Qiu Fazu: How To Be A Good Doctor?

It has been 67 years since I graduated from medical school. I often ask myself during my 67 years career in medicine whether I have made every patient I have treated feel warm and comfortable, and whether I have done what my patients want and what my patients need.

I constantly feel that I have not done enough. In my 67 years of surgical career, I have made mistakes and errors, and because of that I often feel so uneasy and guilty that I even cannot have a good sleep at night.

In my early years, I once read the Chun Qiu Zuo Zhuan, namely The Spring and Autumn Annals and I remember there is a saying, "The noblest pursuit is to set a moral example; the second is to perform great deeds; and the third is to advocate noble ideas." For me, to set a moral example is to be a good man, to perform great deeds is to fulfill my duty, and to advocate noble ideas is to engage in my study.

We, as a doctor, should learn to be a Junzi(Man of Virtue) before working for a good career. Therefore the thinking of how to be a good man, how to fulfill my duty, and how to engage in my study is often circling in my mind.

How To Be A Good Man

How to be a good man? This is a tough question that can only be perceived and answered by yourself. I have been thinking about it for a long time, and I intensely feel that one wants to be a doctor, a good doctor, one should first learn to be a good man.

A good person is to be honest and upright, to be humble and decent, to care more about others than yourself and to be an open-minded man.

Firstly, Be Honest

Last year I encountered two things that made me very unsettled.

One was that a master student from our hospital succeeded in taking up a job in Tongji Hospital of Tongji University, which is also my alma mater, with a highly appreciated recommendation letter. But his poor performance on the job failed everyone’s expectation, so they went to check the authenticity of his recommendation letter. It turned out that the letter was a fake one, it was written by himself. Because of that, he was dismissed from his job.

Another thing was that a doctor from another hospital wrote a paper after finishing his additional studies in Germany, and published it in our hospital’s Bulletin (English version) last year. The publication was approved because when he submitted the article, he also attached two consent letters from his two German colleagues. This year, it was discovered by these two German authors and they did not agree to publish this paper because the research was not done by him alone.

We made a further inquiry and found that the two consent letters were fabricated by him. He wrote these two letters himself and forged their signatures. Now the German authors demanded that the article must be removed, and the doctor must publish a public apology in both English and German in our hospital’s Bulletin.

There is an old Chinese saying: “If you don't want anybody to know it, don't do it in the first place.” If you are dishonest, sooner or later you will pay for it.

A few days ago, I read a short commentary in the People's Daily published on 15 November 2004. When the renowned physicist and Nobel Laureate Prof. Samuel C.C.Ting gave an academic lecture at Nanjing University of Aeronautics and Astronautics, the students asked him three questions and three times he replied, "I don't know". His "Three Don’t Know", surprised all the students present, but won a big round of applause from the audience.

Pavarotti, one of the Three Tenors, once suddenly paused during the climax of a large concert. The audience burst into an uproar, but then Pavarotti said frankly that he had forgotten the lyrics and asked for forgiveness. His honesty won a huge round of enthusiastic applause too.

As the old Chinese saying goes, "When you know a thing, to hold that you know it; and when you do not know a thing, to allow that you do not know it - this is knowledge." Frankness and honesty are the virtues that every doctor or every scientist should learn and possess. I have always believed that the most honest men are the wisest ones.

Secondly, Be Humble

There are people who have studied and learned a lot from abroad or earned a PhD degree, and I am sure that they have accomplished a lot in a specific area. However, they may not gain enough experiences in other areas, such as in clinical practice to handle different patients with different conditions. In this case, they should be humble and ask for advice from others.

I am already 90 years old and I don't know much about new technologies like computers, nanotechnology, or new concepts like cytokines, genes, etc. So I always ask my postgraduate students for help and I don't lose face with my students, on the contrary, they respect me more.

Don't be too arrogant to think that you are superior to others just because you become a surgeon or get a PhD degree. Think about it, a driver or an electrician, if they have the opportunity to study medicine, they would have been a very good surgeon.

Thirdly, Be Respectful of Others, Especially Your Teachers

Fourthly, Be Generous

You should be open-minded and be kind to others, especially when you are a director of a department or a senior doctor.

How To Perform Great Deeds

For me, to perform great deeds means to fulfill my duty as a doctor, as a surgeon.

In 1939, I started my medical career as a surgeon at the Ludwig Maximilian University of Munich, Germany. It was after a year of study in clinical practice that my supervisor allowed me to perform my first appendectomy.

