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Friday, May 04, 2018

Guaranteed!

Have any of you noticed how every healthcare practitioner you go to now seems to be giving guarantees of treatment? Life time guaranteed treatments for common ailments. Guarantee boy child with certain powders and medications. Assurance of a cure even though we may not even have a diagnosis yet. Almost every consult ends with don't worry, everything will be alright!



I was wondering, perhaps, if this is the cause of the growing mistrust amongst patients and their Physicians. 

Why is it that we feel compelled to make the patient feel better by lying to them? Why is it so hard for us to tell the truth to their faces? 

Is it compassion? Is it being a good human being? 

Would it be better to be a better human being rather than be a good doctor?

I don't recollect anything in the Hippocratic oath asking us to be emotionally available to our patients. Empathy is something completely different as far as I'm concerned.

Look at how we take consent for procedures. Everything will be fine. There is nothing to it. Don't worry. Not one word about the chances of complications and the chance that it might not work out. We do not have guaranteed treatments for anything (at least not 100%). I know of people who have been told that everything will be alright even when the Doctor is sure the patient will not survive. Why not just say that the situation is grievous and seriously might not end well?

So, what is the answer here? How do you make sure you are capable of giving the truth as it is meant to be given without attracting negativity from the patient?

Would it even be possible to be brutally honest all of the time with everyone? I guess not. I guess somewhere down the line we have to use our judgement and take a call whether to lie or not.



Some of us do it subconsciously but perhaps it's time we all take a course in communication with the patient.

This truly has me stumped. I would love some replies from my Doctor colleagues but even more from non medical people reading this as to what they would prefer. That's the real crux isn't it. Let us ignorant Doctors know what we need to tell you. Perhaps, it would stop all this negativity against Doctors once and for all

2 comments:

Dharmesh Kharwar said...

Hey Doc , where science has evolved enough and is predictable , guarantees are expected and based on that insurance risk and coverage is determined. E.g. roller coaster, air travel , train travel road travel , mountaineering ,space travel , sports , so in field of healthcare where science has evolved enough , it’s a right to have a guarantee based on risk benefit ratio . However random human body may be healthcare practice is now highly predictable due to modern medicine and devices and for most interventions I would expect a guarantee, even if may be conditional e.g. knee replacement subject to knee being functional or pacemaker etc . For cough cold fever doctor should not charge any fees as doctor can’t heal it if it’s a virus , only time and hot soup can.

Dheeraj Mulchandani said...

Dharmesh, thanks for your comments.
It was exactly this line of thinking that I was hoping to get out. Allow me a little space if you permit.
No matter how much science evolves, it cannot predict to a guarantee how the body will react to a certain substance without error. This is why we have confidence intervals in statistics. We can get the most probable answer but certainly not a definitive one. Keeping this in mind, human bodies all react differently to different medication is not a line I will thrust upon you. I will say, though, that in a controlled setting, most medicines will act as per the norm. However, what do you say to someone who takes a drug prescribed by the physician and then proceeds to self destruct his high fever status by walking hours in the rain just because he's already on medication, to take a simple example.
With your example of knee replacements and pacemakers, were it only that we were machines. We would get an exact fit every time. Unfortunately, we can only get what is the nearest possible fit following with the patients' body must accept the implant and work symbiotically with it. A little difficult to guarantee success but I guess we've achieved enough for it to be accepted as a standard treatment.
Your statement about Doctors not charging to treat coughs and colds we supposedly cannot treat is shocking. If that was the case, why go to the doctor at all?
This also brings to light a larger point. Are you paying the doctor for a guaranteed treatment like a commodity or for his time and experience in treating said complaints.
Most coughs and colds come with symptoms which can be controlled with effective medication (not talking about the causative agent being bacterial or viral here) and those again cannot be guaranteed!

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