In an article titled “The Threatened Chinese Doctor,” the internationally renowned medical journal The Lancet said, “In ancient China, the ideal of intellectuals was “to be a good doctor, not a good minister. Today, however, the image of Chinese doctors is in decline, and some people no longer see medical professionals as “white angels”. According to health department statistics, China currently has more than 1 million medical disputes each year, and malicious incidents caused by doctor-patient disputes occur from time to time.
”Hospitals have become battlegrounds.” The Lancet’s analogy is not without merit. In this war, patients are anxious, doctors are suffering, and some patients even use violence to express their dissatisfaction with doctors. On October 26, Peking University’s Faculty of Medicine celebrated its centennial; on the 27th, Shanghai Jiao Tong University School of Medicine (formerly Shanghai Second Medical University) also celebrated its 60th anniversary. On this occasion, Ke Yang, Executive Vice President of Peking University and Executive Vice Director of the Faculty of Medicine, and Huang Gang, Vice President of Shanghai Jiao Tong University School of Medicine and Executive Director of China Hospital Development Institute, discussed what kind of doctors China needs under the existing medical system and how to bridge the huge gap between doctors and patients.
A good doctor-patient relationship is based on equality and mutual understanding
The common problem behind the numerous doctor-patient conflicts is the poor communication channels between doctors and patients. When a patient spends two hours in line to register, one hour to see a doctor, and a long wait, only to receive an indifferent face or even an impatient attitude, they are easily angered. However, for a doctor who saw 50 patients in the morning, endured the noisy and disorderly queue, and did not drink a sip of water for four hours, maintaining a smile and a gentle and patient tone of voice, is also a somewhat “cruel” requirement. The biggest gap between doctors and patients is that everyone is thinking from their own standpoint.
Reporter: How do you feel about the current complaints of the general public about doctors?
Ke Yang: The deeper reason behind these complaints has to do with the Chinese medical system. At present, a more reasonable medical system around the world is: stratification, classification and grading. For example, in cities, the community is the most basic level, the middle level is the secondary care, and finally the tertiary care. Community doctors first guide patients to make decisions, and then recommend visits to secondary or tertiary care in the event of serious illness. Tertiary hospitals, on the other hand, mainly solve the problems of difficult and serious diseases, the promotion, dissemination and teaching and training of advanced technologies. However, at present, China has not established such a medical network. Despite the government’s great efforts, the reality of the lack of high-level medical talents in primary care is unlikely to change immediately. Patients are flocking to tertiary hospitals all at once, like a triple jump, leaving doctors with no time to cope and unprepared. Coupled with other factors, such as the increasing reliance on high-tech diagnostic methods, resulting in higher and higher costs for patients, higher and higher expectations of doctors, but not necessarily effective treatment; the limitations of medicine itself is still very large, which most patients do not understand, so the psychological gap, easy to vent their frustration on the doctor.
Huang Gang: With the progress of medical technology, doctors rely more on various examination equipment, and patients communicate less and less, CT and B ultrasound on hand, “look, touch, tap, listen” seems to have become a legend. On the other hand, the workload of many doctors is too heavy, and they work overtime seriously. Repeating the same words 50 times a morning, even a patient person will inevitably have a temper. This, coupled with the fact that some patients do not understand the disease or the treatment and are demanding of the doctors, has led to increasing conflicts between doctors and patients.
I often encounter patients complaining, for example, the same CT screening for tumor, some have negative results and complain that they spent money for nothing. For example, if the same CT screening test is done, some patients will complain that the result is negative, and they will complain that they spent money for nothing. At this time, I will give him scientific knowledge, read the treatment process and tell him the indications of the test. When the patient understands, the communication will be smooth.
Reporter: Have you ever seen a doctor as an ordinary person? Have you ever encountered any miscommunication with doctors?
Ke Yang: Yes, I accompanied my mother and daughter to the doctor. I found that the doctor can change the way he speaks. However, there is a perception in society that whenever a person has a little bit of power over others, it becomes an inequality of personality, and when he has a little bit of control over other people’s fate, he is bossy. The doctor often shows this posture and can speak very harshly when he decides that he has administered the right treatment. In the medical profession, a hard attitude represents a kind of condescension, and because one is dealing with a weak person, it hurts. If there is no problem, the patient can accept; once there is a problem, such an attitude will become a “fuse”.
Reporter: What is the reason for this?
Ke Yang: I think this is the failure of education. Our education does not focus on independent personality and equality of personality. This is from kindergarten onwards. We teach children from childhood to obey parents, teachers, elders, authority, and leaders. People who are under the pressure of obedience for a long time, once they grow up with power, they may consciously or unconsciously “retaliate” on those who ask for it. This is something that has been passed down from generation to generation, and it’s a terrible idea. Moreover, this has little to do with the level of knowledge. Medical knowledge alone does not necessarily turn a person into a “mature” person. We call medicine “anthropology”, but “anthropology” is the understanding of the human mind, which is exactly what medicine lacks. It is impossible to change this phenomenon by medical education alone, because students are used to this kind of education and people from childhood. I can only tell students that they cannot treat the weak in this way.