I remember well when I performed my third appendectomy for a middle-aged woman because she suddenly died on the fifth day after the operation. The autopsy report showed there was nothing wrong with my operation, but I got my supervisor’s solemn and intense gaze afterward.

He said to me, "She (the deceased) was the mother of four children!" His words of that day were indelibly printed on my brain, and had been educating and positively influencing me on how to be a good surgeon throughout my 67 years medical career.

In 1947, I returned to Shanghai, China to work in a surgical department. A female teacher came to seek help from me.

She had undergone a laparotomy 10 years earlier and since then she had constantly suffered from indigestion, constipation and abdominal pain. I carefully did an abdominal examination and felt an adult fist-sized lump in her belly, then I decided to do a surgery for her.

I was so shocked at what I saw when I opened up her abdomen. There was a hemostatic gauze tightly wrapped by her intestines, forming a big intestinal loop. The gauze had been left in her abdomen for 10 years! After she regained her health, the teacher sent me a banner with her own handwriting on it, "Magical Hands Bring The Dying Back To Life" to express her gratitude to me.

This surgical accident reminds us that the slightest negligence in the work of a doctor can cause years of suffering or even lifelong disability to a patient.

I believe that if this patient had been a loved one of the attending surgeon, he would have checked the abdomen very carefully and repeatedly after the operation, lest something be left behind.

We should realize that if a patient is willing to allow a doctor to cut his/her body, being totally unconscious under general anaesthesia, he/she must have placed great trust in the doctor!

The patient’s faithful trust in their doctors deserves to earn equal treatment from them! The attitude of a doctor, even if it is just a word, can have a huge impact on a patient's mood and life.

 I remember 20 years ago, a female banker came to me in tears, saying that she had an incurable disease - "thyroid cancer". This was a hasty diagnosis made by a clinician in a hospital.

On that day, after hearing the news her whole family of four hugged each other and cried all night long. I took a careful medical history and examined her neck, and concluded that she had subacute thyroiditis caused by a viral infection.

After 3 weeks of medication, the goitre subsided, so did her clinical symptoms. Surprisingly, the whole family was overwhelmed with joy.

This case shows that if a doctor arrives at a diagnosis with a snap judgement, their recklessness may cause great pain to the patient and his/her whole family. How important for a doctor to be discreet in act and word!

Once, an old woman came to me for help, saying that she had been suffering from stomach discomfort for quite a long time. I checked her history and asked her to lie down for further examination of her abdomen.

After the examination, she held my hand tightly for a long time and gratefully said, "You are really a good doctor. I have been to many hospitals, no one has ever examined my stomach. You are the first doctor who has done a careful examination for me." Her few words made a deep impression on me.

It surprises me that such a simple routine examination that every doctor should do, can bring such huge comfort to a patient.

It shows that many doctors do not pay much attention to what patients are thinking. There was another case that I encountered, a retired pediatrician with duodenal ulcer came to me for a consultation. I noticed a shadow in his duodenal bulb on the X-rays and confirmed my diagnosis thereafter, so I skipped the abdominal examination for him.

After coming back home, the retired pediatrician said to his family, "I was disappointed that Dr. Qiu didn't examine my stomach, even though he gave his medical advice." This starts me thinking that if a doctor with a disease would think in this way, then it is more understandable that an ordinary patient would think the same.

One Sunday, 30 years ago, I went to a large state-run watch shop on Zhongshan Avenue in Hankow to get my watch repaired.

I asked a shop assistant, "My watch is rattling when you shake it, please have a look at it, will you?" She gave it a shake and immediately handed it back to me, saying, "It can't be repaired, we don’t have the watch parts here." I cautiously repeated, "Please open it and have a look," and she just rolled her eyes and said, "It runs anyway, we really don’t have the parts."

At this moment, I stumbled across a man sitting at the corner of the shop. He, Mr. Hu, was a patient of mine and also an employee of this shop.

I went over to him and asked him to find out the reason of the sounds of rattling in my watch. He opened the cover on the back of the watch and found that a screw had come loose. He tightened the screw back and the watch could run well again.

I was half delighted and half angry, and pointed to the assistant, saying, "That lady said it couldn't be repaired and wouldn't even give a look at it, I'm going to confront her." Mr. Hu suddenly burst out into laughing and said, "Dr. Qiu, just let it go! Isn't it the same situation as a patient comes to a doctor?" When I heard this, I could not help but blush, so I thanked and waved goodbye to him.

For decades, I have remembered his words, "Isn't it the same situation as a patient comes to a doctor?" These words have inspired me deeply and have kept me thinking throughout my whole life.

