梁世杰：医学从来不是“哄人开心”的职业，救命没有折中法

世人总爱问：医生究竟该说真话，还是说假话？

影视剧里轻描淡写的一句“你想听真话还是假话”，道尽了人性最真实的弱点：好事盼真话，坏事躲假话。可放在生死攸关的医疗现场，这道选择题，从来没有“折中”，更没有“敷衍”。医生手握的不是话术，是性命；口中说出的不是情绪，是诊断。真话或许刺眼如烈日，无法直视，却是患者唯一能抓住的、通往康复的光。

医学从来不是“哄人开心”的职业，它是求真、求实、救命的科学。中国医师协会曾发布一组医患沟通数据：超72%的医疗纠纷，根源并非治疗失误，而是信息不对等、沟通不透明、患者无法接受真实病情。一句善意的谎言，能换一时心安，却能埋下终身祸根；一次直白的告知，会带来短暂崩溃，却能换来长久生机。这不是医生冷酷，是医学的铁律——隐瞒真相，等于放弃治疗；直面病情，才是对生命负责。

曾有一位中年患者，体检提示肺部高度可疑结节，医生如实告知需进一步穿刺检查，患者当场暴怒，指责医生“危言耸听”“过度检查”，转身投诉、拒绝诊疗。半年后，结节发展为晚期肺癌，再无手术机会，家属追悔莫及，可生命从来没有重来的选项。反观另一位老年患者，医生委婉告知胃肠肿瘤的可能性，患者虽一时难以接受，却在家人陪同下配合检查、及时手术，如今已康复三年。两相对比便知：真话让人痛一阵子，假话让人悔一辈子。

我们总期待医生温柔体贴，却忘了医院从来不是“情绪安抚所”。患者奔赴诊室，目的从来不是求一句“你没事”，而是求一个身体的真相。找医生，是为了揪出疾病、根除隐患，不是为了自欺欺人、逃避现实。就像学生考试，不能因为怕不及格就拒绝看试卷；病人就医，更不能因为怕坏消息就拒绝听诊断。没有直面真相的心理准备，没有承受病情的心理耐受，贸然就医，既辜负了医生的专业，也耽误了自己的健康。

当然，医者真言从非“口无遮拦”，更非“冷酷无情”。医学有温度，真话有技巧。对于癌症晚期、重症精神类疾病等特殊患者，医生会遵循保护性医疗原则，与家属沟通后适度隐瞒，这是人性的温柔，而非职业的妥协。但绝大多数疾病面前，委婉的真话，才是最高级的负责——不夸大、不缩小、不隐瞒、不恐吓，把病情讲透，把方案说清，把选择权交还患者和家属，这才是医患沟通的核心。

古人云：良药苦口利于病，忠言逆耳利于行。 医生的真话，就是医学里的“忠言”。它不像甜言蜜语那般入耳，却能刺破疾病的伪装；它会带来短暂的焦虑、痛苦甚至怨恨，却能为治疗铺路，为生命护航。那些看似“耸人听闻”的诊断、“严苛无情”的检查建议，从来不是医生的刻意为难，而是基于专业的救命提醒。

医患之间，最可怕的从不是“真话太刺耳”，而是“假话太暖心”。患者要明白：就医的本质，是求真，不是求安慰；医院的使命，是治病，不是哄情绪。放下对“好听话”的执念，练就接受真相的底气，才能与医生站在同一战线，共同对抗疾病。医生更要坚守：宁说刺耳的真话，不说害人的假话，以专业为刃，以温柔为盾，说真话，办真事，救真人。

说到底，医疗的终极共识，从来不是“让所有人开心”，而是“让所有人健康”。真话或许难咽，却是医者的初心；真相或许残酷，却是生命的出路。愿每一位患者，都有直面病情的勇气；愿每一位医生，都有坚守真言的底气。唯有医患同心，真话不逆耳，真心不被负，医学才能真正发挥治病救人的力量，生命才能拥有最坚实的保障。