Huang Gang: At present, some medical education follows the “fast-track training model”, emphasizing advanced treatment technology, but there is really less intangible, underlying humanistic inculcation. This is one of the causes of tension between doctors and patients, and also makes poor communication inevitable.
Medicine not only has the rigor of science, and more closely related to people, away from people, medicine has lost its origin; away from the humanistic care, medicine has lost its soul, but only the materialized science. As a doctor, you can become a “master” or a “craftsman”. The difference lies in the fact that the former has ideas and directions, and pays more attention to the people themselves; while the latter just does one thing precisely, and pays attention to the disease but neglects the people. Many doctors today regard patients as mere carriers of disease, which is at best an “artisan”, which is not progress in medicine, but rather a regression or sadness.
When we pass on love to our students, they can take it over and pass it on to their patients.
The university is a place where ideals are cultivated, yet these ideals must be polished in reality. The complexity of today’s society has undoubtedly affected medical campuses. Various doctor-patient conflicts and medical disputes have made the profession of doctor gradually lose its “ideal” aura in the minds of students. How to teach them to deal with these complicated relationships so that the “love” in their hearts will never disappear?
Reporter: Do students nowadays talk to their teachers about the conflict between doctors and patients?
Ke Yang: When there are some extreme conflicts between doctors and patients in the society, students will be more confused, and individual students’ ideal of being a doctor will be shaken. Some parents call me and say, “If our child becomes a doctor in the future, can you guarantee his safety? If not, we don’t want to study anymore, we want to change our profession.” Whenever I hear such calls, I feel especially bad because the reasons for doctor-patient conflicts are very complicated.
Reporter: In the doctor-patient relationship, the system and cultural traditions are difficult to change for a while, so what can we change?
Ke Yang: On the one hand, education is a problem, and it is also important to improve the medical environment and decompose the burden of doctors outside the profession. Hospitals should set up special posts and give more care to patients. For example, if a doctor prescribes a medication, there should be someone to explain how to take the medication; set up a special agency so that patients have a place to talk and confide in. Many hospitals have started to do this, but not enough. Because human resources spending is too large, affecting the survival of the hospital, need institutional and policy support. This is very important for patients.
Huang Gang: Train doctors in compassion, responsibility, and communication skills, and focus on cultivating their spiritual world and enriching their humanistic feelings. It is important for doctors to realize that they are dealing with living, breathing, emotional people. With the enhancement of humanistic background and fraternal care, doctors can empathize with patients’ sufferings, understand patients’ impatient or excessive words and actions, and take the initiative to pacify them at the right time. Patients are comforted and soothed, and there is no more ground for conflicts to grow. In addition, when doing popularization of science to the people, it is also necessary to let them understand the treatment procedures, appreciate the hard work of doctors, and stop being overly critical of doctors.
Reporter: It seems to us that many doctors are relatively indifferent, including a more indifferent attitude toward life and death. Is this their personality, or is it formed after studying medicine?
Ke Yang: Many people studying medicine have a certain inevitability, they are good help and charity, but often also want to find a career, with the ability to eat, all things do not seek. In addition, once you choose this profession, you are bound to face life and death, bloodshed and other kinds of problems, not strong will be eliminated. In education, we require doctors to have both strong nerves and a soft heart. After a serious illness, the attitude of many doctors towards their patients suddenly changes, because they really feel the pain of being a patient. That’s why there is a term “narrative medicine” in medical education, which means that doctors can empathize with patients by describing their suffering.
Reporter: In terms of humanities education, what adjustments have been made to the school’s curriculum?
Ke Yang: The School of Medical Humanities was established in North China Medical University, and now the courses on the history of medicine, ethics, communication, and medical narrative have been strengthened, for example, by adding empathy classes and courses on ways to inform patients. With these classes, little by little, we are increasing the humanistic literacy of our students.
Huang Gang: Four or five years ago, the medical school of Shanghai Jiaotong University began to reform. In the past, the emphasis was on memorization and recitation of medical knowledge, but now there is more emphasis on ability enhancement, and a series of “ability enhancement programs” have been developed, targeting the overall training of medical students, and humanities education has been greatly enhanced.
Reporter: What is the biggest highlight of humanities education in your school?
Ke Yang: Our special features are empathy classes and patient information courses. Through some scenarios, students can experience the different effects of different ways of communication with patients, so that they can appreciate the needs of patients from the heart.
Telling patients about the risks of surgery before surgery is part of the scenario setting. Before surgery, you have to tell the patient what could go badly. Many patients find this difficult to accept, so the surgeon must have the attitude and manner of speaking. The “empathy class” is particularly difficult, and sometimes you have to ask a doctor who has had the disease to teach it. It is for students to observe the patient’s pain, ask the patient how you are suffering, and constantly experience the patient’s feelings.
