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How professional values are developed and applied in medical practice in China.

The accomplishments of Chinese health care in the last fifty years have been recognized internationally. Before 1949, infant mortality in China was roughly 200 per 1,000, while the average life expectancy was about 35 years. According to the fourth national census conducted in 1990, infant mortality in China had declined to thirty-three per 1,000, and average life expectancy had increased to 68.6 years. In the Oxford Public Health Textbook, Carl Taylor and colleagues attribute Chinas success in health care to its (1) consistent policy of prevention first, (2) fully extended primary care services, (3) effective development of technical and human resources, and (4) good coverage of medical care.[1] However, all these tasks have to be accomplished by medical professionals. Thus we believe that the key to Chinas success is the development of a cohort of medical professionals who are committed to serving the people; who are eager to deliver health care despite a low salary; who are willing to work anywhere--in urban or rural settings, on the coast or in the mountainous inland, in big central hospitals or at small community clinics; and who place patients' interests first. Therefore, we face the immediate challenge of educating our doctors in professional values. I shall address this issue from a historical perspective. Professional Values in Traditional Chinese Medicine Traditional Chinese medicine is generally believed to have a history of 2,500 years. The start of the discipline was marked by the publication of Huang Di Nei Jing (Canon of Medicine) the oldest and most respected medical classic in China.[2] In ancient China, medical books were largely written in the classic Chinese literary style, which was rather abstruse and difficult for people to understand. It was commonly recognized that in order to become a medical doctor, one must read a vast range of books, particularly the Four Books and Five Classics.[3] These books addressed many subjects, such as politics, ethics, and history, and the purpose of reading them was to cultivate one's moral attitude. As a result, most medical doctors were intellectuals. In China the word intellectual has a special connotation implying loftiness, a sense of social responsibility, a loving heart, honesty, and scrupulous conduct. In Chinese philosophy, medicine was considered a humane art that was based on a spirit of loving others. Doctors were expected to be of high moral character as well as competent in medical skills. Before the introduction of western medicine, medical education in China was based in a master-apprentice relationship. The master, in the role of a mentor, would expel disciples who were found immoral. What's more, if a disciple was found to be motivated by profit in learning to be a doctor, the master had every reason to refuse to teach him and the convicted student would be forbidden to practice medicine. Hence "no ethical credentials, no medical practice" became a doctrine of the medical profession in China. The Chinese medical world believed that medical skills were closely related to ethical beliefs. Only those who have a loving heart care to know patients' needs and problems and are willing to dedicate themselves to medicine. This devotion is the fundamental drive for doctors to practice to the best of their skills. The special character of medicine was also reflected in patients' attitudes toward doctors: it was common practice in old China for patients to express their appreciation for the doctor's effort by presenting him a "certificate of merit"[4] instead of paying him money. It would be a sinful act to recognize doctors' sacred deeds with money. Doctors were recognized not only for their medical skills but also for their ethical deeds. The inscribed words often acclaimed the doctor as a competent premier, or the famous Chinese doctor Huatuo, implying the high status and reputation of the doctor. Doctors used to take a prominent physician in history as their role model and sought skill and moral perfection. …