Why Is It Said That Healing Requires a 'Medical Affinity'? What Exactly Is Medical Affinity?

Which kind of treatment is most likely to be effective? After treating people for so many years, I began to think about this question.

A person studies medicine with the original intention of saving the dying and healing the wounded. After years of study and mastering a great deal of professional knowledge, a doctor's time is precious—not in terms of how much money it is worth, but how much real value it can create. For a doctor, the value of his time should lie in genuinely helping patients reduce the suffering of disease. If a doctor can save one person, even without taking a penny, the sense of achievement from that success is enough to satisfy him.

For a patient, effective treatment means, within what he can afford, receiving the treatment with the best results, reducing his suffering as much as possible and prolonging his life.

In the course of treating patients, I gradually realized I should settle down and think about what effective treatment really is. My own time and effort, and the patient's time and money, should all yield their greatest value. Otherwise, whether for myself, for the patient, or for society at large, it would be a waste.

For quite a long time I was surrounded by a flood of consultants, spending more than half my day answering their various questions; sometimes they hoped I would give them medical management plans during consultation. The consultants' feelings are understandable—they want professional help—but such help is mostly blind help, because a doctor who cannot examine the patient's body in detail and analyze the various test reports cannot provide truly valuable medical advice.

So most of the time this work was wasted effort. I also followed up on those consultants; over ninety percent only asked questions and never took the consultation seriously, and the prescriptions they got were left on the shelf. In the end I wasted a great deal of my time on meaningless consultations. So starting last year, I realized that continuing this way would be a huge waste of my time; I used various means to cut off over ninety percent of the ineffective consultations.

I also began to reflect on whether my old standards for taking patients were wrong. For a long time I held to the principle of "respond to every prayer": as long as a patient came to me, I would treat them patiently.

But after these years of practice, I found this approach has serious problems. I must learn to identify, among patients, those who can truly be treated effectively, rather than wasting time and effort on patients for whom treatment is impossible, and still less wasting such patients' money.

A good doctor should be able to quickly distinguish which patients can achieve results and which cannot, and devote his limited time to those who can.

A doctor's efficacy first comes from mutual trust between physician and patient; trust is the most basic element of efficacy. If a patient does not trust a doctor, or is only half-convinced, such a patient can hardly truly cooperate with the doctor's treatment, and good results are hard to achieve.

I believe most clinicians, through practice, develop the ability to tell whether patients trust them. The words, deeds, and even facial expressions of patients and their families all contain information about their degree of trust in the doctor.

Of course, it is quite improper to refuse on the spot a patient who does not trust or is only half-convinced. The doctor should end such a consultation gently and reasonably, turning it into friendly advice—neither wasting the doctor's own time nor adding burden to the patient's family.

When I first started out I could not do this; sometimes, even when the patient or family clearly showed displeasure, I still provided the consultation, which often led to medical disputes. Medical resources are abundant, and it is human nature for patients or families to place selective trust in doctors. When patients or their families begin to doubt the doctor, the doctor should tactfully decline and let them seek someone more skillful.

Only when doctor and patient trust each other can a mutually respectful and friendly relationship be built. Medicine inherently carries uncertainty; any doctor treating any patient may fail. Under the premise of trust, patients and families allow the doctor to trial and explore, and only in such an atmosphere can the doctor solve the patient's health problems.

A doctor's efficacy also depends on how well the patient understands his disease and cooperates. I have long studied TCM anti-cancer treatment, and most of the patients I see are cancer patients. In China a very common phenomenon is that cancer patients' families, always fearing the patient cannot bear the blow of cancer, hide the diagnosis from the patient. Such seemingly well-meaning concealment does enormous damage to treatment.

Every long-term survivor among the cancer patients I currently see has, without exception, been a patient who knew his own condition. It is true that cancer is a chronic disease, but it is the most stubborn chronic disease in the world. As cancer progresses, patients develop all kinds of thorny symptoms; concealment only increases the patient's mental burden rather than helping, as the families imagine.

If a doctor cooperates with the family to hide the condition from the patient, the doctor's trustworthiness in the patient's eyes immediately drops sharply. Most cancer patients develop various stubborn symptoms within months of diagnosis; these are not easily resolved, and the patient grows anxious as his symptoms prove hard to control. In the end, the paper cannot wrap the fire—most patients find out anyway.