作者简介：梁世杰 原首都医科大学中医门诊部中医主治医师，京畿瘤科创始人，本科学历，从事中医临床工作25年，积累了较丰富的临床经验。师从首都医科大学附属北京中医院肝病科主任医师、著名老中医陈勇，侍诊多载，深得器重，尽得真传！擅用“商汤经方分类疗法”、专病专方结合“焦树德学术思想”“关幼波十纲辨证”学术思想治疗疑难杂症为特色。现任北京树德堂中医研究院研究员，北京中医药薪火传承新3+3工程—焦树德门人（陈勇）传承工作站研究员，国际易联易学与养生专委会常务理事，中国中医药研究促进会焦树德学术传承专业委员会委员，中国药文化研究会中医药慢病防治分会首批癌症领域入库专家。荣获2020年中国中医药研究促进会仲景医学分会举办的第八届医圣仲景南阳论坛“经方名医”荣誉称号。2023年首届京津冀“扁鹊杯”燕赵医学研究主题征文优秀奖获得者。事迹入选《当代科学家》杂志、《中华英才》杂志。

Liang Shi-jie: Medicine has never been a profession meant solely to “make people happy.” There is no room for compromise when it comes to saving lives.

People often ask, “Should doctors always tell the truth or lie?”

The casual phrase in movies and TV dramas, “Do you want to hear the truth or a lie?”, captures the most authentic weakness of human nature: we desire the truth for good things and avoid the lie for bad things. However, in a life-or-death medical situation, this choice is never about “compromising” or “trivializing.” Doctors hold not mere rhetoric in their hands, but lives; what they say is not emotions, but diagnoses. The truth may be blinding like the sun, impossible to look directly at, but it is the only light that patients can grasp, leading them towards recovery.

Medicine has never been a profession meant to “make people happy”; it is a science that seeks truth, reality, and saves lives. The Chinese Medical Association once released a set of data on medical-patient communication: more than 72% of medical disputes are not rooted in treatment errors, but rather in information asymmetry, opaque communication, and patients’ inability to accept the true nature of their condition. A well-intentioned lie can provide temporary peace of mind, but it can also sow seeds of lifelong harm; a straightforward disclosure may lead to a brief period of distress, but it can also bring about long-term vitality. This is not because doctors are callous; it is the ironclad rule of medicine: concealing the truth is tantamount to giving up treatment; facing the reality head-on is what demonstrates responsibility towards life.

There was once a middle-aged patient whose physical examination indicated a highly suspicious nodule in his lungs. The doctor truthfully informed him that further puncture examination was necessary. The patient immediately became enraged, accusing the doctor of “sensationalism” and “excessive testing.” He turned around and filed a complaint, refusing further treatment. Six months later, the nodule had progressed to stage-IV lung cancer, leaving no chance for surgery. The family bitterly regretted their decision, but life does not offer a do-over option. In contrast, another elderly patient was gently informed by the doctor of the possibility of gastrointestinal tumors. Although the patient initially struggled to accept this, he cooperated with the examination and underwent surgery promptly. Now, three years have passed since his recovery. This comparison illustrates that telling the truth may cause pain for a short period, while lying can lead to regret for a lifetime.

We always expect doctors to be gentle and considerate, but we forget that hospitals are never “places for emotional comfort.” Patients come to the examination room not to seek a simple assurance that they are fine, but to uncover the truth about their bodies. Seeking medical advice is to identify the source of illness and eliminate potential dangers, not to deceive oneself or avoid reality. Just as students cannot refuse to look at their exam papers because they fear failing, patients cannot refuse to hear the diagnosis because they fear bad news. Without the mental readiness to confront the truth and the psychological resilience to cope with illness, rushing to seek medical treatment can both betray the professionalism of doctors and hinder one’s own health.