Huang Gang: The “Medicine in Famous Paintings” lecture series is quite unique to our school. I have been teaching this course since 2011. We have some humanities courses, but the students are not very motivated and the lecturers are suffering. I have been thinking about what is its significance? Therefore, I tried to change the hard teaching method of indoctrination to a soft and silent way to enlighten and inspire the students. The first thing that came to my mind was the world famous paintings that had given me a strong shock back then.
In fact, there are many medical clues hidden in the famous paintings, which are no less than a history of medical development. For example, “Professor Rapp’s Anatomy Lesson” can be regarded as the origin of anatomy; Eakins’ masterpiece “The Great Clinic” is described as a snapshot of American surgery in the 1870s. At the beginning of the course, I had concerns and purposely scheduled the course in the evening without credit, but the result was surprising and often packed. I hope that through the famous paintings, students will discover something new about medicine, experience medicine in art, and feel art in medicine, and more importantly, that they will understand the greatness of doctors and the dedication that this profession should have.
A really good doctor is a mature “person”, not just a “craftsman” who has mastered technology
Almost everyone wants to meet a “good doctor” when they go to the doctor. What is a “good doctor”? A lot of people require this is “better medical skills”, “milder attitude”. I don’t know, to do the first point, a doctor needs at least 8 years of hard study, plus a long period of painstaking clinical exploration; and to do the second point, may be more difficult than the first point, because a simple smile, a warm word behind a person’s deep understanding of human nature.
Reporter: If you go to the doctor yourself, what kind of doctor do you hope to meet?
Ke Yang: First of all, his medical skills must be high. Of course I know the disease is very complex, if he does not have time to explain to me properly, I hope he can at least make a correct judgment and decision; secondly, I hope to find the right doctor at once, not to be pushed around. It would be better if I could be comforted by the doctor.
Some patients will say, “I want the doctor to listen to everything I have to say, and sometimes he interrupts me before I can finish my sentence.” I think it really depends on what kind of disease you have. There are some diseases that doctors do see so much that they are no strangers to life and death. Some common diseases may be understood as soon as he hears them, plus there are so many people waiting at the door, so he won’t give you too much time. In fact, the doctor’s career risk is very high, and problems are subject to lawsuits, so if he is not sure, he can not irresponsibly just interrupt you. I think you have to give your doctor a minimum of trust if you want him to see you.
Of course, from the doctor’s point of view, in the premise of having time, must talk to the patient more, which is the greatest comfort to them. And covering the cold stethoscope before the hearing, patting the patient’s shoulder with your hand and other actions can also take a very good comfort effect. However, these thoughtful and subtle actions are based on doctors having a deep understanding of human nature.
Reporter: What does a doctor’s understanding of human nature tell us about seeing patients? How can a doctor learn more about human nature?
Ke Yang: In fact, many professions need to understand human nature, especially medicine. Humans are a group animal, so you have to understand others. Human nature itself is very complex, not just good, and not as long as there is good, you can necessarily do good. A good social system can tap into human goodness and inhibit human evil, and vice versa. And between people, using goodness can induce more goodness, understanding and harmony.
So, how can a doctor learn more about human nature? I think we have to increase his life experience and life experience. This cannot be fully achieved by medical school education alone; it needs to be refined throughout a person’s education from childhood (including family education), as well as their own experiences and perceptions. One of our efforts is to encourage older and more experienced teachers not only to teach but also to educate, to talk with students, and to encourage medical students to read novels, to read classics, and to study history. We now have 8-year students at Beihang, and the last 3 years are basically in clinical practice. This clinical place is unique, what identity there are, in terms of disease, is the suffering vulnerable people, contact with them, to understand human nature has a unique role.
Reporter: It is understood that abroad there is an interview when selecting medical students to consider whether their personal qualities are suitable for becoming a doctor. In China, it’s almost a one-way street. So how to balance this difference?
Huang Gang: The college entrance examination system restricts us from interviewing, and to a large extent we do use the college entrance examination score as the only criterion. But our school has its own admissions principles and evaluation indicators, such as the first principle is “non-first volunteer applicants, do not”, and the second principle is “if you do not want to study medicine, to change professions, immediately agreed to”. After admission, we will evaluate the quality of medical students, and if we find that their quality is not suitable for doctors, teachers will try to help them improve.
In recent years, some medical schools have encountered difficulties in enrolling students, but this problem has not occurred in our school for the time being. Some schools use scholarships and other means to attract people to study medicine. My attitude is just the opposite: the medical profession cannot be induced by benefits. Because medicine is a discipline that serves people, it should have a high sense of responsibility and dedication, and should not be greedy for fame and fortune.
Reporter: In your mind, what is a real “good doctor”?
Ke Yang: A real good doctor should be a “mature” person, a “whole person”. I think a “mature” person should have a rational way of thinking after education, and a deep understanding and appreciation of human nature. And the “whole person”, not just a mastery of technology “craftsman”, is to have the ability to communicate, innovation, team spirit, face the complexity of the situation and the ability to deal with people.
Huang Gang: A good medical student, like a good doctor, should have good professionalism, be caring and responsible, have the courage to constantly deny themselves, and be good at summarizing and improving, and have the ability and passion for lifelong learning.