The Wisdom of Medical Practice My Masters Taught Me: Reverence, Prudence, Honesty, Thoroughness, Humility
I have studied under many teachers, both Chinese medicine and Western medicine. From them I learned not only professional medical knowledge and skills, but also the experience of practicing medicine and conducting oneself in the world—all of it precious. The longer I myself work in the medical field, the deeper I appreciate their teachings. Professional medical knowledge and skills cannot be summed up in one article, but the experience of practicing medicine and conducting oneself can be summed up in a few words: reverence, prudence, honesty, thoroughness, and humility.
Let me first speak of the character reverence.
One of my masters was a retired senior doctor from the Armed Police General Hospital. When I became her student, she had been rehired to see patients at an outpatient clinic. The elderly lady's hair was completely white, yet she addressed every patient who came to see her as nin (the polite you) rather than the familiar ni, even when those patients were young enough to be her grandchildren. With students like me, of course, she did not use this form of address; she called me by my given name.
My master was very strict with me. She always admonished me that before practicing medicine one must first learn to be a person; as a doctor one must get along well with people—with colleagues, with patients, and with peers—and show everyone at least three-tenths of reverence first.
Back when I studied with her I was still young and brash, feeling that those who practice medicine make a living by their technical skill and have no need to curry favor with others. Especially when a senior, respected doctor like my master still addressed young patients politely as nin, while most patients addressed her brusquely as ni rather than nin, I felt quite indignant on her behalf and thought the patients were rude.
As I myself grew older year by year, I was imperceptibly influenced by my master. Now, no matter who comes to consult me, I respectfully address them as nin. Some patients who have spent a long time with me feel embarrassed when they hear me so consistently call them nin, and ask me to switch to the familiar ni in future, but I still cannot change this habitual form of address toward patients.
My master was an extremely low-profile person. In fact, she was the junior fellow apprentice of a certain National Medical Master. Had it not been for the grandson of that National Medical Master holding a wedding banquet to which my master was invited and which one of my superiors happened to attend, no one around me would have known her lineage. We only knew her clinical skill was superb; she never told anyone who her teacher was, and she did not allow me to adorn myself with the reputation of her lineage. So even now I never mention who my master or grand-master was.
The day I learned of my master's lineage, I mentioned it to her while copying prescriptions for her. My master told me that we must rely on our own ability in practice; we must forge our own path. Our teachers have already taught us our medical skill, for which we should be deeply grateful; we must not use their reputations to gild ourselves. If we bring glory to the lineage that is one thing, but if our skill is poor and people know whose disciples we are, we will have brought shame on the lineage. My master said that when a person practices medicine, the most important thing is to honestly treat people's illnesses; to make up so much hollow stuff to deify oneself and fool patients is bound to bring future trouble. As far as I know, my grand-master practiced medicine in exactly the same style all his life, never, like some people today, flaunting himself as a grand master.
When I followed my master in practice, I was also doing editorial work for the hospital. Seeing that I could write well, my master repeatedly warned me not to become an academic businessman. She said that the people she looked down on most in all her life were academic businessmen; that anyone with even the slightest intention of fishing for fame and profit was not suited to be a doctor.
My master never piously claimed to be a saint. In teaching me these things she was actually looking out for my personal safety. Unlike other doctors who readily classify such matters as moral issues, my master always told me that what she taught me was a matter of safety. Back when I accompanied her on outpatient rounds I truly could not grasp this point, but now I understand. If we treat patients and their families, colleagues, and peers with courtesy and reverence, we will not make enemies all around us.
Now let me speak of the second character, prudence.
I consider myself naturally cautious and careful in my thinking, but even so, when I copied prescriptions for this retired master from the Armed Police General Hospital, I realized I still had ways in which I was not cautious enough. She was especially strict with me. Although a few young people at the time wanted to accompany her on outpatient rounds, she took only me as a disciple; she said she could not teach well if there were too many, and that if she taught, she would teach seriously.
I was already in my early thirties when I copied prescriptions for her, but she showed me no mercy. She often kept within reach something she could hit me with, and whenever she saw me make a mistake she would hit me without the slightest politeness, caring not who was watching. Fearing I would feel wronged, she told me privately: when I hit you now, do not feel aggrieved; if I hit you, you will remember, and in future you will not be beaten by patients or their families. A master's beating is out of love; when patients and their families beat or kill a doctor, they will not be nearly as polite as a master. Because of her strict demands, I rarely make elementary mistakes in clinical work, and even now I am grateful to her for this training.
Every day she made me read through the rules of every consultation room and examination room, and sometimes she even made me recite them back to her; she said she had memorized these rules all her life. Because every rule in the hospital was set for the safety of patients and doctors, she said the core of medicine is safety and efficacy, and one must always bear in mind the word safety. When patients are safe, doctors can be safe; if patients are not safe, a doctor's safety is out of the question.
