WHAT DOCTORS EXPECT FROM PATIENTS

As a doctor, we do our best to help our patients but we often need help from our patients in order to help them. Here are some of our requests to our patients.

Please don’t hide stuff from us

We are not judgemental. If we tell you what to do and what not to do, it is for your betterment only. But if there is something which is important, please let us know. We cannot read your minds. We promise you that even if you tell us your deepest and darkest secret, we will not get shocked or be judgmental. We have most probably encountered a patient with a similar problem in the past. If you don’t tell us, it would just compromise the quality of the care provided to you. For example, if you have had a disease in the past you are ashamed to share, if you were or are into drugs or even had sexual relations or pregnancy before marriage which you had to terminate, just let us know.  This would help us to craft the right treatment plan. This sort of information is very valuable to us, which we have no way of knowing until you tell us.

Please trust us

It is important that you trust us and it is important that we trust you. This way we can work together to help you.  If you are not happy with any of our recommendations, do let us know. Our egos are not that fragile that we are going to get offended if you don’t agree with us. Since we cannot read your minds, if we tell you something and you just nod your heads, we assume that you are going to carry out our instructions. If for some reason you don’t think our advice is not good enough or you would not be able to follow it, it would be helpful if you tell us. Otherwise, this lack of compliance is going to harm both you and us.  It is even possible that we probably are not the right doctors for you, and if you prefer, we can refer you to someone else, or maybe think of another plan. But there is little point if we craft a plan for you are you do not pay any heed to it.  You do not have to agree with everything we say. And if you don’t, please be courteous enough to let us know what you don’t agree about and why, so that we can think of an alternative solution together.

Please give us feedback

If there is something we or our team is doing which you do not agree with, or there is something that we could improve on, please let us know, so that we can try to fix the problem before it becomes worse.  There is no point in bottling up your resentment or being unhappy and not telling us. Because if you do not tell us, we are not going to be able to fix the problem.

Please let us know how we can delight you

If we have done a good job in taking care of you, please let us know.  Positive feedback helps us do a better job and everyone likes being appreciated. Complaints are welcome, and we treat them as gifts which help us to improve. Compliments are also welcome, because they give us positive energy which helps us to do a better job in taking care of our patients.

AN APPEAL BY DOCTORS

These days incidents of violence against doctors and staff are on the rise. The loss of a loved one does bring a lot of grief and heartache, but the attacks on doctors would not bring him back into this world. The consequences of the same then have to be faced by the society. Now, the medical practitioners are scared of treating very serious patients, and referring the patient to other centers wastes crucial time, which, in turn, is not good for the patient.

Doctors have now even started to avoid treating patients from a particular community or profession, who are more prone to sabotaging the establishment. This is not the right thing to do, but everyone wants his family and himself to be safe. Earlier, the doctors used to reassure the patient and his relatives of the person getting well, but now the relatives are warned about the prognosis of the disease and the doctors now tend to look for ways to save their skins even before starting the treatment of such a case. This is not at all in the best interest of the patients.

There is always a risk in the medical profession. No doctor wants to do any harm to his patient. Negligence and incorrect decisions are separate things, and sometimes there is no other option. Sometimes a doctor needs to take split second decisions, and cannot consult any textbook at that point of time. The decision taken at that instant could have done more harm than good, but a number of lives have also been saved due to prior such decisions by the doctor, who could’ve lost their lives if the decision was not taken. Sometimes a doctor does not even have time to think, and the decision comes to him as a reflex, which can be different for every case.

Even Kalpana Chawla had lost her life whilst on a mission. No engineer or scientist was ever blamed for that accident. Bridges and buildings fall down due to the mistakes of builders and engineers even when they have months, and sometimes years, to plan for the same. The verdicts of lower courts get overturned in higher courts, even after the judiciary has already pondered over the case for years. No one of them ever gets assaulted. A mistake by a pilot or a driver can result in loss of numerous lives. Everybody is just a mere human. And when some work is done by a human, mistakes are bound to happen. The thing being justified here is not that doctors should have the right to make mistakes, but that there should be certain limits. If it is case of gross negligence, one should let the law take its course, and not resort to “an eye for an eye”.

No one can treat a patient in a critical condition if doctors refuse to take him up. No minister, M.P. or M.L.A., or people belonging to a particular community or organization, who vent out their phony anger at doctors, making a mockery of the sentiments of general public, would be of any use at that time.

