It is a great honor for me to be here and to be invited to speak at the 1 5" Birthday of the Medical College of National Cheng-Kung University.
I am just one among many people who wish to congratulate you on your achievements, the tremendous efforts which so many people have made to create this college, and the very high standards you have attained.
I feel at home wherever there are medical students! I remember my own days as a medical student, and later as a hospital resident, in London. Like you, we had to work very hard, both mentally and physically, but the interest and excitement of doing what we in our hearts wanted to, made those years amongst the happiest in my life.
I know that in your college there are students who are studying nursing, medical technology and other paramedical subjects- those very important services with which doctors are closely connected (and without which doctors could not function.). Although I speak perhaps mainly to medical students, I include all students in my thinking, because in spirit we are one profession.
I said I feel at home here. There is another reason, and that is that I had a good fortune to be born in Taiwan (I am a "Chiong-hoa-gin-na). I had a very happy childhood and boyhood in Taiwan. My father was a doctor and began the Chang-hua Christian Hospital, my mother was a teacher before she came to Taiwan. When I was 7 years old, in 1922, I visited Tainan and I remember meeting Dr. Maxwell (Ma I-seng) at the Sinlau Hospital, the son of the older Dr. Maxwell who was the first doctor of western medicine to come to Taiwan.
Let me remind you that (as far as I know) the first two western medical doctors to be resident in Taiwan were Dr. James Maxwell (Senior) (Ma I-seng 一世) who came in 1865 and Dr. Patrick Manson who came a year later in 1866. They worked together in Takao (Kao-Hsiung) for 3 years. Then Maxwell moved to Tainan and started the Sinlau Christian Hospital which still stands. Manson continued his work in Kao-Hsiung. He was a doctor to the Customs Service, looking after the health of their personnel, the foreign merchants and sailors on the merchant ships which came to the port. He was a very observant and research-minded doctor. After 6 years he moved to Amoy (Hsia-men), and later to Hong Kong, where he helped to start the Hong Kong Medical College. It is interesting to know that Dr. Sun Yat-sen (the "Father of the Republic of China") was the best student in the first graduating class of that college, which, one might say, had its beginnings through Manson's experiences in Kao-Hsiung.
Western scientific medicine was introduced into Taiwan by Christian missionary doctors, Custom Service doctors, and after 1895, by Japanese doctors.
But over the last 104 years there has been a gradual and great flowering of scientific medicine amongst Taiwanese doctors, and health workers, have contributed to saving lives and relieving suffering, to medical research, and to teaching throughout the country and internationally.
But, however exciting and interesting and astonishing scientific advances have been (take just one example- the invention of the CT scan, followed by the MRI scan, which ave assisted doctors in the diagnosis of neurological and other diseases), I say, however exciting and beneficial these are,, there remains the bedrock fundamental question -which is, "How to be a good doctor"! "How should we as doctors and health workers behave towards humanity in need of our help?" I will try to point to some answers.
Firstly, we have some historical guidance. In about the year 400 BC a famous Greek doctor, Hippocrates, instituted an oath (希波克拉底誓約) for doctors to swear after finishing their training and becoming doctors. This Hippocratic oath stresses the importance of teaching, learning, the benefit of patients, the avoidance of harm, and keeping patients secrets. I will quote two sentences from the oath:-
"Into whatever home I enter I will go into them for the benefit of the sick and will abstain from every act of mischief or corruption, and from the seduction of females or males....
Whatever, in connection with my practice, I see or hear in the life of men, which ought to be spoken of abroad, I will not divulge it, reckoning that all such should be kept secret."
The Hippocratic oath has influenced Europe for 2500 years.
Between AD 581-673 you will know that Dr. Sun Ssu-miao (孫思邈), father of medicine in China, discussed the duties of a physician to his patients. The thought is similar, in some respects, to the Hippocratic oath.
Here is part of it:-
" A great doctor, when treating a patient, should make himself quiet and determined. He should not have covetous desire. He should show mercy on the sick and pledge himself to relieve suffering among all classes. Aristocrat or commoner, poor, or rich, aged or young, beautiful or ugly, enemy or friend, native or foreign, educated or uneducated, all are to be treated equally. He should look upon the misery of the patient as his own, and be anxious to relieve the distress, disregarding his own inconveniences, such as night-call, bad weather, hunger, tiredness, etc. Even foul cases such as ulcer, abscess, diarrhea, etc. should be treated without the slightest antipathy--- A physician should be respectable and not talkative. It is a great mistake to boast of himself and slander other physicians.
