More than half or even all of a doctor’s medical practice may be dealing with indications. If the indications are properly chosen and appropriate, the doctor and patient will be happy, otherwise the doctor may be anxious and fearful, or even make a big mistake, and the patient will suffer immeasurably. Of course, we are talking about indications in a broad sense, including indications for surgery, indications for drug application, and so on, and even including the timing, manner and skills of talking with patients and patients. In this article, we will only talk about the indications for surgery. What is meant by surgical indications, there is no accurate definition in the internet, various books including the new edition of university textbooks. Baidu encyclopedia explains indications as: medical term, indication, also known as indications, refers to the scope and criteria for the suitable application of drugs, surgery and other methods. As far as I understand it, the so-called indication for surgery is the right disease, the right patient, the right social and human environment, the right doctor in a hospital with certain conditions to perform the surgery, meeting all the above conditions is the real indication for surgery. Suitable disease: This is the easiest of all conditions to grasp and the theoretical part that can be mastered through hard work, and is described in every book on surgery. Take partial nephrectomy as an example: the indications for partial nephrectomy include absolute indications and relative indications. Absolute indications are patients whose kidney cancer occurs in anatomical or functional isolated kidney, and radical nephrectomy will lead to renal insufficiency or uremia, such as congenital isolated kidney, contralateral renal insufficiency or non-function, and bilateral renal cancer. I understand that renal insufficiency or renal failure occurs immediately after surgery. Relative indications are patients with certain benign diseases in the contralateral kidney of kidney cancer, such as kidney stone, chronic pyelonephritis or other diseases that may cause deterioration of kidney function (such as hypertension, diabetes, renal artery stenosis, etc.). Understood as a tendency to future renal insufficiency. Selectable indications include patients with clinical stage T1a (tumor ≤ 4 cm), tumor located in the periphery of the kidney, solitary asymptomatic renal cancer, and normal contralateral renal function. With the advancement of surgical techniques and theoretical levels, the scope of surgical indications for partial nephrectomy has gradually developed to stage T2 tumors, which means that partial resection in these patients has similar results as radical surgery. The latest NCCN guidelines include clinical stage T1a kidney cancer as an absolute indication. There are ready-made formulas for these and surgeons should be familiar with them. The right patient: The patient’s education, family environment, personality factors, understanding of the disease, and the patient’s systemic status are among the decisive factors affecting the choice of surgical plan. Taking partial nephrectomy as an example, patients who repeatedly stress and worry about local recurrence or ipsilateral tumor recurrence, patients of advanced age with short life expectancy, and patients who cannot understand the complications of blood transfusion or partial nephrectomy, such as urinary fistula, need to think twice before performing partial nephrectomy at this time. Of course, doctors should be able to communicate with patients and their families in the most common language, sincerely and from the patient’s point of view, expecting to get the patient’s understanding and cooperation. Everything is based on the economy, the patient’s economic conditions are also a factor for doctors to consider, to see a doctor is to spend money, the patient does not have money as a doctor can not help pay, right? Help one is not able to help the second, right? This has nothing to do with compassion, it is a social responsibility. For patients with no money or very little money, the simpler the surgery the better, complications will be very difficult to deal with, for example, total cystectomy ileal cystectomy, ileal cystectomy complication rate of about 4%, will not be less than this figure, after the emergence of intestinal complications significantly longer hospital stay, medical costs increased significantly, at this time the doctor may choose to bilateral ureteral skin fistula, of course, the patient pays for the quality of life Decline, what can be done about it? A suitable social and humanistic environment: various medical disputes often appear in the press, medical trouble has become a social problem, there is a farce of doctors with steel helmets to work and doctors were killed for no reason tragedy. Every year, there are more and more medical disputes. In Tianjin, for example, the number of medical complaints increased more than 10 times in 2010 compared with 2009, reaching more than 2,000 cases, not including cases in which hospitals settled compensation through private negotiations. There are many reasons for medical disputes, including society, doctors, patients and other factors. As a doctor, in addition to regulating personal behavior and updating medical knowledge in a timely manner, it is important to seek help from the department, hospital and even society for difficult and complicating procedures. Suitable doctors and hospitals Hospitals have various classifications, but as far as surgery classification is concerned, it is not perfect, that is to say, it is not yet possible to reach what level of hospital does what. As far as social medicine is concerned, it should be different levels of hospitals to complete different medical tasks, for example, how can a hospital that has never done radical kidney cancer surgery complete this kind of surgery with quality and quantity? There is no precise answer to how to train and assess doctors, and the medical administration is also doing what it wants. The drawback now is that the assessment is based on criteria other than work, such as the number of papers used by doctors and teachers as a condition for promotion, instead of measuring how good they are at seeing patients and teaching. It is clearly not appropriate to promote an attending physician or even a professor after graduation. Back to the point, how can a doctor who has never done a partial nephrectomy perform a partial nephrectomy for central renal cancer in a hospital that does not have intraoperative ultrasound?