Understanding Doctors' Rigorous Way of Speaking

A mother of a child patient contacted me, saying that her child's Western attending physician had spoken about the expected effects of chemotherapy without much confidence. The doctor said they could try chemotherapy but could not guarantee efficacy—not the confident assurance that treatment would surely work, which the family had hoped for. The doctor's rigorous way of speaking made the family anxious, feeling the doctor lacked conviction. So she turned to ask me whether TCM could treat her child. My answer was that TCM efficacy also cannot be guaranteed. At the same time I told her that every conscientious doctor is extremely rigorous when communicating with patients and families, and she should not lose confidence in the Western attending physician on that account. I do not know whether this mother later lost confidence in me as well; her unrealistic expectations of medicine were tormenting her.

Some doctors take full credit for efficacy, vowing with certainty that it will absolutely work, or use intimidation of patients and families to persuade them to accept a treatment they recommend; such doctors are instead untrustworthy. Medicine carries inherent uncertainty; even the smallest ailment has no hundred-percent cure. So those who rashly pronounce on expected outcomes are either frauds or "hobbyists" of Chinese and Western medicine with little clinical experience (or none at all), who have picked up some medical theory from books and then assume things. Such self-satisfied people are especially numerous, and they tend arrogantly to believe that they alone have grasped the essence of medicine, dismissing most doctors under heaven as laymen.

Some people say things like "those who say an illness cannot be cured have not found the technique," claiming that for certain divine doctors there is no incurable disease; such talk is even less credible. But having watched coldly for nearly twenty years, I find that many people believe such talk and such propaganda, and in the end not only waste money but miss the best treatment opportunities.

I originally thought this point was so obvious that it need not be explained to patients and families, but in practice I often encounter those who do not understand it. So frauds always thrive, using a tone of great certainty to make patients believe their sweeping promises.

Robley Dunglison wrote in his History of Medicine this passage on deception in the medical profession: "The belief that some persons possess the power of curing diseases, of producing them in others, and of controlling the operations of nature, are the most ancient of superstitions. Such superstitions are found among every people on the globe. Their wide diffusion proves at the same time that the mind of man is a soil that may be cultivated at will into unlimited credence, especially in those ages of ignorance. There were so many demons in life that ignorant minds could not possibly guard against or escape them... their deception consisted in making use of the threats of the demons, or promises of a better future beyond what society could afford."

Dunglison put this well; the phenomenon he describes is widespread. In every age and every country, many people exploit the desperation of patients and families who, in illness, will turn to anyone, and make false promises to them. Once treatment fails, these people explain that their earlier promises were only meant to build confidence in the patient and family.

Once I said to a patient's family, "If treating disease were as simple as landing on the moon, that would be wonderful." He was amused and said I was joking. In fact I learned that line from the book Saving Breasts, compiled by the Mayo Clinic; I was not joking. Human technology has indeed let us realize the dream of landing on the moon, but human medicine still contains too many unsolved problems.

Earlier I saw Facebook's boss Zuckerberg say he hoped to invest tens of billions of dollars in medical research to conquer all human diseases. I laughed when I read it. The wish is beautiful, but by now humanity has invested far more than tens of billions in medical research. The United States spends 16 percent of its GDP on medicine, yet the diseases we have conquered are still very limited. Moreover, a considerable proportion of the so-called conquered diseases are self-limiting illnesses that would resolve on their own without treatment.

Another time, a patient's family member close to me said: "I see that you medical people can only treat simple diseases; for more complex ones, the results are very limited." I did not take this as an offense at all; on the contrary, I appreciated his rationality. The advance of human medicine has always been slow, and even now the overall level of human medicine is hard to find satisfying. The best medicine is preventive medicine—what we in TCM call "the supreme doctor treats disease before it arises." Many diseases can be prevented; the ideal state is for each of us to learn a little about disease prevention and avoid falling ill as much as possible.

As for TCM physicians who brag about how magnificent historical Chinese medicine was, to delude patients, I personally cannot go along with such practices. When the Medical Sage Zhang Zhongjing lived, plague raged and he was helpless, so that many people died of infection and nine in ten homes were emptied. The Jin-Yuan master Li Dongyuan recorded in his writings the scenes of plague in his day: coffins carried out through the capital's gates without end, no fewer than two thousand a day, and the physicians of the time were equally at a loss. Wang Qingren recorded in Yilin Gaicuo that in his own era, when plague raged, in a single town—Daodi in Luanzhou—up to a hundred children died every day.

We say that Emperor Huizong of Song was devoted to art and governed the state abominably, but we do not realize that Huizong was never entitled to the throne. Had his brother Emperor Zhezong not died young, and had Zhezong's sons not also died in childhood, Huizong would never have ascended the throne in his life—as a prince with no prospect of the throne, his devotion to art was actually a way of preserving himself. The lifespans of Song emperors and princes were not secure, which shows how poor the medical conditions of the time were.

People should read more books; reading more makes one less easily deceived. To encounter an honest doctor is a patient's good fortune. Some doctors, cautious in their wording, may make people uneasy, but they do their utmost in treating patients, and their results are often far better than those of the divine healers who thump their chests and make guarantees. Not deceiving patients and families is a basic professional ethics of medicine; when the doctors we meet speak honestly, it shows they have received a sound medical ethics education.