On short-video platforms, one often encounters a certain narrative: doctors switch between two modes when faced with patients who record audio or video. When the patient isn’t recording, the doctor speaks freely based on experience, “saying what needs to be said and prescribing what needs to be prescribed.” However, once a patient starts recording, the doctor “won’t say a single extra word, follows the guidelines to the letter, and orders every possible test for any area of ambiguity.” These videos usually end with a sarcastic remark: “What’s so hard about treating ‘robotic patients’? You just need to be literate.” These videos often garner a high number of likes.
Similar claims have not been uncommon in recent years, but what is truly worth pondering are the two voices in the comment sections. One says: “Doctors following guidelines is exactly where the certainty of medical treatment lies.” The other mocks: “Then you don’t need to go to a hospital to see a doctor; just ask an AI.” The two sides trade barbs, refusing to budge. On the surface, it looks like a battle of egos, but if you look closer, you can discern a long-overlooked issue: In healthcare—a field highly dependent on information and trust—groups in different social circumstances have never shared the same imagination of what ‘good medicine’ is.
Whether a Patient Records Is Never the Reason for Different Diagnosis and Treatment
The narrative online sets up a binary opposition: when patients don’t record, doctors “say what they think” based on experience; once patients record, doctors immediately retreat, “saying not a word more, following guidelines entirely, and running every test for anything vague.”
This setup seems sharp, but it is built on a presupposition of human malice, assuming that patients record audio or video solely to ‘find fault’ and prepare for future lawsuits.
Is this really the case?
What is the experience of an ordinary person going to a major hospital? Waking up in the early hours to queue, facing a registration window line that seems endless, finally securing a specialist appointment only to wait another two or three hours in the waiting area. When their number is finally called and they enter the consultation room, before their seat is even warm, the doctor has finished asking about main symptoms and is typing on the keyboard while printing out test forms. The entire process might take less than five minutes. Every word the doctor says—whether about the diagnosis, potential treatment plans, or precautions—is extremely important to the patient. But in this high-pressure, fast-paced scenario, how much can an exhausted patient remember? Going home knowing nothing is the norm.
Therefore, many patients choose to record not out of the malice of “collecting evidence” or “finding fault,” but out of a very simple need: I’m afraid I won’t remember, I’m afraid I’ll misunderstand, and I want to go back and watch it repeatedly. This is essentially no different from a student recording a teacher’s lecture in class.
Equating this need with “preparing for a lawsuit” is itself a condescending misinterpretation.
Taking a step back, even if some patients do enter the consultation room with suspicion and defensiveness, where does that defensiveness come from? It doesn’t appear out of thin air. The soil of doctor-patient trust erodes bit by bit. If a society only demands “unconditional trust” from patients without investigating why that trust was lost, that is also a form of evasion.
Returning to the heart of the matter: Does a doctor’s clinical model really change because a patient is recording?
Let’s look at a counterexample. I follow several doctor accounts on short-video platforms, such as Dr. Fang Yousheng from the Hand Surgery Department of Huashan Hospital. He has a large number of consultation videos on Douyin, recording the entire communication process with patients. In these videos, Dr. Fang has a recurring action: requiring patients to redo examinations at his hospital. In front of the camera, he tirelessly explains the reason: hand examinations are highly difficult operations, and equipment conditions and expertise vary greatly between hospitals. Much critical information simply cannot be seen in reports from other hospitals, yet this is vital for determining a surgical plan.
Some patients don’t understand—why spend more money and make an extra trip? But for Dr. Fang, this isn’t an elective; it’s a requirement. He can calmly stand by this demand in front of the camera because he knows it is for the patient’s benefit. If he were truly like the doctors in those narratives who “retreat to the bare minimum of the guidelines as soon as a camera appears,” he could just prescribe medicine based on the outside reports. Why risk being questioned by the patient for “just wanting to earn more diagnostic fees” by insisting on a re-do?
This example also illustrates that whether a doctor follows standardized guidelines is primarily because the guidelines themselves benefit the patient, not because they fear the recording.
Consider another angle. That narrative implies a hidden assumption: without a recording, a doctor can exercise complete “discretion” based on “experience”; only when being watched by a camera are they forced to “follow the book.” This assumption is logically flawed. Any professionally trained doctor has been repeatedly taught the importance of evidence-based medicine and clinical guidelines since medical school. Standardized diagnosis and treatment is not a punishment for the patient, nor is it a shackle for the doctor; it is a basic professional skill. If a doctor feels they can deviate from guidelines at will just because a camera isn’t present, it only proves they are unqualified, regardless of whether they are being recorded.