My master was versed in both Chinese and Western medicine. She always told me that when she studied medicine there was a textbook that was truly excellent, imported from abroad; that textbook even discussed in careful detail where the doctor's seat should be placed in the consultation room. I asked her why a textbook would discuss such a thing. She replied: because if the doctor's seat is arranged sensibly, in the event of a medical disturbance the doctor can escape successfully rather than die in vain. Some readers may find such words laughable, but over the years I have truly felt that my master was a wonderfully good teacher! She taught me solutions to problems I could not learn from books yet are genuinely common in medical practice.
Another of my masters was a senior Chinese medicine doctor in my hometown; I signed a formal teacher-apprentice agreement with him and performed the apprentice-bowing ceremony. This master of mine was extremely humble. There were certain illnesses he felt he had not studied as deeply as I had, so when patients came to him he would refer them to me. Once, a patient in his own village developed a tumor; several doctors were invited in for a consultation, and because of my master's referral, they invited me too. The patient was bedridden, so the doctors could only consult at his home; both Chinese medicine and Western doctors went at the same time.
Back then I was quite warmhearted. The patient's family treated me to a meal, and because I felt this was an acquaintance of my master—old friends need not stand on ceremony—I let myself go a bit while discussing the patient over dinner, offering some rather bold medical suggestions. My master gently nudged my foot under the table, and I immediately took the hint. He was telling me that even with a very familiar patient, in a moment when a human life hangs in the balance, one must mind the risks and speak cautiously.
In my hometown, my master was highly respected. Sometimes as we walked from the Chinese medicine hospital to his home, people kept greeting him along the way, and most treated him with great respect. Even so, whenever we went to ask someone for a favor, my master kept warning me to speak carefully, cautiously, politely, and considerately. In this line of work as a doctor, one is destined to need prudence for a lifetime.
Speaking of prudence, the most important point is the matter of collecting fees. A doctor certainly needs an income to support a family, but not a single one of all the masters I studied under was careless about money. Accepting money means taking on responsibility, so some money simply cannot be taken lightly. Every cent of a patient's money must be accounted for; we would rather be the ones who lose out than let the patient lose out. This is not high-sounding talk about noble conduct, but rather: if the patient loses out, the doctor may end up in trouble.
Once, when I was in the countryside of my hometown, a patient came to see me there. I myself was feeling unwell at the time, and there were no medicines to buy in the countryside, so I asked this patient, who had come from the city, to buy some medicine for me when she passed a pharmacy, and I would pay her back when she arrived. The cost was not much, about 100 yuan. After she arrived, we chatted and grew quite animated, and I forgot to settle the medicine money with her. Later this patient told another patient that I owed her for medicine and would not pay up. I quickly contacted her and returned the money.
I am not willing to take on patients other than cancer patients, because my long-term focus has been cancer alone. Occasionally I treat some difficult, complicated cases only by experimenting on acquaintances; I myself know that because my research is not deep, the success rate is low. Treating acquaintances is one thing—if it does not work, they will not blame me; strangers are different. A few years ago there was a female patient with gynecological disease and mild depression who always wanted me to treat her and on her own initiative paid consultation fees by tipping my articles. Once she had paid, it was hard to refuse, so I took her on. The treatment outcome did not satisfy her, and as a result she became very resentful toward me.
These two incidents taught me a lesson: at no time must one be careless where money is concerned. Falling out with patients over money is quite improper and also very dangerous. Now, for some end-stage cancer patients, or for inquirers whose expectations exceed my ability, I do not collect a fee, because I do not want to rush into a doctor-patient relationship with anyone. Treating such severely ill patients has a precondition: that the patient's and family's expectations are reasonable.
Now let me speak of the third character, honesty.
This master of mine, retired from the Armed Police General Hospital, had many patients in Beijing. When new patients referred by those patients came piously to seek her care, she was always tireless in communicating with them, learning their psychological expectations and assessing how far her treatment outcome lay from what the patient or family expected. If the patient's condition was severe, the patient's and family's expectations were too high, and she felt she lacked the ability to achieve the result they wanted, she would truthfully tell the patient and family where the boundaries of her ability lay, leaving the choice to them, and never exaggerate.
My master told me: do not lose your honesty just to win patients' approval quickly; tell every patient the truth. Why you studied medicine, how long you have studied, what you are good at and what you are not—tell patients honestly. If they choose you, treat them well; if they do not think much of you, do not feel ashamed. There is a long life ahead; as long as you are honest and upright, no disaster will come.
I now understand these teachings of my master, and understand them more deeply year by year. Although I already have a certain reputation among some special patient groups, whenever I communicate with any patient or family who comes to me, I strictly follow the principles my master taught me. I used to be truly itching to practice, eager to treat people's illnesses; after hitting a few walls and taking a few scoldings, I now know that what my master said was truly born of experience.
Now let me speak of the character thoroughness.
I studied medicine under three female teachers. One was my master; another was a patient of mine—a graduate of the old Peking University Medical School and formerly Dr. Li Zhonghui, the leading detoxification expert of our nation's Ministry of Health (now the National Health Commission); the third was Professor Huang Xizhen, an expert in respiratory medicine at Peking Union Medical College Hospital. I came to Professor Huang while seeking care for my master's wife, and I regularly returned to her for follow-up visits and prescriptions, which gave me the chance to receive her instruction.
