"Heal thy Physician?" Old Story Retold

This is a very good article published in THE HINDU in june 2003. I was very much moved by the content and felt that it's true to it's core. Please take time and read ahead...

Heal thy physician?

These days, it is almost with a sense of relief that one hears something pleasant being narrated about doctors and healthcare professionals, says Dr. SARANYA.

THE HINDU PHOTO LIBRARY

Patient and doctor ... does the fault lie on both sides?

A FEW days ago, as I drove past the Central railway Station, Chennai, I noticed, with mixed feelings, that the General Hospital or GH as it is known, had been razed to the ground and in its place, the new building. As I saw the construction work going on at a frentic pace, my thoughts went back to the number of years I had spent inside that historical monument, as a student and later on as a house-surgeon and then as a post-graduate with virtually no time to breathe.

At the time, more than 20 years ago, we were told that our mission in life was to save lives and we were determined to use all the skills we had become equipped with, to ensure that we did the best by our patients. Why then 20 years later, does one hear only depressing things being spoken about the medical profession? These days, it is almost with a sense of relief, that one hears something pleasant being narrated about medical care or doctors.

Take this instance of a friend's relative, who was admitted into a hospital. The doctors were very comforting and the family was delighted that they were "so lucky". The treatment progressed smoothly for a while, until post-operative complications set in. A few days later the patient passed away and the family was in a state of shock. Disbelief not because their family member had died (someone up there keeps the score and they accepted this very readily) but because they were kept totally in the dark about the patient's status. To their questions even a couple of hours before she died, they were told she was doing well and would be sent home shortly. In this instance, communication between the medical personnel at the hospital and the patient's family was totally lacking. Now if this is the plight of well educated individuals can you for one minute imagine how their less fortunate counterparts would fare? Post-operative care in many of our hospitals leaves much to be desired. Despite the best of efforts of hospital staff, things do go awry.

On the same subject of communication, there are patients who on their visit to the laboratory for testing, would like to discuss either their "illness" or their reports with one of the doctors. After doing this, they feel very relieved and often offer us "consultation fees" which we obviously refuse. They apologetically tell us that the consultant was "so busy" or that he/she was in a hurry or that there were several patients or that they did not feel like "troubling" the doctor and therefore, were unable to get their doubts cleared. In spite of being well away from the clinical field, the increasing need for communication between the patient and the doctor is being brought home to us repeatedly.

The patient has read a bit, is very anxious, and reaches the doctor most often imagining the worst and with implicit faith in this "worker of miracles". Let's face it, but for the fact that doctors themselves are in the same profession, and, therefore, know a bit about what ails them, they too would probably feel the same. Death being the leveller, sickness or illness makes doctors more human. Ever so often we see some of the high flyers of the profession become entirely different human beings, when it is their turn to be part of the patient's family, or the patient himself. Illness or personal tragedy makes the very same doctor more humane in his subsequent dealings and it seems unfortunate that we tend to forget that we are human beings first and doctors next. Long years ago, when the time came to choose the area of specilisation, someone jokingly told me that I would be at a total loss while dealing with patients, as I would become an emotional wreck. While empathy can cast a big burden of responsibility on the doctor, the opposite of indifference or callousness is far worse.

With communication being the key to solving most problems, at times I wonder how much of a patient's recovery is attributable to the medical treatment given and how much to doctors' bedside manners. I refer here to patients with surgical and non-surgical problems. Some doctors have mastered the art of communication so well that they would put graduates from the schools of marketing to shame. This skill that they have perfected over the years, compensates for all their other inadequacies. Forgive me for sounding so cynical, but I say this after being a helpless witness fairly recently.

Like in the computer industry, the medical profession set the trend three decades ago, when the "brain drain" started. While it was for acquiring more knowledge, higher qualifications, and exposure to working in hospitals abroad for a while that were the reasons that most young doctors left the country, now several "still idealistic" doctors feel they cannot cope with "the pressures" of being a doctor in this country and, therefore, run away. Some of these doctors return as they want "home" to be their final resting place and when they no longer need to play doctor.

However, in the midst of all this chaos, we still have a few doctors, who are tenacious, who still follow and honour all that they were taught and maintain the highest standards of medical care. A young doctor comes to mind as I say this. Several patients and other junior colleagues have spoken about this person in glowing terms. Patient care is his prime concern. This doctor is so committed to his profession, that almost all his waking hours are spent seeing patients. Irrespective of how busy or tired he must feel, he is extremely kind to all of them. It's hardly surprising that he is revered amongst students, staff and colleagues alike.

