Cathy Li is a medical student in the Class of 2020 at the University of Toronto
"Doctor, what do you recommend for my grandmother's pancreatic tumour?" My heart was fluttering nervously as I scribbled down his suggestions. This was the third meeting I had arranged.
Growing up, I had a very close relationship with my grandmother and lived with my grandparents until I was six years old. I received the news of her diagnosis during my third year of university. The words “intraductal papillary mucinous neoplasm” haunted me and echoed incessantly in my head for days; I could neither think nor focus. The feelings of powerlessness grappled to hold me down. Yet deep down, I was aware that simply being a passive bystander would be the greatest personal defeat. With that, a new wave of resilience inundated my thoughts.
I began to take action. Healthcare in China paled in comparison to that of Canada, and so I sought advice from local oncologists in London, Ontario to mitigate the shortcomings of treatment plans in China. From scrutinizing medical journals to emailing healthcare providers to arranging meetings, I exhausted every resource to learn about my grandmother’s intraductal papillary mucinous neoplasm (IPMN). As the only one in my family with a science background, I shouldered the responsibility of gathering credible information and creating the best treatment regime. Despite distance being a physical barrier, I communicated with my family members regularly and was determined to help my grandmother make a well-informed decision.. On many occasions, however, I felt strained and anxious in my role as an advocate—strained by the limited support I could provide and anxious about the potential consequences.
While my personal emotions were overwhelming, I was pleasantly surprised by the sheer number of healthcare practitioners who were willing to help my grandmother’s case! Many physicians took the time to educate me about the recommended practices in Canada, such as the importance of confirming a diagnosis by biopsy prior to surgical intervention. I was touched by the willingness of these physicians to provide compassionate healthcare advice to a complete stranger overseas without expecting any personal gain. Their actions were motivated purely and simply by genuine concern for patients. As a current medical student, I could begin to appreciate the depth of a physician’s commitment to patient care in medicine; these brief, inspiring encounters gave context to the concept of “physician altruism”.
On the other hand, I had a remarkably less pleasant impression of healthcare in China. Unlike in Canada, healthcare is completely privatized in most parts of China. In fact, bribing surgeons is common practice in China: patients and their families thank the surgeons by gifting “red envelopes” with the ultimate goal of bypassing the long surgery waitlist. The thought of this compensation-driven model of healthcare was very unsettling.
During the consultation with the surgeon, my family voiced my concerns regarding confirmation of the diagnosis and its grade with a biopsy so that my grandmother could make an informed decision about next steps. The surgeon responded dismissively to this suggestion, insisting that the tumour was benign and surgery was the only viable option. Reading between the lines, my family also suspected that the surgeon had no intention of returning the red envelope regardless of the decision to undergo surgery. In retrospect, the surgeon was perhaps also defensive about having his healthcare expertise questioned.
In China, the unspoken rule and dominant school of thought is that “doctors know best”. Accordingly, my grandmother obeyed and continued with the operation. The hours leading to and during the surgery were incredibly stressful, but thankfully, there were no complications and the surgery was a success. When the surgeon returned, however, he briefly glanced at the report and a shadow of perplexity flickered across his face. The unsettling expression disappeared as he casually tossed us our paperwork. On his way out, the surgeon offhandedly noted that there were some unexpected signs of metastasis on pathology; in other words, the tumour was malignant.
Silence filled the room.
What did that mean? Was the prognosis worse than anticipated? Was surgery even necessary? A storm of questions raged inside our heads, but there was no one to answer them. We knew surgery was not an easy feat for a frail senior’s body. We were under the impression that the tumour was benign, and a successful surgery would allow my grandmother to fully recover. Realizing that the cancer might have metastasized and the surgery might have been in vain crushed our family’s morale. Equally alarming, the surgeon made no effort to ease our anxiety from this horrific news, answer our slew of questions, or apologize for his misdiagnosis. We demanded an explanation from the surgeon, but the surgeon casually dismissed our objections with a simple shrug and nonchalantly walked off as if nothing had happened.
Such unapologetic and emotionless encounters with physicians blinded by greed and compensation juxtaposed harshly against the compassionate and thoughtful physicians who willingly helped a complete stranger overseas. This stark contrast does not indicate a dichotomy. Instead, it paints two extreme cases along the wide spectrum of healthcare quality—from greed-driven to patient-centred care. Through this life-changing experience, I learned the importance of advocating for patients’ health and respecting a patient’s suggestions with earnest consideration. Ultimately, I came to truly recognize and appreciate the type of patient-centred care that I will strive to provide in my own future practice as a physician.
Note: This is a true story. The patient has given her consent for this story to be told.