Why Doctors Grow More Timid as They Grow Older
Someone once joked with me, "You are truly Hua Tuo reborn." I jokingly replied, "I really have no wish to be Hua Tuo reborn." Hua Tuo died at the hands of his own patient, Cao Cao. Even earlier, the Western-Han physician Chunyu Yi nearly lost his life at the hands of his own patient because of his superb skill; fortunately his daughter Tiying petitioned Emperor Wen of Han to take her father's punishment upon herself, moved the emperor, and saved his life. The idiom "Tiying rescues her father" tells just this story.
Once, when my teacher was teaching me the standards of medical practice in the consulting room, she spoke with deep feeling: being a doctor, the first thing is safety—first the patient's life, and then the doctor's own personal safety. She told me she had once read a monograph on emergency medicine in which a passage had impressed her deeply: it told doctors how to keep the consulting-room door open when receiving emergency patients, so that if the patient suddenly turned violent the doctor could run, ensuring his own safety. This was a monograph written by a Westerner, which shows that a doctor's being assailed by patients is no Chinese invention—the whole world shares the same cold and heat.
Medicine is an imperfect science with great uncertainty; both Chinese and Western medicine are alike in this, and no doctor can guarantee to cure a patient's disease. So when some patients now tell me, "If you can cure my illness, I'll pay any consultation fee," I tell the patient or family that I am a person of limited talent and learning, have not the slightest grasp of this disease, and ask them to find a more skilled physician. A doctor treating tumors, if in his right mind, cannot be foolish enough to promise results to the patient. Toward patients who do not know me, I am now basically cautious at every step, avoiding risk wherever I can. The reason is simple: I have been scared.
Such things cannot be said in too public a place, for saying so would bring down a storm of public abuse. Often, too, some patient or family member who has read one of my articles will, full of indignation, step forward to denounce me, call me an unethical physician, and then blacklist me forever. Had I not undergone Buddhist training and cast out my angry mind, encountering such things would truly be unbearable.
A person very dear to me once told me, when treating people, not to hurt myself by sympathizing too much with patients. I feel that for a physician this is hard to do: "The patient wrongs me a thousand times, yet I treat the patient as my first love"—this is probably the common cry of most humanitarian doctors. Even after being hurt countless times by patients, at the critical moment of saving a life the doctor still instinctively casts aside all ill feeling and all possible terrible consequences, forgetting himself and using his professional knowledge to do his utmost to pull the patient back from the gate of death. In today's Chinese social environment, where doctor-patient disputes run high, medicine is a profession that keeps one's family and friends in constant anxiety.
In the traditional beliefs of the Uyghur people, the doctor is one who can speak directly with the gods and who ascends straight to paradise after death. For ordinary people, dealing with life arises only when birth, old age, illness, and death arrive; the doctor deals with life at every moment. The medical profession is filled with humanitarian spirit; few doctors truly touched by the calling of medicine are in it for profit—the profit-seeking ones are the businessmen who pull the economic strings of hospitals.
I myself was drawn to study medicine by the spirit of "Great Physician, Sincere and Earnest" in Sun Simiao and by the suffering of my own mother. Since I entered medicine, besides relieving patients' illness, I have often given financial help to destitute patients. I do not regard this as any particularly lofty deed, for among the doctors I have known, many do the same.
Once a cervical-cancer patient in her early twenties came to me for help because of massive bleeding. After I wrote her prescription, I kept worrying whether the bleeding had stopped. Two days later I asked how the medicine had gone. She told me she was waiting for a friend who owed her money to repay her; only then would she have money to buy the medicine. She had grown pale from blood loss, yet she was literally penniless.
I at once asked for her bank account and wired her five hundred yuan, telling her to hurry and buy the medicine to stop the bleeding; afterward I helped raise funds among some friends. The patient then asked, oddly, "Aren't you afraid I'm a scammer?" I told her: if you are a scammer, I lose five hundred yuan, which means little to me; but if you are not, I would carry a guilty conscience all my life for having let you die. She burst into tears and told me she had in fact been abandoned by her husband and her own parents, and now, with no money for treatment, she was waiting alone in a rented room to die.
I believe that the abandonment of patients by their families is something many doctors—especially oncologists—encounter in practice; in these patients' final moments, only the doctor can give them warmth. Saving lives is the doctor's bounden duty, and giving money to a patient in crisis is the instinctive reaction of many doctors.
With some infectious-disease patients, families often isolate them for fear of infection; the doctor also needs to give these patients emotional comfort, while educating the families professionally so that they do not discriminate against the patient. Standing where we stand, we deal with all kinds of unexpected illnesses almost every day, and the risk of infection is always present; but if we too were cold to the patient, no one would comfort the wound in the patient's heart.
Someone once said to me: have you considered that some patients suffer today because they did something wrong in the past and are now getting their karmic retribution, so we should not be too compassionate to them. There may be truth in that, but as doctors, our calling does not allow it. Our calling requires that even if our own father's murderer came to us for treatment, we would do our utmost to save him, not letting revenge delay the patient's care. So a truly good doctor has a broad heart. Even if a patient were utterly wicked, in the doctor's eyes he is still someone who needs help. A doctor should harbor no hatred or aversion toward anyone.
This is why the ancients said: "He whose virtue is not close to that of the Buddha cannot be a doctor; he whose talent is not close to that of an immortal cannot be a doctor." From ancient times to today, the good doctors truly remembered have all borne a certain knight-errant spirit.
But society is a mixed bag, and the present state of the medical profession is shocking. There are frequent news reports of some respected doctor being killed by a patient, and frequent reports of some hospital cheating patients out of money until their families are ruined. Medical disputes often rage in full public view.
On one hand, this is indeed because China's irrational medical system has produced many problems. On the other, ordinary people's excessively high expectations of medicine are also one reason for today's flood of medical disputes. Human medicine is still at a low level, and many patients simply cannot be cured. The doctor can only do his best, cannot guarantee results, the outcome of treatment carries great uncertainty, and treatment risk exists objectively.
Practicing medicine has made me excessively cautious by nature, constantly anticipating every risk I might encounter, so that my family and friends often feel my risk awareness is too strong—that I foresee even impossible consequences and do not live freely enough. I suppose it cannot be helped; in today's social environment, a doctor who does not cultivate caution easily runs into medical accidents and disputes. The trouble this caution brings to daily life can only be borne, with understanding, by those closest to me.
In social dealings, doctors may show a slow-to-warm-up tendency, carefully ruling out every risk before daring to truly befriend someone. This profession-shaped character is common among my colleagues. Our entire professional training is the constant judging of risk. When a doctor signs his name or makes a promise, he thinks far ahead: if it cannot be kept, we are responsible. Yet in medicine, where is there no accident? In medicine as in life, accidents are everywhere.
In medical circles there is an old saying: doctors grow more timid as they age. That is why some older doctors actually achieve worse results than younger ones. Why? Because to achieve results, a doctor must sometimes not fear taking risks or the possibility of disputes. And patients and families must also give the doctor enough trust and be willing to bear some risk, in order to gain more chances of snatching someone back from death. If both sides are overly cautious, in the end they will inevitably miss the best chance to save the patient.
In my practice, the people I am most grateful to are the families who still maintain a good relationship with me after their loved one has died. As for some sharp, demanding patients and families, I now deal with them carefully. For with the slightest carelessness, we ourselves could die at their hands. I honor compassion, but I am not foolish enough to risk my life for such kindness. The world is hard; without sharp eyes, it is easy to die on the job.