Guowei He is Vice President of Teda International Cardiovascular Hospital of Tianjin University, director of Institute of Cardiovascular Disease of Tianjin University, Director of Teda International Cardiovascular Institute of Chinese Academy of Medical Sciences and Peking Union Medical College, professor of clinical surgery at Oregon Medical Science and Technology University School of Medicine. He was elected academician of French National Academy of Medical Sciences in 2019.

What is a doctor? Who can be a doctor? How to be a doctor? These are the questions that haunt medical students. Professor He Guowei, Vice President of Taixin Hospital, Director of the Institute of Cardiovascular Diseases of Tianjin University and academician of the French National Academy of Medical Sciences, recently shared his experience of practicing medicine for 50 years with the medical students present at the Tianjin University Beiyang Medical Lecture Hall: Good doctors should set up the spirit of dedication, adhere to clinical work, cultivate the idea of lifelong learning, maintain a strong body, and strive to improve the humanistic quality. -- Editor

1 What is a doctor

When I was a teenager, the person I admired most was Albert Einstein. He was obsessed with the theory of relativity and was determined to be a theoretical physicist. When I was in high school, my favorite subjects were math, physics, Chinese and foreign languages. In 1964, he graduated from high school with high scores and was called the "science champion". By chance, he entered a medical school.

Before that, I had never touched medicine, nor did I expect to become a doctor one day. I didn't want to at first. But after graduating to become a clinician and practicing medicine for many years, I feel like one of the luckiest people in the world.

What is a doctor? I would like to make two quotes. The first sentence is the famous British writer Lou Lou Stevenson said: doctors are the essence of our civilized world. The second sentence is the famous American thinker and writer Ralph Waldo Emerson said: as long as life can be precious, the doctor's profession will always be admired. It can be seen that the profession of doctor is highly respected.

Why do western developed countries attach great importance to doctors? I've been thinking about this question for years before I finally have an answer.

I visited museums in many countries around the world and saw many famous paintings by artists from different periods. What are the differences between famous Chinese paintings and famous foreign paintings? Foreign famous paintings mainly focus on people, while Chinese paintings are divided into three categories: landscape painting, figure painting and flower-and-bird painting. The best Chinese painting is landscape painting. Why is that? Since the Renaissance, the West has emphasized that man is the greatest spirit and the most important person in the world. In the feudal history of China, the first emphasis was on imperial rule and the second emphasis was on the mind of the literati. Landscape painting painted by Chinese literati is not a complete imitation of scenery, but a combination of literati mind and landscape. Huang Gongwang's "Living in the Fuchun Mountains" is not only a picture of landscape, but also the lofty ambition of the literati, the gully in the chest of the literati, and the ideal of the literati for the society and the country.

Since the West values people, it must value the doctors who treat people. Doctors have received special attention in the West since the Middle Ages.

Many western countries practice hierarchical diagnosis and treatment. Large hospitals generally do not admit patients directly, except as emergencies. Patients should first see a doctor at a community clinic. General ailments are treated by the community doctor, the general practitioner. The complex is recommended by the community doctor to see a specialist in a large hospital. Even community doctors are highly valued and respected by Westerners.

How important are general practitioners in community clinics in the minds of Westerners? If you have a legal document that needs to be notarized, in China to find a lawyer, find a notary office. But in some Western countries you can go to a community general practitioner to sign off on it, which is legally recognized.

The Yellow Emperor's Neijing says, "To cure the country, to cure people, and to cure diseases." He that healeth the nation, and he that healeth men shall not be counted as healers. That's why Dr. Sun Yat-sen, Mr. Guo Moruo, and Mr. Lu Xun finally gave up studying medicine. But how many foreign doctors have you heard of giving up studying medicine to go into politics? Not nothing, but very few. Because Westerners will study medicine as one of the most important life purpose.

Fan Zhongyan, a writer and statesman in the Northern Song Dynasty, said, "If you are not a good face, you are a good doctor." This sentence has two meanings. One meaning is that if I can't be a good prime minister, I will be a good doctor. Another meaning is that a doctor is not as good as a prime minister.

In the Qing Dynasty, Xu Dachon said in the Theory of the Source and Flow of Medicine: "A man is the weight of the world, and the world is tied to the people, their lives and hanging on the doctor, and the next country and a family of people more regardless, its responsibility is also heavy." It still means that governing is more important than treating people. I think this is probably the difference between Chinese and Western culture.