Of course, medical practitioners do not speak carelessly or display callousness. Medicine has warmth, and telling the truth requires skill. For patients with advanced cancer or severe mental illnesses, doctors adhere to the principle of protective care, sometimes concealing information from family members after thorough communication. This is a manifestation of humanity’s tenderness, not a professional compromise. However, in the face of most diseases, a gentle expression of the truth is the highest level of responsibility—avoiding exaggeration, minimization, concealment, and intimidation. By clearly explaining the condition and the treatment options, and returning the choice to the patient and their family, this is the essence of medical communication.

As the ancients said, “Good medicine tastes bitter for the sake of one’s health, and honest advice may be unpleasant to hear but is beneficial for one’s actions.” The truthful words of a doctor are akin to “honest advice” in medicine. While they may not be as pleasant to hear as sweet words, they can pierce through the deceptions of illness. They may bring temporary anxiety, pain, or even resentment, but they pave the way for treatment and safeguard life. Diagnoses that seem “sensational” or examination recommendations that appear “harsh and unforgiving” are never done out of deliberate malice by doctors; rather, they are based on professional advice aimed at saving lives.

The most frightening thing between a patient and a doctor is not always “the truth is too harsh,” but rather “lies are too comforting.” Patients must understand that the essence of seeking medical help is to seek truth, not comfort; the mission of hospitals is to cure illnesses, not to soothe emotions. Let go of your attachment to “pleasant words,” and cultivate the confidence to accept the truth. Only then can you stand alongside doctors and jointly combat diseases. Doctors, in particular, must adhere to the principle of preferring harsh truths over harmful lies. Use professional expertise as a sword and gentle care as a shield, speak the truth, and do genuine work to help real people.

Ultimately, the ultimate consensus in healthcare has never been about “making everyone happy,” but rather about “keeping everyone healthy.” The truth may be difficult to swallow, but it is the original intention of medical professionals; the reality may be harsh, but it is the path to life. May every patient have the courage to confront their condition; may every doctor have the confidence to uphold the truth. Only when healthcare providers and patients work together in harmony will the truth not be unpleasant, and genuine care not be compromised. Only then can medicine truly exert its power to heal and save lives, and life can enjoy the most solid protection.

Author profile: Liang Shi-jie was a chief physician of traditional Chinese medicine at the Traditional Chinese Medicine Outpatient Clinic of Capital Medical University. He was the founder of Jingyi Tumor Clinic. He holds a bachelor’s degree and has been engaged in clinical work in traditional Chinese medicine for 25 years, accumulating extensive clinical experience. He studied under Chen Yong, a renowned senior traditional Chinese medicine practitioner at the Hepatology Department of Beijing Traditional Chinese Medicine Hospital affiliated to Capital Medical University. Over the years, he gained great respect and acquired genuine expertise. He specializes in using the “Shang Tang Classic Classification Therapy” and combining specific treatments for specific diseases with the “Jiao Shu-de Academic Thought” and the “Guan You-bo Ten-Principle Diagnosis” approach to treat complex medical conditions. He is currently a researcher at the Beijing Shu-de-Tang Traditional Chinese Medicine Research Institute and a researcher at the Beijing New 3+3 Project for the Inheritance of Traditional Chinese Medicine – Jiao Shu-de’s Disciples (Chen Yong) Heritage Workstation. He is a Standing director of the International Yi-lian Yi-xue and Health Preservation Committee and a member of the Committee for the Inheritance of Jiao Shu-de’s Academic Thought of the China Research Promotion Association for Traditional Chinese Medicine. He is also a member of the inaugural Cancer Expert Pool of the China Cultural Research Association for Traditional Chinese Medicine’s Prevention of Chronic Diseases. He was awarded the title of “Expert in Classic Prescriptions” at the Eighth Nanyang Forum of the Zhang Zhongjing Medical Division of the China Research Promotion Association in 2020. In 2023, he won the Excellence Award in the First Beijing-Tianjin-Hebei “Bian Que Cup” Yan-Zhao Medical Research Theme Essay Competition. His achievements have been featured in the magazines “Contemporary Scientists” and “China’s Elite”.