At noon today, a friend from Shanghai consulted me about being hospitalized for a battery of medical tests. She had developed diabetes at an unusually young age and had struggled with poor blood sugar control. A major tertiary hospital in Shanghai had recommended inpatient admission. Before she was admitted, she asked me whether she should go through with it. I told her that hospitalization would allow for more systematic glucose management and better control of dietary and other contributing factors — a sound option if circumstances permitted. Most patients, after receiving standardized inpatient treatment, manage to bring their blood sugar down to an acceptable range.

What neither of us expected was that, once admitted, her doctors ordered more than a dozen ultrasound scans, along with full-body CT, MRI, bone density tests, and more. The sheer volume was baffling. The patient in the next bed was also grumbling loudly about the mounting costs from so many tests. So the question arises: were all these examinations really necessary?

This question is steeped in a distinctly Chinese paradox. Many patients assume that when doctors order a barrage of seemingly unrelated tests, it must be to pad the bill. I cannot honestly deny that this happens. China’s healthcare environment has reached a troubling state — partly thanks to the notoriety of the “Putian” hospital chains — and the public harbors deep resentment toward doctors who overprescribe tests and medications. The slightest misstep invites accusations of profiteering, and the unfortunate truth is that some doctors do indeed profit from these practices.

Then there is the opposite scenario: a doctor orders only tests directly relevant to the condition, or a patient declines the doctor’s recommendations. If, during subsequent treatment, an unexpected complication arises — worsening condition, a secondary illness, or even death — the vast majority of patients will blame the doctor for failing to conduct a comprehensive workup. Medical disputes inevitably follow.

There is yet a third scenario: the doctor explains the significance and importance of every test, the patient consents, or perhaps the patient actively wants a full screening. On the surface, this seems harmonious and unproblematic — but deeper issues lurk, touching on the trajectory of modern medicine itself. For better or worse, most advanced diagnostic technologies are dominated by Western medicine, and many prominent Western medical authorities are, in practice, spokespersons for medical device and pharmaceutical companies. They exploit the patient’s fear of missing something — the “better safe than sorry” mindset — to aggressively promote the supposed effectiveness of various screening tools and drugs, when in fact many have significant limitations.

Take the rabies vaccine as an example. In China, it has become practically a household name, yet rabies is not nearly as fearsome as most people imagine. Statistics suggest that only about 20% of people bitten and bleeding from a rabid dog actually develop the disease; many who are bitten never fall ill at all. If the animal that bit you remains alive and healthy for ten days, the rabies vaccine is unnecessary. But no one wants to be part of that 20%, and even fewer are willing to shoulder that risk. Doctors, for their part, often cannot be bothered to assess each case individually — after all, if the patient gets the shot, they feel reassured, the doctor bears no liability, and everyone makes money. Why not?

Beyond the question of which tests to perform lies the deeper issue of when to perform them — and this has everything to do with a doctor’s clinical competence. Many doctors in China take the easy way out: run every available test, absolve yourself of responsibility, and perhaps stumble upon something new in the process. Why not, indeed? This mindset is diametrically opposed to the philosophy of precision medicine. It is intellectual complacency, pure and simple.

The Society of General Internal Medicine in the United States has explicitly warned physicians: “Do not perform routine general health checks for asymptomatic adults… Periodic general health checks, including ‘health maintenance’ annual visits, scheduled without a specific clinical reason, have not been shown to reduce morbidity, mortality, or hospitalization rates, but they do cause potential harm from unnecessary testing.” Blood draws and X-rays — which Chinese patients are particularly fond of requesting — are invasive and carry radiation risks that are, frankly, detrimental to health. In China, medical testing often feels like an assembly line — devoid of the human touch that medicine ought to provide. What patients receive in the end is simply a stack of cold numbers and prescriptions.

These concerns have long since ceased to be purely professional medical questions; many have become social issues. How do we ensure that doctors order only appropriate tests and prescribe only necessary medications? How do we help the broader public trust their doctors — to stop blindly pursuing more tests, more scans, and the relentless chase after so-called “normal ranges”? These are questions that deserve the serious reflection of every one of us.

今天中午，我的一名上海朋友向我咨询了住院做检查的事情。她由于过于年轻罹患糖尿病多年，血糖控制不佳，上海某大型三甲医院要求其住院治疗。在住院前她也曾问我到底要不要住，我认为住院能够规范降糖，且能控制饮食等其他影响因素，如果条件允许是个很好的选择，大部分患者在住院按规定治疗后，基本上都能将血糖控制在可接受范围内。

但没有想到的是，住院后医生给安排了十余个B超，全身CT、核磁共振、骨密度等检查项目，令人十分不解，隔壁床因为检查项目太多，花销太大也连声抱怨，那么问题来了，这些检查究竟要不要做？

这个问题充满了中国式悖论。很多患者会想，医生让做那么多自己看起来根本没关系的检查，肯定是为了多赚钱。说实话我不能否认这一点，中国的医疗环境已经到了一种不可思议的境地，大约是拜莆田系所赐，社会上对于医生多开检查多开药的不良现象深恶痛绝，稍微不注意就会被认为是挣黑心钱，而且，现在很多医生确实在赚这笔钱。

另一种情况是，医生只为患者做了与疾病直接相关的检查，或者患者拒绝了医生的检查建议，如果在后续的医疗过程中出现了任何一种意想不到的并发症，导致患者病情加重、别生他病或者死亡，这时候绝大多数患者都会怪医生为什么不给自己做全面的检查，也会产生医疗纠纷。

还有一种情况是，医生向患者阐明了所有检查的意义和重要性，患者同意了，或者患者本来也希望做一下全面的检查，这样看似和谐没有问题，其实问题也很大，这里面牵扯了医学的发展问题。无论如何，各种现代检查项目基本上都是有西方掌握并操作，西方很多著名医学家实际上都是医疗厂商的代言人。他们利用了患者宁可错杀三千不可放过一人的思想，大力宣传各种检查手段和药物的有效性，其实很多都是有缺陷的。举一个例子，狂犬疫苗在中国已经家喻户晓，但是狂犬病实际上并没有想象中的那么严重，根据统计，大约只有20%的被疯狗咬出血的人才会发病，很多人即使被咬也不会发病，若咬你的动物在十日内没有发病死亡，狂犬疫苗是不用打的。但是，所有人都不愿意做那20%，更不愿意去承担这里的风险，医生也懒得去鉴别情况，反正你打了自己放心我也没责任还能赚钱，何乐而不为呢？

再说检查，做什么检查，什么时候做检查，这与医生的水平有直接关系。中国的很多医生不思进取，他们简单地认为所有检查都走一遍，自己不仅没有责任，说不定还能发现新的问题，为什么不干呢？这种想法与当前精准医疗的思维截然相反，这是典型的不思进取。美国普通内科学会(The Society of General Internal Medicine)郑重提醒医生”不要对无症状的成年人进行常规的普通体检……没有特别原因而定期安排的普通体检，包括’保健’在内的年检，在减少发病率、死亡率或住院率方面显示并无作用，但不必要的检查却引发了潜在的危害”。尤其是国人热衷的验血、拍片，都是有创性、有放射危险的检查，可以说对健康不利，在中国做检查更像是流水线上的机器，体现不出医学的关怀，最后得到的只是一堆堆冰冷的数字和药物。

这些都已不仅仅是医学层面的专业问题，很多已经变成了社会问题。究竟如何才能让医生只做合适的检查，开必要的药物？究竟如何才能让广大老百姓相信医生，不盲目地追求检查，不盲目地追求所谓的指标？这值得我们所有人思考。