In other words, “relying on experience” and “following guidelines” have never been mutually exclusive. Experienced doctors apply their experience within the framework of guidelines; truly “winging it based on a whim” was never on the checklist for a qualified doctor. Recording might make doctor-patient communication more cautious or formal, but it won’t turn a good doctor into a “robot,” nor will it turn a bad doctor into a “model.”
Therefore, the dichotomy of “warmth without recording vs. robotic with recording” is groundless from the start. What truly determines whether a doctor engages in “warm communication” or “cold procedures” is the necessity of the diagnosis itself, the doctor’s professional ethics, and the long-term accumulation of trust. Those doctors who still communicate candidly under a live stream prove exactly that: as long as neither party presupposes the other is a “troublemaking suspect,” the camera itself is not an obstacle.
Mode A vs. Mode B: Not a Simple Comparison of Good and Bad
Stripping away the interference of recording, let us re-examine these two modes.
The premise of Mode A (discretion based on experience) is trust. The doctor trusts that you won’t hold them liable afterward, and you trust that the doctor won’t engage in over-treatment. On this basis, the doctor makes personalized adjustments based on your economic situation, family burden, and insurance type—using more imported drugs for those with better conditions and focusing on the most critical treatments for those with less. This mode is efficient and low-cost, but the soil it grows in is a “society of acquaintances.” There needs to be a certain tacit understanding between doctor and patient, usually built on long-term relationships, regional ties, or at least the identity of being “the same kind of people.”
The premise of Mode B (following guidelines and procedures) is rules. All decisions are executed according to public guidelines and processes; if there is a dispute, the medical record is the ironclad evidence. This mode is “clunky,” expensive, and might involve a bunch of unnecessary tests, but it has a merit that Mode A lacks: predictable results, traceable processes, and unified standards. Whether you are a well-connected official or a newly arrived migrant worker, when you enter the consultation room, the doctor treats you the same way because the system is watching him.
The key point here is: Mode A and Mode B are not about which is superior, but about which conditions they apply to. In an environment with a foundation of trust, Mode A can function very well; in an environment where trust is missing, relationships are unequal, and information is highly asymmetrical, Mode B is instead the fairer and more reliable choice.
The sarcasm of “What’s so hard about treating ‘robotic patients’? You just need to be literate” hides an elitist arrogance. It suggests that practicing medicine according to guidelines is a low-level labor requiring no technical skill, and only “discretionary experience” constitutes high-level wisdom.
This is not the case. For complex and rare diseases, differences in experience are indeed vast, and the value of a veteran doctor is irreplaceable. But for the vast majority of common and frequently occurring diseases—colds, fevers, gastroenteritis, hypertension, diabetes, etc.—standardized clinical guidelines are very mature. The gap in efficacy between a young doctor who follows guidelines and an old doctor who relies on experience is not as large as people imagine. On the contrary, the latter might make non-compliant or even harmful decisions because of an over-reliance on “experience.” Guidelines are not manuals for “robots”; they are consensuses condensed from a vast amount of evidence-based medical research—they are the basic baseline for medical quality.
More importantly, Mode B provides a form of accessible fairness for socially disadvantaged groups. When a patient wants to keep a record because they are afraid of forgetting, the standardized processes and traceable records of Mode B satisfy this simple need. No need for secret recordings, no need for defensiveness—the system itself gives you a sense of certainty that you can “take home and review repeatedly.”
Why Mode B Is Worth More People’s Consideration
Let’s turn our gaze to Guangdong, which has a real-time population of 165 million. It is roughly estimated that at least half of them are working or settled away from their hometowns. They share a common trait: “They have no deep-rooted social connections in their place of residence.”
My own situation is a typical example. Although my household registration has been moved to a city in the Pearl River Delta, in this city of over ten million people, I have no medical connections to pull. If I get sick, I either queue up honestly or pay a high price for a scalper. I don’t have a second uncle who is a “department head at the Provincial People’s Hospital,” nor do I have a classmate “working in the Health Commission.” For me, the only thing I can rely on in healthcare is the system—including insurance reimbursement rates, hospital diagnosis standards, and the traceability of medical records.
My recent experience with perianal abscess surgery at a local hospital is a case in point. The entire process—from registration, ultrasound, admission, surgery, discharge, to dressing changes—was all standardized. I had no connections to rely on, gave no red envelopes, and only realized at discharge that the surgery I expected to cost several thousand out-of-pocket ended up costing only a few hundred. This wasn’t because I was lucky, but because this hospital strictly implemented insurance policies and clinical standards. The system gave me certainty, and certainty gave me a sense of security.
So when someone says “Doctors following guidelines is the certainty of medical treatment,” I completely understand what they mean. They aren’t opposing experience; they are opposing an opaque medical ecology where treatment depends on who you are, making it impossible for those without resources to judge right from wrong. They choose Mode B not because they want to sue, but because they want to stand on the same starting line as those with connections.