A doctor works day in and day out, not just for money but the responsibilities bestowed upon him as well. Many times a doctor goes to sleep after operating on a drunken accident victim at 3’o clock in the morning, only to be woken up by another emergency call at 5’o clock. Doctors and also humans, and deserve a good night’s rest. One cannot get the services of a plumber, mechanic, engineer, lawyer, CA, no matter how urgent it may be, in the middle of the night. Still, doctors hardly ever complain about their work schedule, they just want the respect and appreciation which they deserve.

It is a well known fact that students getting admissions in medical colleges are the ones who were considered more intelligent, capable and hard working than their counterparts. Every mother wants to see her son as a doctor. It is surprising that people accuse such people to be careless and sloppy once they graduate from medical colleges.

Many times a doctor leaves his personal commitments to take care of those in need. Children of doctors always complain that their parents never have time for them. Spouses of doctors complain that there is little obligation being shown towards the family due to the busy personal schedule. And still a doctor is termed careless.

There is a prevalent known racket of counterfeit medicines, which everybody knows about and still little is being done to curb this menace. People allege that a doctor has administered a wrong injection which has resulted in a patient’s death. But the truth remains that even the doctor does not know whether the injection was genuine. A not-so-old example is the death of 18 women at a mass sterilization camp in Chhattisgarh, and it was proved later on that the deaths were due to counterfeit medicines. Still, action was taken only against the operating surgeon, as the drug manufacturing firm belonged to the son of a minister.

Many times, it is perplexing even for the doctor that how a seemingly healthy patient suddenly dies without any apparent disorder. Medical science is still developing and still has many mysteries to uncover. This does not mean that the patient died due to erroneous treatment. And this definitely does not justify the assault on the doctor.

The author is not trying to justifying all the doctors, or that cases of negligence do not exist. But in such cases, one should approach the law, file a case, have a word with experts, and go through a proper channel. Violence with doctors, their family members and staff is not the right thing to do. And as is said, “An eye for an eye would eventually make the whole world blind”.

WHEN DOCTORS’ OPINION DIFFERS

Many people think of medical science as a simple discipline, where everything is in black and white. They naively believe that all doctors, irrespective of their specialty or where they practice, would take a patient’s history, look at his medical record, recommend some investigations and then formulate a treatment plan which will be exactly the same, no matter who the doctor is.

Unfortunately, this is not to be, and the fact remains that medical practice is not just a science, but it is also an art, and requires expertise. When doctors disagree, the patient is often left confused and upset, because he is then not sure who to trust, and it is hard to deal with uncertainty. There are doctors who would advise comprehensive investigations to be done for a certain ailment, while others feel that this is not required if the history given by the patient and a fewer number of investigations point towards that particular illness.

This also means that if a patient who goes to a doctor to get himself treated and does not get well, goes to another doctor for a second opinion, and this new doctor starts with a thorough investigation before starting the treatment for the disease, the patient is going to feel cheated. The patient tends to complain that the earlier doctor was negligent, and that the reason he did not get well earlier was because the earlier doctor did not bother to fully investigate before starting with the treatment. He jumps to the conclusion that the earlier doctor was sloppy, careless and incompetent because he did not test him properly before doing his treatment. He might even feel that the doctor was out to make money from him, without any compassion for the patient, which is why he took a short-cut which resulted in the failure.

This reasoning is flawed.  It is not always compulsory to perform a detailed investigation for every case, as most of the times the detailed history of the patient and some routine investigations do the job, and whether or not the doctor had ordered for a complete investigation is very unlikely to have changed the outcome of the treatment. However once the seed of doubt has been planted in the patient's mind, he loses confidence in the doctor. The problem is that once a person loses confidence in one doctor, he loses confidence in all doctors. He starts treating all of them with suspicion and wonders whether they know what they are doing.

The fact of the matter is that doctors disagree because each of them has his own preferences, which is quite acceptable. The problem arises when doctors do not explain what they are doing and why they are doing it.  This is not because doctors are trying to hide information from patients. It is just because they do not think it is obligatory to tell the patient the reason for prescribing or not prescribing a particular investigation or treatment. Many doctors also believe that the patients should trust them and accept whatever advice they give them, without any counter questioning.

When there is a discrepancy between what one doctor advises and a second doctor's opinion, this does not mean that one is wrong and the other is right.  People need to be mature enough to understand that there can be more than one approach to deal with a particular ailment. They need to appreciate that no one doctor has a monopoly on knowledge. If there is a difference of opinion, this is not because one doctor is clueless, or the other is smarter or better informed, but it's simply because that there are no black or white answers in medicine. Patients need to do their own homework first, so that they can find the treatment path which they are most comfortable with.

LETTER TO DRUNK DRIVERS

Dear drunk drivers,

I am really tired.

I am tired from the lack of sleep, tired from the long hours of work, and tired from bearing the brunt of the destruction caused by you.