When a patient learns his true condition, his first reaction is that the doctor who hid it from him is dishonest; he will no longer trust such a doctor and will hardly cooperate with his treatment. So in recent years I have gradually stopped accepting cancer patients whose families demand that the condition be hidden from the patient. Because years of practical experience tell me such treatment ultimately comes to nothing—the patient resists the doctor from the bottom of his heart.

Speaking of honesty, besides not hiding the patient's true condition, the doctor must also not exaggerate efficacy. The doctor honestly telling the patient what his own skill can achieve helps the patient judge the prognosis and make comprehensive decisions.

Today, medicine is also a profession of divided labor and cooperation; most cancer patients receive comprehensive treatment. No single doctor possesses all the skill that can help the patient. If the doctor truthfully tells the patient the role his own skill can play, the patient will be more patient during treatment, and the result will be better.

I never exaggerate my efficacy to patients who consult me; I always plainly tell them TCM's role and shortcomings in cancer, my own strengths and weaknesses, and the likely costs during treatment, leaving the decision to the patient. I believe most responsible clinicians do this. It helps patients make the most rational decisions and also eases the doctor's pressure.

I am not worried that patients will leave me because of my candor; in fact this happens often, but I do not think I need to try to keep those who leave. I will wish them the results they seek from another doctor, but to deceive or exaggerate efficacy just to keep a patient would bring endless trouble.

Deceiving patients is not only a matter of the doctor's reputation; in this era of fierce doctor-patient disputes, it can even mean the doctor's life is at risk. Communicating factually beforehand makes the patient and family's expectations of efficacy more rational.

Sometimes, after a patient has died, the family comes to thank me, thanking me for the help I gave the patient in his final years, and also thanking me for being candid with them rather than deliberately hiding things to earn a little money.

When some patients or families talk with me, they keep saying, "You doctors have such a good business." Frankly, I deeply resent calling medicine a "business."

Although medical work generates fees, medicine is not a business; it is very special. In our society today, a great many medical institutions have indeed turned medicine into a business, causing patients to seethe with resentment, medical disputes to flare frequently, and doctors now and then to die at patients' knives. Once a doctor enters this medical system, it is easy to be commercialized; this is the sorrow of all who study medicine.

Medicine is the most specialized technical profession; the doctor provides professional help in healthcare. Medicine inherently carries high risk. Only when the doctor's help to the patient comes from the heart and is conscientious will he earn the patient's recognition and understanding. If the doctor treats healing as doing business, talking a blue streak to persuade the patient into treatment, once the result is poor a dispute arises, and in serious cases the patient or family may take a desperate form of revenge against the doctor.

Some doctors are good at brainwashing patients, making patients and families trust them absolutely at a certain stage; even when results are poor, they still believe the doctor is their savior. Such doctors plant endless hidden dangers for themselves. Throughout history, in China and abroad, famous doctors coming to bad ends is common; the most famous in TCM history, Hua Tuo and Bian Que, both came to no good end.

If the doctor truthfully tells the patient the expected efficacy and side effects, then even if the disease progresses during treatment, the patient can understand and continue to trust the doctor. For most advanced cancer patients, we should see factually that we can only help them reduce part of their suffering and moderately prolong their lives.

Of course, on that basis the doctor must also help the patient build confidence in overcoming the disease and encourage the patient to face it bravely. Any disease—even advanced cancer—has a certain cure rate. The doctor has a duty to provide mental support. Practice shows that only when both sides work together, the patient's confidence is built up, and the patient cooperates, can the most ideal result be achieved.

Many people say healing requires "medical affinity" (yi yuan), a concept so vague that it has come to be understood as luck. In fact, true medical affinity is, on the basis of mutual trust and candor between doctor and patient, the various conditions most favorable to the patient's recovery, created by both sides. Luck is uncontrollable, but trust and good communication between doctor and patient are achievable through personal effort.

Only in such a friendly atmosphere can doctor and patient create the best results. From this angle, not only should the patient choose the right doctor, the doctor should also choose the right patient; only when both choose correctly and cooperate well does the patient's money get spent where it counts, and the doctor's time and energy get spent on what matters most.

For society as a whole, this is also the most effective allocation of medical resources. Perhaps the various medical problems in our country today can be fundamentally resolved only under such conditions.