“My 4 year old has a huge swelling at the site of the tetanus injection… Any suggestions? I would have called up the doctor, but the doctor is a grouse!” This was the post that greeted me in one of my groups on a popular social networking site. Like many others on the group, I advised her to visit her child’s doctor.
Nevertheless I couldn’t rest easy – Is this what we have come to? When patients trust and worst prefer, to take advice from unknown people than call up their doctors? Where social networking sites are serving as the primary source of health information? Every day we are deluged with information on health related topics – whether it is a cure for cancer or growing your hair, some self professed ‘expert’ has answers to all! But people turning to these sites for medical advice, voluntarily, came as a complete shocker. And rather than dismissing it as a one-of-its kind incident, let us look at this ‘unhealthy’ trend in a more rational way.
If it is so easy to share information, where have we, then, as doctors, missed the bus?
Maybe when each of us decided to ‘specialize’ in a particular subject, leading to the demise of the centuries old tradition of ‘family doctor’… The ‘family doctor’ was the primary trusted advice giver, the first step of the health care pyramid, who resolved about 60 – 70% of the cases and queries. This layer has rapidly eroded with specialization and the bulk is now handled by specialists. As a result, a patient goes to a cardiologist for his blood pressure, an endocrinologist for his diabetes, an ENT for his sore throat, so on and so forth… this is putting additional pressure on the specialists, where earlier it used to be filtered by the good ol’ GP. Also the patient has no connect with any of them, merely seeking and getting instant relief. The family doctor was easily approachable in times of crisis; a specialist is generally available by appointment only, further widening the communication chasm. A holistic outlook and easy availability for patients during emergencies will go a long way in replacing the patients’ trust in us.
The second reason is, obviously, too many patients and too little time! The pace of the world has changed and doctor-patient conversation is its worst fatality. Gone are the days when you could tell the patient to wait without taking any medicines for a cold! Patients want instant relief and doctors are subscribing to this trend. With a full waiting room and pre-booked online consultations, who has the time to explain to the patients the side effects of over medication? No wonder then, India tops in antibiotic use, rather abuse, in the world (http://timesofindia.indiatimes.com/india/Antibiotic-addict-India-losing-fight-against-lethal-bacteria/articleshow/48993699.cms ). With lack of time, the quality of the conversation has gone down with most doctors issuing orders than explaining the treatment or resolving apprehensions. ‘Informed consent’ is a mere formality.
Add to it the Indian tendency to glorify the doctor as a ‘god’, and we have a sure shot recipe for disaster. Anything goes wrong and the doctor is blamed – whether it is due to disease progress or human error – rising cases of violence against doctors amply prove that the patient takes matters in his own hands without understanding the cause or the implications. And how will he understand if nothing has been communicated to him? Insurance companies and clinical research organizations have further muddied the waters, with patients losing even the last shreds of trust in their doctors and giving in to suspicions and rumours.
So here’s what we can do to improve doctor – patient conversations and relationships –
(It’s not the be all and end all, so feel free to post your experiences)
- Talk with the patient – Talk with and not ‘to’ the patient. Nobody likes a monologue, least of all the suffering patient. Let the patient express his concerns, hear them out and then give the solutions. Most doctors cut off the patient in the middle and start with their advice, giving an ‘unfinished’ kind of experience, resulting in the patient turning to other means for answers. Also, catharsis itself starts the healing process sooner.
- Be patient with the patient – We know that all the symptoms the patient is describing are part of a diagnosis, but for the patient they are all different issues which need to addressed separately. Friction happens when the doctor has already come to a diagnosis, tells it to the patient and yet the patient keeps narrating his symptoms. Telling the patient their diagnosis is not self-explanatory! Be patient, explain to the patient that you have understood his illness and all these point towards the same, and that the medicine he is taking will gradually reduce all.
- Share – your own experiences! Yes, you read it right. My daughter’s paediatrician shares his grandson’s issues with us and believe me it’s a huge relief to know that even the doctor is sailing in the same boat! It’s no more a question of ‘them’ and ‘us’ and pretending that the doctor or his family can never be ill. Showing our humane side goes a long way in comforting the patients.
- The nitty-gritty – This is a grey area, and the most common reason why doctors hold back information. Too many details and the patient gets anxious, hampering his chances of a quicker recovery; too few and the clueless patient gets anxious about his symptoms and disease turning to the Internet or lay sources for information. This is where the doctor’s experience and discretion comes in to play. If you feel that describing the details will make the patient more anxious, avoid it. But if the patient sitting across you can understand and will like to be better informed, by all means go ahead. Be the genuine source of information for the patient, rather than the Net.
- Smile or better still laugh – Nothing like a good laugh with the patient to relieve stress and cement bonds! A renowned cardiologist is always ready with a joke when we visit him for my FIL’s follow-ups and going to him is more of a treat than a serious chore. Not all of us can reach this level of levity, but yes we can definitely manage a warm smile.
Is the onus only on the doctors? The patients can meet the doctor halfway too! 🙂
- Make a list, be prepared – most patients are not well prepared for their appointments, walking in and simply going through the motions. If you want to make the most of your and the doctor’s time, make a list of your queries and get them answered. All doctors are happy to answer, if the patient is organized and ready to listen. Make it a habit to write down their answers too, so that you do not repeat your questions each time. Nothing is more irritating than having to answer the same queries repeatedly especially when you are so short of time!
- Avoid hypothetical questions – avoid all those questions which have ‘if’ in the start, end or middle! ‘If this happens….’, ‘should I do this if this increases….?’ Cross the bridge when you come to it. Don’t anticipate. All doctors are reachable for emergencies or have a system in place for them. Request for the emergency contact numbers and call when something actually happens.
- Don’t extrapolate – Avoid coming to conclusions like – ‘my friend had acidity (with full description of her symptoms) and she got diagnosed with gall bladder stones, so I think I might be having the same, because even I am having acidity!’ It’s a waste of your and the doctor’s time and energy. A better way to put this is – ‘Doctor, do you think we should get any tests done for my acidity?’ and if the doctor says ‘no’ leave it at that. Do not bring other people and their diseases for your consultations!
- Discuss – the risks/side effects/duration of treatment frankly. Voice your concerns. But don’t panic when the doctor explains the details of the treatment or the procedures. Medical science has advanced to a great degree and most procedures and treatments are absolutely safe. All doctors are committed to reduce the patient’s pain/discomfort as much as possible. However there are minimal chances that a patient may develop an adverse reaction to the procedure/ treatment, but doctors/hospitals are well-equipped to handle these. A positive outlook would be to ask the doctor what precautions you can take or additional measures you can follow – doctors are more than willing to share this information, after all it will help in quicker recovery which is the ultimate aim of both.