You will remember that in the Ming dynasty, in AD 1556, Kung Hsin (鞏信) wrote a maxim for respectable physicians, which is very concise:
" The good physician cherishes kindness and righteousness.
He reads widely and is highly skilled in the arts of his profession. He has in his mind adequate methods of treatment, which he adapts to different conditions. He cares not for vainglory, but is intent upon relieving suffering amongst all classes. He revives the dying and restores them to health. Such a good physician will be remembered through endless generations."
There are many writings on medical ethics in Chinese literature up to the 19'h Century, before the introduction of western scientific medicine. One of the good features of these writing is the secret remedies (in contrast to the sharing of all therapeutic advances and prescriptions in modern days) nor is there mention of the teaching of medical knowledge such as is referred to in the Hippocratic oath.
In 1968 the World Medical Association meeting in Geneva, Switzerland, formulated a physician's oath on being admitted as a member of the medical profession (the Geneva Declaration.) It is much shorter than the Hippocratic oath.
The new doctor says:
1. "I solemnly pledge myself to consecrate my life to the service of humanity.
2. I will give my teachers the respect and gratitude which is their due.
3. I will practice my profession with conscience and dignity; the health of my patient will be my first consideration.
4. I will maintain, by all the means in my power the honour and the noble traditions of the medical profession; my colleagues will be my brothers."
Finally, the General Assembly of the United Nations in 1948 passed the "Universal Declaration of Human Rights" (Mrs Rosevelt was the Chairman of the drafting committee.) Article 1 says, "All human beings are born free, in dignity and rights" (the word "dignity" has a special meaning here, which is "worthy of respect"); Article 1 goes on: "Human beings are endowed with reason and conscience and should act towards one another in the spirit of brotherhood." There are 50 articles.
The whole declaration states what each human being has a right (權利) to expect on entering the world - simply because he or she is a human being! This must and does include the right to health, and a successful patient-doctor relationship. This is regardless of all cultures and creeds.
It has been suggested that every medical student on graduation should be given a copy of this declaration.
I return to the question, "How to be a good doctor?"
Do tradition and religion influence the question? Certainly! In the East, in the Chinese race, Confucianism with its emphasis on benevolence, righteousness and humanism greatly influences the behavior of doctors. In the West, Christianity with its emphasis on loving God and loving your neighbor as yourself has a powerful influence.
What do you think is the answer to this question? I myself decided to write to a doctor friend (a woman doctor) who lives in Scotland and ask her opinion. She wrote back and said - (here is the letter dated 9' September, 1998.):
"At first thought, a good doctor, I should say has the characteristics of a good member of society: he has kindness, patience, interest in other people, temperance (moderation), humility. But he, unlike the rest of humanity, also needs:
I feel sure you will agree with her views. I must point out the human qualities which she mentioned such a kindness, patience, moderation, humility, and interest in other people. But she also mentions "up-to-date knowledge of new technical achievements in his specialty"
At the present time there is tremendous emphasis on using scientific medical equipment for diagnosis and treatment.
Hospitals are full of advanced scientific equipment: the CT and MRI scans, microsurgery, advances in molecular genetics, and the astonishing range of tests available in the clinical laboratories.
This is right and perfectly understandable.
But we may forget the human side of medical practice and I would remind you of its importance:
A machine (機器) can not show kindness (仁慈);
Radiation (放射線) cannot show sympathy (同情).
100 years ago there was a pastor, Rev. Campbell Moody (梅監霧牧師) who observed doctors in Changhua tremendously busy at their work with patients pressing the doctor from every side. He wrote down ":No equipment can compare with a long-suffering kindness" (long-suffering, means 忍耐, or 耐心) Of course, he knew the importance of equipment, but it seemed to him that the human factor -kindness- surpassed the equipment in importance!
I will insert just one comment about clinical medicine. The emphasis on scientific methods of examination of patients is now so great that, as doctors, we forget, or omit, the physical examination of the patient. When I was a medical student, one of my teachers used to say "Examine your patient from head to foot, otherwise, you may miss some information of importance for diagnosis and treatment". I am sure his advice is still valid and I pass it on to you now.
So what are the human qualities a doctor needs when seeing his patients?
1. I would put compassion (憐憫、憐恤) as of first importance. It is a fellow-felling for the person who is suffering and your strong desire to help him if you can. It is best illustrated by the famous story, movingly told by Jesus, of the care of a foreign traveller (a Samaritan) -for a man he found left half dead at the side of a lonely road., who had been beaten up by robbers; he had been neglected by his own countrymen, who passed by on the other side of the road.
