Warm Medicine Grounded in Reality

Several years ago I joined a hospital to do both clinical practice and administrative work. I was fortunate to be trusted enough to enter the top management and decision-making body, helping plan the hospital's development direction. At the time I put forward a vision—to practice warm, humanistic medicine that values the care given to patients and their families. Regrettably, though, this wish was not easy to realize: hospital costs were high, and in practice too many things forced me to act against that intention, so in the end my ideal came to nothing.

But that did not weaken my longing for, and pursuit of, such a model of care. As the son of a cancer patient, I encountered many regrettable things while seeking treatment for my mother, so I very much hope I can offer cancer patients a more ideal model of care.

I have kept studying cancer-related expertise, continually reading works of medicine and anthropology to raise my own understanding. After all these years of clinical practice and study, I now have a clearer idea of the model I want. I describe it as "warm medicine grounded in reality." If the timing is right, I may consider founding my own medical institution to realize this vision on a larger scale.

Let me first use one case of doctor-patient communication to describe vividly the model I hope for.

The communication above is, in my view, the ideal doctor-patient model: both parties objective and rational, and mutually trusting.

The consultor's father was a lymphoma patient I had treated, and his whole family recognized the results. Now his father-in-law has been diagnosed with dual cancers—lung and prostate—with bone metastases. He hopes I can help his father-in-law, and his psychological expectations are realistic rather than pitched at an unrealistic level.

This lets me search at ease for the most effective treatment plan for them, and as far as possible, while treating the patient, provide humanistic care to ease the physical and mental burden on patient and family. This is a realistic model of care, and it is the kind I like—friendly and rational, yet warm. I must admit I prefer to serve families like this; though I want to help everyone, in reality that is very hard. In the end we will devote our main energy to serving such patients.

As physicians we need solid professional competence—which demands day-in, day-out study and accumulation—the ability to judge how far a patient's condition has progressed, to outline a basic comprehensive treatment strategy, and to give patients and their families professional guidance.

And above all, we must always hold the bottom line a physician should hold: the spirit of objectivity. If, to please patients or families or to win their trust, we violate objectivity, exaggerating and distorting the truth, then not only will patients and their families pay the price for our actions, but the doctor himself will pay it too—because departing from objectivity plants the seeds of doctor-patient disputes.

Now many doctors like to exaggerate and scramble for patients, and some patients have unrealistic expectations. So I often hear people tell me how this or that doctor promised them such-and-such high and wonderful outcomes. The outcomes promised by certain quacks reach a level that would easily win a Nobel Prize in Medicine; anyone slightly rational would know they are frauds, yet many patients believe such obviously deceptive advertising.

When I consult patients, I am often asked whether I am confident about their condition. Usually I tell them that medicine is uncertain and I cannot guarantee outcomes; most patients with over-high expectations, on hearing this, go off looking for someone better.

Some lay friends, seeing how I communicate with patients, always feel I am not good at communication. That is because they treat medicine as a "business," feeling a doctor should persuade patients the way a salesman persuades customers. In fact a doctor's work is far more complex than a salesman's; if our words lack rigor and contain exaggeration, there are hidden dangers, even risks to our own safety. If being factual loses us patients, then we should accept that loss and not force things.

At the same time, while upholding objectivity, the doctor should as far as possible provide emotional comfort to patients and families. If possible, we should try to ease their tension and do what we can to improve the patient's overall condition. Because a doctor's sympathy and understanding can greatly relieve the physical and mental suffering of patients and families; this affects survival time and quality of life, and improves the family's quality of life.

Doctors must raise both their professional level and their art of consultation; patients, in seeking care, must also remain rational and calm. If a patient is not rational, the doctor should communicate more, telling the truth; if the patient loses confidence and goes elsewhere, the doctor should let it be, and must not lie to keep the patient.

For junior doctors with few patients, this may be hard. But I believe a doctor must, from the very first day of practice, have this awareness and build this habit. Only thus can our professional road grow wider, steadier, and better, and only thus can we offer patients truly high-quality care.