Every other day, you cause an accident while under the influence of alcohol. And you are badly injured, requiring emergency surgery. Your liver is hard, cirrhotic, and unforgiving. Although I can get you through this surgery, but I know you will not survive for long. Not because of this accident, but because of your habit. I know that in the near future, the broken and beaten liver of yours will begin to fail, your kidneys will stop working, you will start bleeding from every orifice of your body, and you will eventually die.

I meet your families. They think you have quit drinking, but they ask, and I answer, “No, he is still under the influence.”

Yes, you have been drinking and yes, your liver carries the scars of your addiction. Yes, it is likely you will not make it. I see the hurt cross their eyes, the anger, and the embarrassment. And then, the part that I dread the most, the part I hope would not happen, but it always does. They ask about the accident. They ask if someone else was injured. They ask if the other person was alright.

And a fresh, new, searing pain begins.

Every other night, you kill someone. Someone’s husband, wife, father, son, mother or daughter is not coming home, just because of your addiction.

I see a shadow cross your daughter’s soul as she weeps. I see your son’s image of you crumble upon the impact of my words. I see their shame, their sorrow, with no outlet other than tears. Their heartbreak reaches out and stabs at me, their confusion begging my sympathy.

Another family is being informed of their loved one’s death, just because of you. Their souls, hopes and dreams are extinguished with the three words, “I am sorry.”

Like every other day, you are blissfully unaware and asleep. Disoriented, medicated and sedated because of your own wrong doings. But while you sleep, I wish you dream of all the wreckage you have caused.

You blaze a trail of tears.

Today, I am angry.

Angry at all the hurt you have caused.

Today, I am angry because I know this will happen again.

When would this end? When would you stop assaulting your body, your family and your friends? When would you stop tearing through lives, ripping out the hearts of people you know and of people you don’t?

When would you stop?

Please, let it be today.

Sincerely,

A Tired, Angry Doctor

TRUST THY DOCTOR

One of the commonest complaints patients have about doctors is that they have become very commercial.  They feel doctors no longer provide any personalized care, and that they are really not interested in the patient, or the emotional trauma which they are going through.  They feel that doctors just look at patients as a source of revenue, and all they want to do is do procedures and tests and treatments in order to extract money from them.  This is a really sad scenario as it creates an obvious rift between the patient and the doctor. It is important that the patient is able to trust that his doctor is doing what is in the patient’s best interests. Otherwise it becomes very hard to move forward.

These days, people have a very cynical view of the medical profession as a whole.  Medical practitioners are also partly to blame for this, because they do not spend enough time to educate their patients about their problems, and what the possible treatment options are available.  This is one of the reasons why patients have very unrealistic expectations from their doctors. Doctors often tend to over promise their patients, and this creates a lot of unhappiness when the treatment does not bring expected results.

Patients also need to understand that just because a doctor charges for his treatment, this does not mean that he is commercial and uncaring.  After all, a doctor does need to earn money and, unless he makes a profit, he’s not going to be able to run a clinic or treat his patients.  However, it is important that there is transparency in the dealing.

Equally importantly, doctors need to understand that the patients are much more than just people with some physical disease. It is not enough to just suggest some tests and prescribe medicines. Doctors need to deal with the patients with compassion and empathy. Just high quality care is not enough. There has to be a caring attitude as well.

A good doctor is the one who is interested in his patient as a person, and not just as a patient who needs to be treated.  Not only is this good for the patient, it’s actually very good for the doctor. Otherwise just prescribing medicines or performing the same procedures can get very monotonous and repetitive.  Every patient is different, because every patient has their own unique story to tell, and this is what makes medical science so interesting and exciting. Doctors need to start looking beyond the lab reports the patients bring with them, and start looking inside their heart and brain. This also helps one to respect his patients, and enjoy what one is doing. Helping patients to get back to health is a great opportunity to do well, and a doctor should make the most of it, for his own sake, and the sake of the patients as well.

SUICIDES BY MEDICAL STUDENTS: NOW IS THE TIME FOR ACTION

Suicide has always been painful for everybody, and a curse for the family, community, nation and the humanity as a whole. Suicide is acceptable neither in the eyes of the society or the law, so an attempt to suicide is a punishable act.

Recently, a 21-year old dental student from Punjab committed suicide by hanging herself in her room. The question remains that what exactly has happened to all the medical fraternity, who’ve taken a pledge to save other’s lives, suddenly taking their own? This incident is not the only one, with many such incidents being reported all over the country.

