常常有中国医生同事说，中国医生看病多，经验多，解决问题的能力别美国医生略胜一筹；美国医生检验手段多，仪器先进，药物先进，所以医疗科学发达。的确如此，论软硬件各有千秋。不过有一件十分重要但又很容易被人遗忘因素，就是医生爱心、责任心。医生是服务于人的，而且是服务于弱势人群的，爱心尤其显得重要。要比较这最后一点，举几个近年亲身碰到在咨询方面的例子，这里有中国医生，美籍华人医生（中国医学院毕业）和美国医生。
每当国内亲朋好友向我咨询医疗问题，我首先请教国内的医生朋友，然后是本单位的华裔医生，最后是美国医生。
例一， 问题：淋巴瘤。经国内4个疗程R-CHOP方案化疗后，PET检测肿瘤活性消失，CT下肿瘤缩小一倍，主治大夫迷惑，是治疗有效还是耐药？继续化疗还是换治疗方案？我先后请教3位医生。
医生A，国内著名医院的专科副主任，博士导师，首席专家。回答支支吾吾，说问题太复杂，要看病人和CT和PET照片。
医生B，华裔医生，给他的第一个Email他没有回，第二个Email，简短一句话，去找他的助手（实验室的instructor和国内刚来来进修的某医生）。
医生C，美国医生：PET显示肿瘤活性消失是治疗效果的最好指标，建议完成现有治疗方案，然后行活检以判读病灶内是否有肿瘤细胞残留。具体详细，提出了5中假设的情况下所要采取的预备方案。
例二， 问题：甲状腺癌复发转移至纵隔，近喉返神经，是否可以手术。病人在国内辗转看了好几个专家教授，红包银子没少使，就是找不到人拿主意。国内家属把所有CT检查影像寄过来，我找了一位头颈外科医生咨询，他又主动联系了另外三位医生会诊，最后得出结论可以手术，并建议了具体的手术方案和术后治疗。
例三，问题：胃癌。患者在美国，开始治疗后，病人希望我给找一位华裔医生咨询一下，因语言关系，总觉得和华裔医生交流方便。当按约定把病人带过去，该医生只问了一个问题：是不是已经开始化疗了。病人说是，没等病人落座，医生当即下逐客令：既然已经治疗了，任何问题你应该去找自己的主管大夫，态度之冷漠足以令癌症病人万念俱灰。
以上是个案，当然不能以此说明什么问题，但显示一个事实，至少部分中国医生以及在中国培养的华裔医生在如何表达爱心方面和美国医生相比的确有距离，这和医疗体制系统没有关系，和医生收入没关系，但和医生的基本职业道德素养有关，这种素养部分来自天性，部分来自学校的教育和社会环境的影响。许多医患纠纷莫不因此而起。
许多美国医生选择医生这一职业是完全出于自己的喜欢和爱心，这奠定了他们职业道德基础。
补充：实际上，由于开始没有得到Dr. B 的回复，我又联系医生C和D， D将我的问题转给医生E。以下是他们的回复。
Dr.B's response:
(No response from him then I send 2nd email to him)
Please see O first. And Dr. L
(note: “O” is lab research person; L is an observer who came recently)
Dr. C’s response 1:
I am currently out of the office and will return on Monday. Should you need immediate assistance, please contact my assistant, XXXX XXXX, phone:X-XXXX.
Dr. C’s response 2:
HI,
You ask a number of questions that are complicated, but we have answers. If the PET is negative after therapy, we call it CR. If the disease still is visible on PET, we get a biopsy. We do not change therapy based on CT or PET, and instead obtain a biopsy when there is a change in treatment planned. You do not say that he had a biopsy prior to starting R-ESHAP. If he hasn’t had a PET, we would get one now. If it is negative, we would probably stop therapy. However, in order to be sure, we might get a biopsy of the residual mass, and if it is negative would stop. If it were positive, then that would mean a lot, and at that point, we would probably send him for SCT after further salvage therapy. However, we would not send him for SCT now, because he has not had full documentation of persistent disease after R-CHOP.
And the business center asks for 45,000 US dollars for a person to see us without insurance. Amazing amount for an outpatient consult and tests.
XXXX XXXXXX
Dr. C’s response 3
Hi,
We can discuss this pending the biopsy. It is better to discuss this type of thing on the phone.
XXX
Dr. D’s response:
I am referring your questions to Dr. E, our Lymphoma/Myeloma Clinic Medical Director. Please follow up with him directly.
(note: D is the Chair of the Department)
Dr. E’s response:
A negative pet scan is a very good indicator of response.
I recommend
1 exact bidimensional measurement of the target tumors before and after the treatment.
2. If possible repeat the Pet and have the path reviewed at our hospital
3. Before considering refractory depending of the size of the lesion accesability! And PET activity, may recommend a ct guided biopsy (core and FNA) to be sure this is not only scar tissue specially with a negative pet
I am back from croatia at 5 pm tomorrow. Page me
XXX XXXX
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