I have been a surgeon for 67 years, and in the past 67 years I have seen and heard of many medical errors and medical negligence.

No doubt, most of the medical workers work very hard, and devote themselves wholeheartedly to providing the best healthcare service to patients. But we have to admit that there are still a few of them that treat their patients with a tough and bad attitude and even are unwilling to listen to them.

In the outpatient department, we see many patients come to us from far away with great hopes of getting the right diagnosis and proper treatment from us.

However, when they finally meet the doctors, some doctors just send them away by saying a few words without any explanation; some even treat them with a cold face and rebuke them.

We, as medical workers, when meeting a patient, should form the idea in our minds that - if the patient sitting or lying in front of you is your loved one, what would you do?

How To Advocate Noble Ideas

 For me, to advocate noble ideas means to make more contributions to the people.

Firstly, Be Diligent

To achieve something in one’s life, a person needs three things:

①intelligence; ②opportunity; ③diligence.

We must cherish every minute we spend! I remember five years ago during the National Clinical Academic Conference in Yichang, Hubei Province, we had a half-day free outpatient consultation.

I met a female patient with a goiter that needed surgery. She requested that I should arrange her surgery on either Tuesday, Wednesday or Thursday. At that time I was confused and asked her why.

She said that the surgeons had been playing mahjong all night on Sunday and were in a terrible state the next morning on Monday, and on Friday they will be easily distracted and only think about playing mahjong at their weekends.

I was stunned to hear that. Although this phenomenon is rare, it does exist. Knowing to cherish your time by reading more is good for you and for your patients.

Secondly, Lay The Foundation And Expand Your Knowledge

I have always advocated that young doctors should take clinical rotations before figuring out what specialty they want to join. Choosing a specialty is needed, but to be ultra specialized is not practical for young doctors.

During the National Clinical Academic Conference in Yichang, I also heard that some orthopedic surgeons would specialize in spine, and some of them would specialize only in the cervical spine, or even only in the upper three cervical vertebrae, which is obviously not conducive for young doctors to advance their medical career. Laying a good foundation is deepening your “root”. Only deep roots can promise luxuriant leaves. Just like only with a solid foundation can one expand his/her knowledge and further have the ability to be creative.

Thirdly, Be Industrial In Thinking And Exploring

In his article "The Growth of A Surgeon", Prof. Wu Jieping said that before performing an appendectomy, a surgeon should ask himself/herself these questions: is the appendix located anterior, posterior or behind the cecum? Is there any adhesions around the appendix? How is the peritoneum? Are there any appendiceal fecalith?

With much advanced equipments available, such as CT, MRI, B-mode ultrasound, etc., many young doctors rely so much on these advanced devices to make their diagnosis that they forget to do the basic physical examination for patients.

My teacher used to say that you can tell three kinds of doctors when they are looking at X-rays: the bad ones, who only look at the report but not the X-rays; the better ones, who look at the report first and then the X-rays; and the best ones, who look at the X-rays first and then the report.

Fourthly, Be Rigorous, Honest And Respect Scientific Ethics

In recent years, medical science in China has developed rapidly and has achieved many fruitful outcomes in medical research, but on the other hand, a phenomenon of seeking quick success and instant benefits has also appeared and generated adverse effects in the field of academic research.

Recently, I have read some critical articles written by Prof. Zhu Yu and other professors about academic misconducts, in which some phenomena are listed.

For example, some papers are fabricated with fake numbers of cases and follow-ups, and exaggerated treatment outcomes; some papers are poorly written, with many typos, but without solid statistical supports; some papers are labeled as “advanced” or “leading”, and the methods used and results do not stand up closer scrutiny but surprisingly lead to an exaggerated conclusion; One research can be divided and written into several papers, which then can be published in different journals; Some even plagiarize other people's work, using their tables or illustrations without indicating the source, which obviously violates the intellectual property rights of others.

This phenomenon is becoming more and more serious, and we sincerely hope that the medical researchers, especially those young generations should learn a lesson from it, and hope that medical discipline leaders, especially postgraduate supervisors, should pay more attention to supervise their students’ scientific practices, and to scrutinize and review their papers. And they should be patient and honest; they should believe in truth and respect scientific ethics; they should construct a humble style of study in medical science.

It has been 67 years since I graduated, and during this long period of my life I deeply understand the importance of worth, work and words.

I sincerely hope that the surgeons of the younger generation will seize the day to be diligent in study and thinking, to work hard to become a good doctor, an outstanding surgeon.

In the end, I would like to share with all my colleagues the following words, "Be content with your life, diligent with your work, and investigative with your study".