The mission: is it for us or for them?
In Chinese, the term for doctor is yi sheng, which roughly translates into “medicate to life.” From this interpretation, the mission of a physician is to restore livelihood to patients, whether in the literal or in the metaphorical “wholesomeness of life” sense. While this may seem intuitive, the ingredients of “quality of life” and “satisfactory care” are much less clear and much more complex.
It is natural for us, as students of logic and problem solving, to treat medicine as a series of causes and effects. Much of our training pushes us to do our best to match patient presentation with classical textbook diagnoses. If there was an ultimate handbook of all the possible combinations of diseases and sufferings, it would solve much of our frustrations.
But in so many ways, this analytical, black-and-white method of perception constitutes a small iceberg chip among the multiple tenets of being a competent physician. Despite our movement away from overbearing paternalism with modern medicine, we still often believe we know what’s best for our patients. It is so easy for us to reason through the “obvious” best course of action, that we often forget the unique and complex social context that every patient brings besides their presenting symptoms.
These thoughts began to plume in my mind when I received a phone call from my unhappy mother. She had just returned from an unpleasant visit to her endocrinologist. Earlier this year around March, she had first met with the endocrinologist, and she felt comfortable with his patience and open attitude. However, this time, she returned from the office feeling threatened and even ashamed of her medical illness. Instead of congratulating her for making a successful recovery from the operation, he berated her for coming to his office so late given the red flags during her worrisome ultrasound results three years ago, and taking so long to schedule the surgery after his strong suggestion. Not only was he unhappy with her delay, but he actually told her that “you had better listen to everything I say from now on if you want to get better.” When she had jokingly mentioned how large her scar was, he aggressively implied that it was her own fault due to her reluctance to pursue the proper medical procedures that had been instructed to her.
My mother is a well-educated but traditional Chinese woman. Growing up, she had turned to Chinese herbs, remedies and other medicines in her times of illness. When she experienced bouts of menstrual pain, she took herbal soups to help ease her pain. She utilized herbal patches for her bumps and bruises. When she started ailing with back pains and sore tightness of her body from age and overwork, she scheduled herself for acupuncture and massage therapies. When her children became sick, she made herbal teas and Chinese medicinal soups to help alleviate the symptoms. She was never averse to Western medicine — she had always made frantic appointments for us and for herself when we showed any signs of serious illness — but the traditional, cultural remedies always brought her comfort and security. To her, Chinese medicine was as integral and natural as grabbing that bag of cough drops at the first signs of a sore throat and sniffles.
When they found abnormalities — nothing alarming, just something to check out — in a routine check-up three years ago, she had scampered away in avoidance when the words biopsy, needles and neck were put together due to her fear of pain. Eventually, after so much patient coaxing and remonstrating threats, I finally (gently, of course) twisted her arm to get that biopsy before I left for medical school. When her diagnosis confirmed both her physician’s and my worries, she became hesitant about pursuing the next steps. Her continual disappointing experiences with the surgeons — one told her “you’ll come back sooner or later” after she mentioned she wanted to wait, while another ridiculed her for her desire to pursue concurrent Chinese therapies — strongly dissuaded her from making any tangible plans.
Instead, she turned to what she knew well, to the prescriptions and medicinal remedies of Chinese medicine. She tried acupuncture and daily soups with sulfur. I was skeptical, but I opted to make a deal with her. If biopsies did not illustrate improvements after a few months, she had to pursue surgery. I huffed a huge sigh of relief when she finally found a surgeon who sat down and explained to her the significance of her disease, the reasons for such urgency for resection, and the steps that were involved.
And I was enraged for my mother. These physicians ignored my mother’s concerns and failed to educate her about her own disease because they felt that not having surgery was completely out of the question. In their minds, there was no point explaining all the minutiae to her because she just did not get it, and it would not matter anyway. They already knew surgery provided her with the best outcome, so why wouldn’t she do it? They had deemed Chinese medicine such a ludicrous alternative that it not only reflected her educational incompetence as a patient, but that there was absolutely no value in even discussing it.
It wasn’t that my mother would not have agreed to the surgery sooner, but more that no one bothered to consider what she defined as a good clinical outcome and what constituted her quality of life. No one bothered to learn that she read online that she could develop long-term depression and lethargy after the operation, and she was terrified that she would be unable to be active and take care of her children. After all, being capable of supporting her family was absolutely necessary for her. No one bothered to find out that she had always been sensitive to medications, and she did not want to take hormones for the rest of her life. No one bothered to consider that being open to the matter of Chinese medicine would have made her much more comfortable with both the physician and the therapeutic options.
When did these things not become important? When did the clinical survival become so much more important that these “silly concerns?” When did our definition of a competent doctor outrank the different needs of our patients?
So what does it really mean to be a doctor? Do we decide what’s best for our patients as medical experts? Do we yield to every patient’s requests and needs in order to completely accommodate them? Or is there a way for us to meet at the middle? And if so, how do we achieve that through our training?