The reports of farmers committing suicides due to poverty can be seen on a daily basis, with their agonies appreciated and reforms advised on print as well as social media. But if a medico is forced to take such an extreme step, rarely does it find a mention on any media platform. It is baffling that a doctor, who might be aware of his depression, and the curative options available to him, seldom seeks help.

The stress on a doctor gets started to be planted on him right from the day he enters the professional college. Due to the vast course and limited time to complete every subject, a student cannot think anything except studying, in turn, making him a book worm. Even after that, the fear of not being able to pass in examinations completely shatters them. This fear of failure, along with fear of bringing a bad name to family and friends, makes one choose to end his life. Even in the premier medical institutes across the country, students fall prey to pressure and loneliness. To add to this pressure is the fact that Indian families generally do not welcome back defeated or recalcitrant students as much as they do not welcome back daughters after a failed marriage. According to them, they have already invested too much so there is no point in discontinuing.

One can read about suicides being committed by students, particularly in the medical field, every other day. Suicides committed by a student are an issue of considerable concern resulting in loss of individual lives. It also causes significant trauma for the family members and friends of those who commit suicide. Since the society has undergone a dramatic change during the past few years, there is a constant duty to address current problems and to develop effective solutions. Concerning the matter of student suicides, medical colleges presently enjoy relatively limited responsibilities in these matters, but it would be thoughtless to assume that this will continue in the future.

The problem today is most prevalent among medical students is the hierarchical and competitive structure of medical colleges and hospitals. Students are the backbone of any medical college. In a private medical college, parents pay humungous amounts, with most of the colleges lacking a proper infrastructure of teaching, getting recognition by bribing. Instead of good quality education, students are completely squeezed, with the government or the medical and dental councils hardly having time to look into the matter. When an incidence of suicide by a student takes place, a board is set up to carry out an enquiry and hush-up the matter. No emphasis is ever given on how to control this menace in future.

The Indian medicos are facing a tough time. There are very less government jobs available, with no campus placements for medical students, even at premier medical institutes. Even when doctors somehow manage to get jobs in private hospitals and nursing homes, they don’t get a decent remuneration. All these add up to the stress levels of young doctors.

After an extensive study, at a time when most of their peers in non-medical fields are already earning, when doctors come out with a degree, they do not have proper jobs. A handful of “lucky” ones do get a chance to work with prestigious hospitals, others are pushed to work for private institutes, pushed to work hard, with pays not coming on time, having salary backlogs for as long as three to four months. After so many years of study, a doctor just gets around Rs. 20,000-25,000 per month, which adds up to a doctor’s depression.

Post-graduation is the toughest period in a medical student’s life, when he has to study hard while working tirelessly in a hospital. Not getting a post-graduation seat is not an option these days as the society hardly recognizes non post-graduate doctors. And with very few post graduate seats in the government colleges, and the ones in the private colleges being openly sold, the frustration of a doctor only tends to grow.

The government officials are often heard cribbing that there is a shortage of doctors in the rural areas. Still, there is little recruitment of doctors by the government, leading to an ever increasing number of unemployed doctors, with the society reluctant to accept fresh crop of doctors in private practice.

It is high time that the government starts caring for the doctors, or the time is not far when meritorious students start to opt for other fields. Admissions into private medical colleges should be made in accordance with the all India pre-medical entrance test, with the admission process being totally transparent.

Medical and Dental Councils of India, the regulatory bodies governing all the medical and dental colleges in the country, do not currently have a policy that specifically addresses student suicide. Making and implementation of a policy would not take a lot of time or expense, and could potentially be a strong source of support, should an unfortunate situation arise. There is a presumption among the managements of various colleges that teachers and other employees have received such instruction about student safety (including student suicide) during their years of education. Without specific guidelines, merely conducting an inquiry and brushing one’s hands off is no way. The authorities should choose to address the issue of student suicide by both action and policy.

There is a strong need for a student and faculty grievance cell, based upon the idea that, while one can never be able to eliminate the risk of suicide, specialized services can be provided to identify students at risk for suicide, and also provide on campus counseling sessions or through referral to specialists, depending upon the individual case.

Although a professional college ultimately has little or no control over the actions of a student with suicidal tendencies, it is the very basic necessity to look out for the well-being of the students and to do everything within the powers to protect them. Teaching faculty of colleges is entrusted upon with the challenging task of shaping young minds and advising them as they mature. Unfortunately, the colossal demands of the adolescent society intrude on a daily basis and may severely hinder the ability of the colleges to carry out their original mission of educating its students. In order to educate the students, one must do everything within his powers to help them be ready to learn. As well wishers of the medical and dental fraternity, which includes the students as well as the faculty, the government as well as the college managements, should be morally as well as legally, obligated to address the issue of student suicide.