Conversely, those who mock Mode B often assume a premise: that you have the ability to choose your doctor. They often say: “Why in reality does everyone look for veteran doctors or chief physicians, and dare not let young doctors see them?” This sentence seems to argue for the importance of Mode A, but in reality, it is another form of “Let them eat cake”—after all, not everyone in this society is qualified to hand-pick their doctor.
In a country of 1.4 billion people with billions of outpatient visits annually, the appointment slots for chief physicians in top-tier Class A hospitals in first-tier cities are scarce resources. For an ordinary patient, being able to get a randomly assigned general outpatient slot, queue for an entire morning, see a young attending physician, and have tests ordered in three minutes is already efficient. The so-called “looking for a veteran doctor” is, for the vast majority—especially the massive migrant worker population—a false proposition. You either can’t get the appointment, or even if you do, it’s not the person you were looking for.
This reminds me of the medical leave system I wrote about before. When the Ministry of Labor designed the medical leave period, the planned economy was just transitioning, and a large number of workers were still in state-owned enterprises; there was a “unit community” relationship between the employer and the worker. Thirty years later, private sector employment accounts for over 80%, personnel turnover is frequent, and the tacit understanding based on long-term employment has long since vanished. When a society shifts from an “acquaintance community” to a “society of strangers,” those institutional arrangements that rely on trust and relationships can only benefit the few who possess social capital.
People with local household registration, resources, and networks can continue to enjoy the convenience of Mode A—having acquaintances introduce them, easily securing specialist appointments, and enjoying personalized treatment. But those without these things can only embrace Mode B: standardized, procedural, and traceable. This isn’t because Mode B is inherently “better,” but because in a resource-limited environment, Mode B is the only protective charm for ordinary people.
IV. Medical Certainty Is Not a Luxury, But a Baseline
This discussion is worth deepening because it touches upon a broader issue than just healthcare: In a high-mobility, highly uncertain society, “certainty” is becoming a luxury, and ordinary people are paying a heavy price for “uncertainty.”
I once wrote about the experience of a relative seeking compensation after being hit by an auxiliary police officer—a process that dragged on from 2022 to 2025. Why so long? Because the other party was a government agency; the compensation promised during negotiations was constantly delayed citing tight finances, leadership changes, or budget approvals. Its eventual resolution didn’t rely on “pulling strings,” but on a court mediation document. This event made me feel deeply: In a society of strangers, rules are your only reliable protective charm.
In another case I posted previously—an enforcement-difficult traffic accident—the victim, a migrant worker, was left hemiplegic, and the perpetrator was an uninsured minor. Not a cent of the 1.3 million yuan compensation was received. Later, his father developed esophageal cancer, and the family couldn’t even produce a few thousand yuan. Ultimately, they scraped together over 100,000 yuan through multiple channels like judicial aid, minimum living security, and veteran assistance. In this case, the most agonizing part wasn’t the disease itself, but the uncertainty of “not knowing if help can be obtained, not knowing when money will arrive, and not knowing what to do next.”
Similarly, I discussed the values behind Western medicine in another article. The design of Western medical systems hides a set of value rankings regarding individual rights, procedural justice, and risk tolerance. This ranking is highly self-consistent in Western societies, but when transplanted to China, it requires caution. Because China’s social structure, family concepts, and collectivist traditions differ fundamentally from the West. If we blindly pursue “individual choice first” or “procedural compliance above all,” we might create new injustices. But conversely, if we completely deny the value of procedures and guidelines and retreat to the old path of “relying on experience and connections,” it would be a disaster for those without connections.
Mode B is not perfect, but it is fairer than Mode A. It might be clumsy, it might be inefficient, and it might make doctors feel like they have “degenerated into AI,” but it provides the only accessible certainty for the country’s hundreds of millions of mobile population, tens of millions of inter-city workers, and hundreds of millions of patients seeking medical care away from home.
Looking back at those narratives on short-video platforms, the comment sections are full of people trading barbs. On the surface, it’s a pointless war of words; at a deeper level, it is a head-on collision between two states of existence.
One side says: “Rules are important, certainty is important, and following guidelines is reliable.”
The other side says: “Experience is important, trust is important, otherwise just ask an AI.”
Neither side is wrong. What is wrong is someone thinking their experience can represent everyone; what is wrong is someone mocking others’ “need for certainty” as “robotic patients.”
In this country of 1.4 billion people, those who can leisurely hand-pick veteran doctors, leisurely utilize social connections, and leisurely enjoy Mode A will always be the minority. The vast majority—such as the ordinary people on assembly lines, at construction sites, in rental rooms, and on the road to seeking medical care in distant cities—what they need has never been “high-end medical care,” but rather a predictable certainty that doesn’t depend on who they are.