The common trait of these three female doctors was thoroughness.
When my master demonstrated how to examine a patient, she did every single step with great care and precision. Usually she spent at least twenty minutes on one patient; I never once saw her rush through seeing a patient. Afterward, she would explain to me the reasoning behind what she had done.
Dr. Li met me by chance. Dr. Li's grandfather was a Chinese medicine doctor, but she herself was a Western doctor; she was feeling unwell and hoped I would treat her with Chinese medicine. Our two families lived nearby, so we visited each other often; I shared my views on Chinese medicine with her, and she taught me Western medical knowledge, passing on many clinical skills.
She told me how to view the relationship between lab reports and clinical symptoms. She said that for a period there was a large outbreak of Japanese encephalitis; she admitted many patients back then, and she did not wait for lab reports to make a diagnosis. Instead, relying on experience, she carefully examined patients and gave medication in time.
Dr. Li said that in such acute illnesses, by the time the blood test results came back it would already be too late, and the patient would be delayed to the point of death. So she attached great importance to physical examination, and she also taught me how to read all kinds of lab reports. Some people wonder why I know so much Western medicine; actually, much of my Western medical knowledge was taught to me by her. This elderly lady taught me for three or four years.
Professor Huang Xizhen was the kind of doctor whom, once a patient had seen her, they could hardly forget for the rest of their life. She was a Western doctor, a special-needs expert in respiratory medicine at Peking Union Medical College Hospital. Professor Huang probably no longer sees patients now; when I took my master's wife to see her, the old lady was already over eighty. Her registration fee was very expensive; more than ten years ago she was already one of the highest-paid special-needs experts at the hospital. When we saw her, the fee was 300 yuan—equivalent to one or two thousand today.
But she saw patients with extreme care and thoroughness. She patiently went through every prior examination report, taking notes as she read, carefully helping the patient analyze the condition and explaining the illness to them. She herself did not order a single additional test for my master's wife; she told us to treat the asthma from multiple angles. Her entire analysis and explanation of the condition took the old lady over forty minutes, and she resolved my master's wife's problem extremely well.
I used to be forever enthusing about the holistic view of Chinese medicine, but only after seeing Professor Huang did I realize that a brilliant Western doctor also has holistic thinking. We went to her for a respiratory disease, but she felt that because my master's wife had been ill for so long and taken so many medicines, her stomach had been damaged, so the stomach had to be treated as well to achieve an ideal result. She also prescribed some medicines to prevent colds; with multiple approaches working together, she controlled my master's wife's condition very well.
Because my master's wife was not in Beijing, each follow-up visit and prescription I went to Professor Huang on her behalf. Every single time Professor Huang was never slipshod; she always had me call my master's wife, and over the phone she carefully took the history, noting it down item by item, then earnestly made a pattern differentiation and wrote the prescription. My master's wife had been ill for years; the two years she spent under Professor Huang were the two years she suffered least, and the medicine costs were also very low.
Back then I was ravenous for knowledge, reading medical books in great quantity and always running into questions I did not understand. I respectfully consulted Professor Huang, and she tirelessly explained things to me, passing on her clinical experience without the slightest reservation, always with a grandmotherly smile. Later Professor Huang stopped seeing patients, and I myself have continued my master's wife's treatment ever since. That I can keep my master's wife in such good health is also thanks to over two years of Professor Huang's guidance.
Finally, let me speak of the character humility.
A doctor's humility is not the modesty of being self-effacing, but the lowliness of willingly occupying a lowly position. This is one of the deepest lessons on how to be a person that I learned from my masters. I never once saw any of my masters strut about with arrogance.
My hometown master: many people locally treated him with deep deference, yet he never regarded himself as some somebody. Whenever we wanted someone to do us a small favor, my master never failed to tell me to be courteous and polite. In fact, if my master merely made a phone call, people would basically willingly help, but he never forgot to tell me: we are just small doctors, don't take ourselves too seriously.
Many people may think that being a doctor earns great social respect. I do not know how many doctors truly enjoy that respect; my observation of my masters taught me that every one of them was deeply humble. The ancients described those who practice medicine as treading on thin ice and trembling with fear, and this description is extremely apt. It is impossible to say a doctor went a whole lifetime without a moment of brilliance. Most doctors have glorious histories of bringing patients back from the dead, but if we rest on such laurels and go around bragging unabashedly about how great we are, the scoldings we receive in this post will surely be beyond count, because there are still many patients we are helpless before. Giving people too much hope is misleading them.
A university teacher once told me that I should publish my articles in those authoritative journals and magazines, so that quack doctors' articles would not mislead people. I told her at once: the label of quack can only be worn by oneself, not pinned onto others. This is my heartfelt word: I would rather others think me a quack than think my skill superb. Because honestly, I truly feel my medical skill is nothing special and cannot meet the psychological expectations of the great majority of patients and families. If we let excessive praise turn our heads and make us think ourselves extraordinary, and let such feelings show when we communicate with patients, then when treatment does not go well, patients will make trouble for us.