When there is a talk about a
doctor-patient consultation, it usually means that when someone falls ill, he
goes to a doctor, who then tells him what to do. This is usually perceived as a
one-way road, where the doctor is the one in-charge. He takes the history,
examines the patient, orders laboratory tests, makes a diagnosis and provides
treatment. Whenever there is an unforeseen error in the process, the focus usually
is on mistakes made by doctors or the medical staff. However, the truth remains
that often, mistakes are made by patients as well.
For example, a patient
supposed to take 0.5 mg of a medicine ended up taking 5 ml by mistake. Mistakes
like this are upsetting and irritating for both patient and doctor. The patient
is scared that by taking too much medicine, she may end up causing harm to himself.
The doctor is irritated, because he feels that he did an excellent job
explaining to the patient exactly what to do, and that if he did not
understand, why did he not just ask him for clarification and cross check with
him, rather than pretending to understand. Doctors sometimes forget that
patients can be quite intimidated by them.
There can be many reasons
for these mistakes. Sometimes, patients are confused, because the doctor has
not explained things properly. Patients do not understand the doctor’s medical
jargon, and are scared to cross question the doctor or are reluctant to display
their ignorance. They therefore continue to dumbly nod their head, and the
doctor is misled into thinking that the patient has understood.
A key component of the
consultation needs to be the fact that the doctor needs to consult with the
patient as well. Unfortunately, this is something that is quite often
forgotten. A doctor needs to understand that everybody makes mistakes, and it
is best to be understanding. After all, no one goofs up deliberately.
Rather than start assuming that all patients are idiots, these mistakes can
actually be great learning opportunities.
Sometimes these are minor
issues, which can be safely ignored. However, sometimes these mistakes can
create major problems, but these can be tackled only if there is a healthy
communication between the patient and the doctor.
Thanks to the advances in
medicine, patients today have a lot of choices. Each patient is different, and depending
upon their personality, world-view, religion and culture, every patient would
tend to select a different option. There is no single right answer, and doctors,
like any other normal human being, are not mind readers. They need to take into
consideration the patient’s personal preferences, which can only be found out
by talking to the patient.
Doctors cannot afford to
guess. And they should also not try to impose their choices on the patient.
They need to be non-directive and non-judgmental, and allow the patient to
decide. They need to ask the patient which line of treatment they would prefer,
explaining the pros and cons of each option. This is not a sign of weakness on
the part of the doctor. It is actually a sign of strength.
Sometimes patients get
confused when the doctor asks them for their opinion. They believe that the
doctor is confused and does not know what to do, which is why he needs their advice.
In reality, this means that the doctor is a good professional, who is being
respectful of his patient’s belief. He understands that it takes two to tango,
and that patients need to provide inputs so that doctor can help them to make a
decision which is right for them.
In making any decision
regarding the treatment, both the doctor as well as the patient should be
involved, with both the parties sharing information, taking steps to build a
consensus about the preferred treatment so that an agreement is reached on the
treatment to be implemented.
In decision-sharing, the
doctor does not actually ask the patient to make the final decision on his own.
He just describes different treatment options, tell the patient how effective
each of the option is, and lay out the potentially negative side effects and
their chances of happening. But a doctor can’t know what the patient wants out
of treatment, or what he fears about it. Those ideas and feelings play
important roles in the decision-making process.
The only way to have a
healthy doctor-patient relationship is when both contribute. This will help the
patient gets the best possible medical care. All this seems quite obvious, but
is rarely followed in real life.
The problem is that most of
the doctors have big egos, especially the big specialists in the big towns, who
are brand names in themselves. They think they have all the answers with them, and
are happy to dish them out to everyone who comes to them. After all, when one
has a hammer in his hand, all he sees are nails. As long as everything
goes on fine, patients go on to meekly agree with whatever the doctor has to
say. They are passively compliant. When things go wrong, as they are bound to
do in any complex biological system, patients become angry and vengeful.
On the patient’s part, he
should also share all information with the doctor, like if he is also taking any
alternative medicines. Patients often hide this information from their doctor,
because they are scared he may get upset with them for doing a non-standard
treatment. However, if they get better and share this information, the
doctor can learn from their experience, if he is willing to keep an open mind.
Maybe he can even start advising other patients to try out alternative
medicines.
A medical consultation needs
to be a two-way process, where both doctor and patient provide their inputs,
and take responsibility for the outcomes. Sadly, many doctors still believe
that shared decision making means sharing the decision the doctor made with the
patient. Doctors need to respect their patients and their choices.
A doctor-patient interaction
can play a very important role in reducing the errors which patients make
inadvertently, and it's important that doctors and hospitals invest in tools
and techniques which help patients to become better informed, encouraging them to
have a say in the treatment process.
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