Patients too have learnt to demand a certain basic minimum from their doctors in return for the consultation fee. The pervading atmosphere of suspicion about the medical profession has made most people have the doctor under a magnifying glass. The doctor, right or wrong, has retaliated by practicing defensive medicine, by taking no chances.

A friend with a gynaecological problem recently voiced her concerns about her doctor to me. The doctor refused to collect any fees from her, but suggested that scans be done at every visit. My friend's question to me was whether scans were required so frequently and why instead couldn't the doctor collect the fees directly from the patient. I am certainly no expert on this. Neither did I want to make an observation without having all the facts, but this is one more instance which highlights how the entire issue of "trust" between the doctor and the patient has almost been eroded with time.

Let's take a look at the other side too — patients are very difficult to handle at times. This reminds me of an amusing incident that took place almost a year ago in one of our government offices. A colleague and I had gone to meet an official and as we arrived a few minutes ahead of time we were shown into the comfortable boardroom and offered a glass of cold water. This courtesy came as a very pleasant surprise and we were more than willing to wait. We soon had enough entertainment to keep us going for the rest of the week. One of the staff in the office had apparently felt giddy and was ushered into this waiting room so that he could rest a while. A soft drink was given to him, followed by some coffee/tea. Even as he came into the room he had recovered sufficiently to feel embarrassed by the fuss being made and told his friends that he was fine. However, Indians by and large being a very warm and caring lot of people, can't let such an issue go unheeded. So as we watched, the doctor on board, came to have a look and ordered some tests and left. Arrangements were then made to draw a blood sample. In the meanwhile, other friends dropped in having heard of their colleague's giddiness. Each of them recounted their own "similar" personal experiences and how they were taken care of.

On hearing that a blood sample was going to be drawn, each of them helpfully looked at the list of tests asked for, and added a couple more for good measure. The sample was taken with five other friends in attendance and the hero of the day, who was by now suitably gratified with all the attention showered on him, explained for the tenth time, the entire sequence of events from the minute he opened his eyes that morning to the second he had "lost consciousness". Having been fortified with the cold and hot drink, the plantains, the biscuits, hot vadai sambhar and most importantly the concern showered upon him by his co-workers, he was ready to start work for the day. He looked at his watch, realised it was getting on to lunch break, so decided instead to just sit down for a few minutes more, go for lunch and then start the day's work after that.

Patients sometimes want this kind of attention when they go to doctors also, forgetting that every one has an illness that needs the doctor's time. Some patients are totally insensitive to the needs of other patients and the doctor, and presume that only their illness is important. They also visit the doctor with hoards of relatives, who apart from adding to the confusion make quite a noise and in addition contribute to more dust and dirt getting into hospitals.

While hospitals do understand the concern of relatives, patients too must understand that it is in the interest of the patient, that hospitals are strict about the number of patient attendees, or the visiting hours and so on. Even in a laboratory where the patient comes to give a sample, three or even four relatives most often accompany him. While this is cause for concern in a laboratory, in a hospital, all it takes is just one attender with a runny nose to cause untold harm to yet unseen patients. Studies done in the best hospitals in the world have proven conclusively that the risks of post-operative infection, or hospital-acquired infections are minimised when visitors to the hospital are much less.

As I wrote this, I wondered if there was any point at all in hoping to achieve by writing, and had kept it aside for a couple of days. Yesterday however, an incident that took place, made me feel that I should complete this piece.

A friend described at length how his family doctor is so committed to all his patients. His home is open to anyone throughout the day, he refuses fees from critically and terminally ill patients and has been a tremendous emotional support to them at all times. In addition he has kept himself abreast with the latest trends in medicine and has no hesitation in getting an additional opinion from other consultants when in doubt. It is no wonder therefore, that he has a very large, happy and respectful clientele who are extensions of his own family.

Listening to this, made me feel that all is not lost yet. We still do have several young doctors, who following the highest standards laid down by the "giants" in the field, practise medicine the way it was and will always, be meant to be practiced. There is no denying that our hospitals still have the best brains and highly skilled doctors; however post operative care needs to be improved. It needs to be impressed on all young doctors, that good bedside manners and effective communication are equally if not more important in good patient management. With increasing specialisation in the field of medicine, unfortunately the "family doctor" concept has all but disappeared. This needs to be revived. Our "specialist consultants" too will then be less burdened and be able to devote more time for patients who really need their help. Even in 2003, we can still boast of being able to give the best "on the spot" medical care to any patient based entirely on human considerations. We can, I am certain, through combined effort make sure that our medical care is once again considered on par with the best anywhere in the world.

The writer is with the Lister Laboratories, Chennai.