Vigilance Day and Night, Reverence for Life: Reducing Medical Risk
The renowned Qing-dynasty physician Xu Lingtai described his own state of mind when treating patients as “standing as though on the brink of a deep abyss, as though treading on thin ice,” and I believe the great majority of clinicians would deeply resonate with this. Whether in Chinese medicine or Western medicine, which doctor does not fear that something may go wrong with a patient?But medical risk exists objectively. Medical treatment is an action that may bring trauma and harm to the patient. Left untreated, a patient may die; treated, the patient may still be harmed, and some may even die on the operating table. Moreover, during treatment a patient may fall ill from other causes—improper diet and daily routine, climatic changes triggering another illness, epidemics causing infection, or other behaviors that may endanger health and even threaten life at any moment. Therefore, closely observing and monitoring adverse reactions or sudden symptoms during treatment, and weighing the benefits and harms of medical measures, are problems that doctors and patients must face at all times.Doctors grow more cautious the longer they practice. The ancients said, “A physician does not knock on doors,” meaning a doctor must not proactively seek out patients and offer to treat them. For if an accident occurred during treatment, the doctor who had volunteered would bear greater responsibility, and when the patient’s family blamed them, they could neither give a proper account nor clear their own conscience. “The physician does not knock on doors” exists to avoid such trouble. For this reason, when acquaintances often ask me to proactively contact patients they have referred for treatment, I never do as they suggest.Yet in medical practice, merely not knocking on doors cannot dodge the omnipresent risks. Differences in patients’ constitutions, and the inherent risk and uncertainty of medicine itself, all determine that in treating patients we can hardly avoid risk entirely.Risk is unavoidable, but it can be minimized as far as possible. The closest observation of changes in the patient during treatment by both doctor and patient is the most effective way to reduce medical risk. Patients should actively report to the doctor any adverse reactions during treatment, and the earlier the better—taking countermeasures at the first sign prevents serious consequences. Doctors must also patiently listen to patients’ feedback and earnestly reflect on the causes of various situations arising during treatment, seeking solutions without the slightest ambiguity.The responsibility of guarding life is weighty; the patient’s life and safety always come first. One of my teachers, when training me clinically, would repeatedly murmur to me: “When patients are safe, the doctor is safe.” Her hair was white; she had practiced clinical medicine her whole life, and this refrain had already merged into her blood.I once did not quite understand why experienced doctors would rather sacrifice therapeutic effect to ensure safety, prescribing “peace-preserving” (taiping) formulas. I felt such conduct was unfair to patients and would delay their chance of recovery. But now I deeply understand: when we can treat a patient safely and steadily, we should do so as safely and steadily as possible—preferring slower effect and a longer course rather than gambling with the patient’s life.Beyond caution, doctors must strive to improve their knowledge and skill; only thus can risk be better reduced. One must not become arrogant after learning only a smattering, nor hold to sectarian prejudices. Those who practice medicine should broadly study Chinese medicine, Western medicine, and biology, drawing upon all schools and continually refining their craft. The medical profession demands lifelong learning—both deep specialization and broad erudition. I do not agree with the current mutual denigration between Chinese- and Western-medicine practitioners. Western-medicine doctors should learn some Chinese medicine, Chinese-medicine doctors should learn some Western medicine, and both should study biology and other basic sciences well. This is responsibility both to the patient and to oneself.Only by learning more can one better recognize disease. In clinical work we must have the ability to recognize disease—some diseases are our specialty and may be easy to identify, but others are not and are harder to recognize. How to improve this ability? Read more literature, learn more from other doctors’ experience. The more you learn, the stronger your clinical recognition, the lower the probability of accidents in practice, and the safer both the patients served and the doctor themselves.If we do not understand a disease, we may misdiagnose or miss it—clinical misdiagnosis rates are very high; statistics show outpatient misdiagnosis rates exceed 50%. A great many doctor-patient disputes arise from misdiagnosis and missed diagnosis. Therefore reducing misdiagnosis and missed diagnosis not only helps patients resolve their problems in time but also raises the doctor’s professional safety margin.Even if a doctor accomplishes all of the above, over a lifetime of practice it may still be hard to avoid risk entirely. For in medicine there is no 100% safety, and no doctor wins every battle. This requires the public to raise its scientific literacy, understand the nature of medicine, appreciate the difficulty of medical work, and be more tolerant of doctors. Only then can the doctor-patient relationship become more harmonious, doctors grow better and serve patients better, helping them guard their health and lives.