post it in my Qzone for other patients to consult. I thought that was a worthwhile thing to do, and so I did.

Still later, some patients told me that many fellow sufferers on Tianya Hospital and Sina Blog shared their experiences of seeking treatment, and suggested I go talk with them; so I successively registered accounts on Tianya and Sina.

I registered a Sina Blog purely because I wanted to get to know a TCM anti-cancer hero called "Shengdi Meiya" (Toothless Holy Land)—a late-stage cancer patient whose condition, under treatment by the elder physician Sun Bingyan, was controlled and did not recur for more than ten years.

By the time his cancer recurred, Dr. Sun had already passed away, so he had to treat himself with the TCM knowledge he had taught himself over the years, while also helping several fellow patients.

Our stories were very similar, and back then both of us treated people free of charge (I myself only began charging in recent years, after the patient load grew so large and occupied so much of my time and energy that I could no longer keep up my former work); so the two of us felt a deep affinity and corresponded at length through our blogs.

My mother died in 2012. I was devastated and felt utterly incompetent, unable to save my own mother's life. At that time I grew deeply skeptical of both Chinese and Western medicine, shut my blog, and withdrew from the world for a long while.

Before she died, once when I rushed to the pharmacy to buy her medicine I was so flustered that I lost my phone; after that I simply went without a phone for three years. It was not until 2015 that the boy's mother bought me an iPhone 5c and I began using a mobile phone again.

But some of the patients I had treated still reached me through QQ. They trusted me and pinned their last hopes on me, so I had to keep on treating them. Fortunately, many of those patients are still alive.

I did not at the time think my results with them were anything remarkable. Only after seeing many more cancer patients over the years did I realize that keeping those patients alive so long—while letting them work and live normally—was itself a kind of miracle.

After 2015 I again opened accounts on several online platforms. As my reputation grew and my patient load swelled, the energy I could give each patient shrank. Honestly, my results did not improve as my experience broadened; they actually got worse than before.

Moreover, overwork and the constant encounter with extreme netizens—there are always some utterly unknown, vicious-minded people who, because I cannot meet their demands and because they are anonymous online and bear no responsibility, heap abuse on me when they consult me.

By the way, let me warn some of the disgusting among you: I may well publish your WeChat accounts and chat records. My articles circulate among people I know; I believe some of my readers will recognize you—perhaps even be your relatives or friends. Do not think that your moral corruption online comes without a price. Please discipline yourselves and behave like civilized people.

I answer so many of your consultations free of charge, and the moment I refuse because your demands are excessive you throw a tantrum. The internet is not a lawless land. You are a grown person; what is the point of constantly behaving at such a low level?

Invariably, the ones who hurl abuse are enquirers who have never paid a cent. Some people's quality is simply that low; the environment for Chinese physicians is grim. To this day, not a single patient who has actually consulted me in person has abused me. I am confident my professional conduct is solid.

All of this bred burnout in me. It was quite unexpected—I had originally been full of passion for medicine.

These things led me to reflect deeply: when a doctor treats a patient, what on earth determines the efficacy?

Experience matters, certainly, but the key is really how seriously and carefully the doctor treats. If I could reduce the number of patients and enquirers and spend more effort on a few long-term patients, the results would be entirely different.

This year I closed my accounts on multiple platforms, keeping only my personal website and my WeChat official account.

The personal website's server is unstable and often goes down, so for the safety of my article data I need to store my writing in at least two places. Hard-written articles deserve a backup.

Most of the followers on my WeChat official account are patients I have treated and their relatives, friends, or fellow sufferers—but there are also a few of unknown provenance.

My patients need a convenient channel to read my articles and learn some knowledge to support their treatment; I should provide that convenience. After all, I do not have the time and energy to explain, one by one, the cancer-related medical basics they urgently want to know.