The cultural differences between Chinese and Western medicine are also reflected in the system of the Academy of Sciences. In developed countries such as the United States, Britain and France, the national Academy of Sciences and its academicians are independent and equal, namely, the Academy of Sciences, the Academy of Engineering and the Academy of Medical Sciences. The Academy of Medical Sciences is separate from the Academy of Engineering, but China has only two chambers. Medicine is in the Academy of Engineering. This also reflects the western emphasis on medicine.

However, with the progress of society, the integration of the world and the integration of civilizations, this gap will become smaller and smaller. In the future, we will pay more and more attention to people, and we will pay more attention to the profession of doctors.

Xu Tingzuo in the Qing Dynasty said, "If you want to save people, you can study medicine; if you want to profit, you can't." This is a very important sentence to remember in your future medical career.

Second question, I want to talk about what kind of people can be doctors.

The Huangdi Neijing says, "Do not teach others unless they are real, and do not teach others unless they are real. I was a Chair professor at the University of Hong Kong and a Research Chair Professor at the Chinese University of Hong Kong for 15 years. How difficult is Hong Kong medicine? Hong Kong every year 60 000 ~ 70 000 secondary school students graduation examination university, seven subjects full A++ students are generally called the "top scorer", only 3 ~9 every year. The threshold for admission to a college is 22 points for general subjects, but the threshold for admission to a medical school is 39 points, 17 points higher than the threshold for admission to a college. In 2016, 4 "top scorer" 3 studied medicine; In 2017, all six top scorers chose to study medicine. In 2016, I read a media report that none of the 36 top scorers in the college entrance examination in mainland China chose to study medicine. This reflects the difference between the professional concept of doctor in mainland China.

In the United States, you have to do four years of undergraduate study before you go to medical school. The admission rate for good medical schools is 2 to 5 percent. The best students of the best students become medical students. Shouldn't you feel lucky to be a medical student?

When I was assigned to medical school for the college entrance examination, I used to feel that I was the most disappointed middle school student in the world, because I could not realize my dream of becoming a theoretical physicist. But as I became a clinician and grew to love medicine, I felt like the luckiest person in the world. I hope the students attach importance to your major, to your learning, to your opportunities.

The word Doctor used to refer to a doctor before the Middle Ages. In the early days, a doctor was a doctor from a seminary, which developed the famous University of Oxford. A PhD is awarded to a scholar who has advanced achievement in the study of theology or philosophy. After the Renaissance, Western society paid special attention to people themselves, especially to the doctors who treated people and extended their life. Therefore, doctors were honored as Doctor, even though they did not all have a doctor's degree. In general, respecting doctors reflects the human respect for life.

2. How to train good doctors

First of all, I want to emphasize what the purpose of training medical students is. The most important thing is to train clinicians, the first thing any medical school has to do is train clinicians. It is important that medical schools do not focus on scientific research, but on clinical people who can treat patients. No medical school in any university should forget this basic tenet and go astray. On the basis of training clinicians, some medical graduate students can be trained in order to improve the level of clinicians. The purpose of training graduate students is to train research talents on the one hand, and train logical thinking of clinicians on the other hand, so that doctors can better develop medicine and serve patients.

When I was a PhD student at the University of Hong Kong, I would ask students, what is your purpose for doing a PhD? Now in mainland China, if you don't have a doctor's degree, there will be problems in professional title evaluation in the future. If you want to find a good job in a big hospital, people don't want you, and the salary is low if you don't have a high degree. Everyone's thinking about these real problems. In fact, the main training of postgraduate students is logical thinking ability. With such ability, no matter what you do in the future, you will have a very solid foundation.

Modern medical education system comes from European and American countries, so we should learn from the training experience of British and American medical graduate students. In the United States, medical school is followed by an internship or residency. Then, if you want to be a specialist, you have to do a second specialist residency. After completion of the specialty resident, he/she should work as a Fellow (equivalent to a semi-independent training doctor), conduct further training in clinical specialty, and finally work as a Consultant(that is, an independent attending physician, equivalent to a chief physician in China).

So roughly, if you go to college at 18, you graduate at 8, you're 26, you do one year of internship at 26, you're 27, you do another 3 years of residency at 30, you do another 3 years of specialty like heart surgery, brain surgery, you're 33. Can you graduate at 33 and find a long-term job? Usually you can't find it. You have to find a good teaching hospital, a famous expert to teach you, his patients to give you a part, to further cultivate you. In a few years, if you've done really well, someone will hire you. This is still the best case scenario. How old was he? Statistics show that the average age of long-term employment for heart surgeons in the United States is 38.