2. Kindness (仁慈) A Taiwan doctor told me he thinks of a patient as a friend, and so he wants to help a friend in trouble. It is the action of helping.
3. Patience (忍耐) not patients but patience! This is the most difficult thing to learn. The pressures on doctors are sometimes enormous. But patience is a great quality. It includes pauiong (包容) in its meaning.
4. Doctors should be willing to listen carefully to what the sick person is saying. He should also be sure to explain the illness, and the treatment, to the patient. If not, the patient is confused and discouraged.
5. Respect the patient as a person (病人也是人), as having commonsense, though he may not have much education. Acknowledge that you do not know the answers to all his questions.
An attitude of intellectual pride is a common weakness in doctors. (" The doctor knows best". "The doctor will decide." "The patient does not need to know".) Rather, we doctors should treat our patients in the spirit of humility.
Calmness, equanimity, is required in the face of unexpected events. Suppose your patient becomes suddenly worse- what should be done? The doctor must keep calm even in stressful circumstances. Most doctors have to try and learn it. It is a valuable quality.
Lastly, my friend's letter says doctors should be "interested in other people." Interest in other people often is a social activity, but it may be a concern for the people with special needs, that is "humanitarianism". Webster's Dictionary defines humanitarianism as "having concern for, or helping to improve, the welfare and happiness of mankind."
Here are some examples of humanitarian work in Taiwan. i. During the Japanese occupation of Taiwan, there were many opium addicts.
Professor Tu Tsung -Ming (杜聰明) specially helped them
In 1900 there were 169,000 opium addicts, (6.3% of the population)
In 1942 there were 6000; these disappeared in 1945
2. After the war, Dr Hsieh Wei (謝緯醫師) knew that there was much TB in the aboriginal people, so he built a special hospital and out patient clinic for them in Pu Li and treated them himself. Dr Hsieh also knew that the seacoast people in Changhua Hsien were poorly served medically, so in 1956 he started a clinic in Erh Lin specially for those people. He was overworked and was too tired that one day, on the way to his clinic in ErhLin he feel asleep at the wheel of his car and was killed. He gave his life for those people.
3. The Mennonite Hospital (門諾基督教醫院) in Hualien was started in 1948 to give treatment to the aborigines in the mountains.
4. The Tzu Chi Hospital (慈濟醫院) and Medical College were started to serve the needs of the people on the East Coast of Taiwan.
5. In Lo Tung the ophthalmologist Dr. Chen Wu Fu (陳五福) saw the needs of the blind people learn an occupation, a technique, so he built an institute called (慕光盲人重見中心) for this purpose and paid for its operation out of his own clinic.
6. Of course, you all know of Dr Schweitzer, the German Christian doctor and pastor and musician, who gave up a pleasant life in Germany and went to be a missionary doctor in Africa- as he said
"to repay Africa for what the western countries had taken from it."
7. I will add one more example of someone who took an interest in people with a special need. But she is not a doctor!
Diana, Princess of Wales, before she died, felt sorry for those innocent people, farmers and country people, who had been injured by land-mines (地雷). The wars in Vietnam and Africa had ceased, but land-mines were still scattered around, invisible in the ground. People stepping on them would loose one or both legs. Diana made trips to the countries in Africa and met those people who had lost one or both legs- to see them and comfort them. By doing so she called the attention of the world to a neglected problem: how to get rid of the mines.
My speech is at an end.
I should like to ask, for what reason you decided to study to be a doctor?
"I need money to support my family, to send my children to good schools; my brothers are poor- they need help for the education of their children." Nothing wrong with that!
"The intellectual stimulus of medical practice, research, and teaching." Nothing wrong with that!
But maybe it is not enough!! There are people with special needs !
What about prisoners, the forgotten people of society? Are their medical and health needs adequately met?
What about the aborigines (原住民) who come down from the mountains to the cities of the plain, and some go off as sailors on fishing boats all over the world - are their medical needs adequately provided for?
When the black foot disease appeared in south Taiwan many years ago there was much suffering. A doctor named Wang Chin -Ho (王金河) lived nearby. He saw his chance of helping these people, took it and helped many.
The humanitarian side of medical practice is timeless - it is always there! What is your dream?
I wish you all well.
May you enjoy the professions you have chosen, and may your college attain every success.
David Landsborough Feb. 1999