I also cleaned out about two-thirds of my WeChat contacts. Those I deleted were mostly enquirers I had never met and who refused in-person consultations, plus a few patients who had passed away or their relatives. I am very cautious about adding new contacts. I have sharply cut my unproductive workload and once more concentrated my energy on patients under long-term follow-up.

Two days ago, six of my patients came together for follow-up visits. These six all know one another as cancer patients; five of the six, after my treatment, showed varying degrees of stage-wise or sustained benefit—tumor markers falling, tumors shrinking, symptoms improving.

Only one, treated for three months, had progressive disease, but his strength and weight had clearly rebounded. This patient has not given up on treatment with me, and we are now discussing adjusting the regimen to make another push.

Why such a high response rate among this group of patients referred by one another? Honestly, it is because there is a very solid foundation of trust between them and me. We can communicate fully; I can devise ways to solve their problems; and they do not question my ability.

They basically all live near Qilihe in Lanzhou, having met one another through practicing exercises in the park and through treatment at the same hospital (the Joint Logistics Force Hospital).

Some people I had treated earlier were their acquaintances; coming to me through such personal referral, they had no doubt of me from the very start.

I in turn trust them, dare to use medicine boldly, and communicate with them more than with other patients—hence the good results.

My results with these few patients were so good that their own Western doctors were very favorably impressed; through the patients they passed word that they would very much like to make my acquaintance.

Among the other patients I have treated over the years, arriving through every channel, many have seen me only once. They come once and do not return a second time, and my results with them are merely so-so.

A doctor treating all patients alike is an ideal. In reality, the degree of mutual trust between physician and patient directly determines the outcome.

In ancient times, without today's advanced communications, a doctor's reputation spread only by word of mouth among patients; his efficacy determined his standing, so trust between doctor and patient was higher than today.

We must realistically recognize that a physician's energy is very limited and the number of people he can serve is not infinite. Only when a physician has enough time to look up references, think through each patient's condition, and exhaust every means to solve his problems can the efficacy be raised.

And a patient, in turn, will entrust his life and health to a doctor only when he has high trust. For most people such trust cannot come from nowhere; it grows only when their relatives have been treated by a doctor with good results.

So, after treating people for more than a decade and earning this small reputation in patient communities, I realize that from now on I must move forward in a contracting way—slowing down, controlling my pace, making time to study and think, and making time to care for each long-term follow-up patient.

With casual, lightly-acquainted patients and enquirers, I must let go. Those who cannot see me in person, cannot follow long-term, or are total strangers to me—I should urge them to see other doctors and divert them away. My main effort goes to the care of long-term patients and their relatives, friends, and fellow sufferers.

If I cannot settle down and put raising efficacy first, I will fail every patient who truly comes to me for treatment. The personal reputation I have painstakingly built will one day be destroyed.

Every patient I treated ten years ago—I knew their condition and personality, even some of their habits and hobbies, intimately. Many patients I treat today, once they walk out the door, I cannot recall their faces within days.

That is deeply shameful. If this continues, my treatment of disease will become assembly-line work, with no very good results.

Every patient who comes sincerely for treatment—especially those who have traveled far—arrives with enormous hope and sincerity. If a doctor, pleading that he is too busy, neglects them, he will not only fail to get good results but will sow the seeds of doctor-patient disputes.

I also hope that from now on all long-term follow-up patients will, when they come, bring photocopies of their medical records and every test report and leave a copy with me for me to study in my spare time. I will do my utmost for your health.

At the same time I must deeply apologize to those patients outside the scope of my work. Out of responsibility both to my patients and to you, I have to decline your requests.

I believe the specialists who devote themselves to your particular disease are better suited to you. Each trade has its master; every disease has its fixed laws. I am only an insignificant TCM anti-cancer researcher, not a panacea.

When my own family develops a disease I am unfamiliar with, I too must turn to other doctors—how could I cure every disease under heaven?

Henceforth I will retire into my own little room, close the door, and serve mainly my long-term patients and the new ones they refer.