Perhaps only 5% to 10% of the people are successful like this. Most people want to become a specialist doctor. It is very difficult for them to go through such a long training and study, during which they also need to pay the tuition loan for medical school.

Now look at Britain. British high school is 7 years, university is 3 years, medical is another 3 years, when you graduate with a double bachelor's degree, because you went to two universities. The training of clinicians in the UK is similar to that in the US. After receiving a PhD from an British university, one can also apply for an advanced PhD, such as a PhD in science. For advanced doctoral degree, you must have at least eight years after completing your PhD, compile a collection of papers published during this period, apply to a university school of Science, and then have them reviewed by world-class experts.

What's wrong with medical education in China? It's five year, six year, seven year, eight year. It's very complicated. All countries in the world have adopted these kinds of medical education systems, but no country has several kinds of internal. We must reform and unify the medical school system. I suggest six years under the British system. After 6 years, a double bachelor's degree is awarded, equivalent to a doctor's degree. No other degree is required as a clinician. The clinician's job is not to do scientific research, but to look after the disease so that patients have the lowest death rate, the highest cure rate, and the lowest incidence of complications. To do this, you sometimes have to rely on research, which you don't have to do yourself. You can learn about the latest medical research through continuing education. Only a small number of clinicians who are interested in scientific research and who work in university teaching hospitals need to do research. I think this should be the main direction of medical education reform in China in the future.

Now the hospital recruit clinical graduate students, attracted to go out to do training. Finally, the research did not do a good job, also did not have the mind. Now hospitals blindly require a high degree, a good hospital must have a doctor's degree in order to enter, a doctor's degree may be three years have no contact with clinical experience, no clinical experience. It is also a strange thing against the law of medicine. In my opinion, a medical school degree is enough to be a clinician, but only after the rigorous residency training described above.

There are also doctors who have the desire to do research, not only in clinical work, but also as university professors. Such people, like myself, need a research degree, such as PhD, to train their research thinking. But such doctors do not need too many. In the United States and the United Kingdom, only a few out of 100 clinicians are university professors, which is also highly competitive.

3 How to be a good Doctor

First of all, they should have the spirit of lifelong dedication to medicine, have complete clinical skills training, have the purpose of patients first, always maintain front-line clinical work, always do a good job in their continuing education, and have good physical and humanistic quality.

Dedication is the most important thing. I have been a doctor for 50 years, and for at least 35 to 40 years I never took a day off. I did ward rounds every Sunday morning and never took a day off for family matters. I can't do this job without dedication. After 30, 40 years of hard work, I found it enjoyable. I have performed over 7,000 heart operations and cured many patients, although I am often woken up in the middle of the night, but I think it is worth the pain. Adherence to clinical work is critical. For the first three days of my lecture today, I was in surgery every day.

The other thing is to put patients first. As long as the patient needs, in any case to try to put aside other things to serve the patient, the patient's life is the most important. A doctor's duty is to cure diseases and save lives. It's the value of a doctor's job to help a patient regenerate.

Doctors should constantly summarize clinical experience, improve knowledge reserve, develop new diagnosis and treatment methods, and train their thinking ability.

Another important point is that a good doctor must be in good physical condition. Surgeons often stand for hours at a time performing operations. We sometimes do major cardiac and vascular surgery, do not eat, do not drink, do not spit, do not cough, do not go to the toilet for seven or eight hours, do not have good physical condition is impossible to persevere. For a long time, cervical and lumbar spine diseases are common problems of surgeons. Need to improve their physical fitness through proper exercise. Now, I often ride my bike on weekends and can do 30 kilometers a day.

Clinicians must also have good human qualities. What are the aspects of humanistic quality? I summed it up, including character, IQ, EQ, knowledge, thinking, neat, diligent seven points.

First, personality. The profession of doctor is the intersection of natural science and humanities. Doctors are scientific workers as well as social workers. At each of the 150 or so medical schools in the United States, a committee is required to determine if you are fit to be a doctor. There's a committee of a dozen people, and it's all about how well you react and how well you can communicate, not how well you do on a test. A doctor should be cheerful, good at communication and good at uniting people around him.

These qualities need to be cultivated. I used to be a bookworm and read books all the time, but later I found that being a doctor requires a good personality. You have to talk to the patient, you have to see things from his point of view, you have to talk to him. This is very artistic, is to learn and cultivate. This is emotional intelligence. The students who get into medical school get high marks, do well in school, have no problem with IQ, but more importantly, EQ.

Also cultivate logical thinking. American university is a general education, undergraduate casually transfer department, random transfer, it is to cultivate people, not training tools. I think the purpose of education should be to cultivate people