Who Should Recognize the Value of a Doctor?
If the medical profession were to adopt Taobao's "good-review" rating system, I doubt a single doctor in the world would have a good-review rate above 50%. I used to allow comments below my articles, and the great majority of the messages were flattering; a large part of the reason was that most of those who wrote were kind-hearted readers I had never met. Some readers who were displeased with me never commented on my articles; they preferred to vent their frustrations anonymously elsewhere.So I simply switched off comments on most of my articles—partly to avoid being swamped by endless consultations that would interfere with my work and rest, and partly because I did not want to read a one-sided chorus of praise. I am not the kind of person who grows giddy and self-satisfied in the glow of others' flattery.I want my own work to satisfy me, but regretfully, after all these years I still cannot feel satisfied with myself. I often wonder whether the help I give my patients is really worth the fee I receive. Toil as I do in a despairing field where the results are disappointing most of the time, such doubt is only natural.Before I took up medicine, I was full of expectations for it; after I had immersed myself in it, I was full of doubts about its value; and having passed through both expectation and doubt, I still walk the road of medicine, and in continuing to explore my understanding of it—like my understanding of all sorts of other questions—has come to lean toward the Doctrine of the Mean. It is not as wonderful as I imagined when I was young and ignorant, nor as bleak as I pictured it after setbacks. Medicine has its uses, but its uses are limited.After COVID-19, several colleagues I knew well back in my hometown left medical practice and chose other ways to make a living. Despite the grim employment situation, they firmly walked away from the profession. A large part of the reason was that the pandemic laid bare the serious problems in China's healthcare system; the official-rank mentality chilled many doctors to the bone. After all, many doctors in Hubei paid for that official-rank mentality with their lives this year. But part of the reason was also that the real practice of medicine was not as perfect as they had pictured when they swore their medical oath. Like me, they were seized by self-doubt: have we actually helped our patients?There have been many times when I felt utterly drained and wanted to study medicine without ever practicing it again. My teacher said to me, "Don't forget why you started." So I gritted my teeth and kept going for a while, and as I tempered myself things gradually improved. Sometimes we feel despair simply because we have not walked far enough. Many who study medicine go through a spiritual purgatory in which they deeply doubt the value of medicine and of themselves; some even torture themselves with that doubt for a lifetime, and in the end make themselves ill with depression.After a period of self-doubt, I gradually came to realize that we must not be so harsh on ourselves, nor so harsh on medicine. I have a patient with lymphoma whose condition has recently progressed. I felt that on my own I might not be able to control her disease, so I had her simultaneously seek help from a Western oncologist at the local cancer hospital. When that oncologist learned that she had lymphoma, had been treated by me for more than three years, and was still doing quite well, he was astonished and wanted to get to know me through her.This was a colleague expressing recognition of me, and it gave me some comfort. Colleagues often express their recognition in similar ways. Another of my patients, with ovarian cancer, had all her tumors disappear after my treatment. When she went back for a check-up, the doctor examining her was so surprised that he suspected something was wrong with his own procedure; after she left the examination room he called her back and ran the exam again, refusing to stop until he had confirmed once more that the tumors were gone. Her former Western-medicine attending physician—an oncologist about ten years my senior—has also repeatedly asked her to introduce me to him.I am grateful to these colleagues I have never met; and because of this, others have gone from total strangers to acquaintances and close friends. Patients keep coming to me and telling me they came on the recommendation of this or that doctor.A doctor can hardly make an objective assessment of his own work, and patients can hardly assess their doctors objectively either. Patients who do very well overrate their doctors; those with disappointing outcomes look down on the doctors who once treated them. Medicine makes patients doubt its value—and it makes the doctors themselves doubt it too.I feel deeply grieved that senior doctors are leaving their posts. I regard it as a loss to our society, because they have accumulated rich clinical experience whose value is far beyond money. There is no doubt that the knowledge and skills they hold can help patients—though not all patients. I very much hope these colleagues will not give up clinical work, will not be too hard on themselves, and will stay on to serve patients.Medicine is an imperfect discipline. If we demand of medicine, and of ourselves, a perfectionist standard, doctors will rate the value of their work very low. Such self-assessment will eventually drive some doctors to give up, and will push many into depression—somewhat shamefully, doctors, whose calling is to relieve the physical and mental suffering of others, are themselves one of the groups most prone to depression.I mention that I am recognized by other colleagues not to boast about how skillful I am—most of my treatments end in failure—but to tell colleagues going through the same self-doubt: try not to sink into a state of negativity and pessimism; do not, because of the dissatisfaction of some patients and their families, write off the value of your work entirely; and do not label yourselves with too many negative tags. Personally, I believe a doctor's value should be judged by other doctors, because only doctors know how hard medicine is and how hard-won any therapeutic effect really is.Of course, there are many other genuine difficulties in medical work: some patients or their families are rude, and doctors are even assaulted from time to time; most doctors are sidelined in medical institutions steeped in official-rank culture; the professional risks are high and the working conditions unsatisfactory. These are all very real hardships.I believe that if society allowed doctors to practice freely and to choose their own patients, their professional happiness would soar. Such an idea is not easy to realize institutionally under current conditions, but I believe many doctors are already trying it in practice. After all, allowing only patients to choose their doctors while forbidding doctors to choose their patients is not a fair arrangement. We cannot use professional ethics to hold anyone hostage, forcing them to take great occupational risks without giving them the protections they deserve.The medical profession needs talent to develop, and its institutional problems need generation after generation of medical workers to improve. Only by holding an objective, rational understanding of the nature of medicine can we walk this road farther.