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

How would you prefer to communicate?

Happy New Year!

For this year, I've decided the only way to write more would be to write whatever comes into my head and make sure it gets put up here. This would also mean that we will have shorter posts, but hopefully, more often.

Carrying on from what has been the theme over the past few months in India, this post is meant to ask you one very important question:

How would you like to communicate more with your Doctor?

I understand that everyone has their preferences including the doctors, which is why I think this is an important but often overlooked question in the Doctor Patient Relationship.

Would you prefer a face to face encounter, a telephone call, a video call (Skype, Google Duo etc), Whatsapp messaging, SMS, via a friend or any other means?

Once you have this answer, I need you to think about one more question and I would appreciate both answers in the comments field. Having made up your mind about the first question, do you ever think about your Doctor before initiating the said means of communication? Things like whether they would be comfortable with the same means of communication, have the same tech that you would like to use, be in the same frame of mind as you to answer your queries etc etc.

Please do reply in the comments section and share with your colleagues so we can improve the relationship to a 2018 level :-)

Bouncers in Hospitals and Drips in Discos!

A couple of resident Doctors were assaulted by some relatives of a patient at a public hospital recently. Again. The Doctors go on strike. Again. The hospital gives a knee jerk reaction. Again. The police register a case and do nothing about it. Again. We outrage on social media. Again. The government will issue a statement. Again. Life will move on. Again. Spirit of Mumbai. Again. 

The initial reactions were as follows:

• Assault happens between 4 am and 5 am. 
• Eagle Security Staff allegedly runs away
• Flash strike called as soon as the commotion dies down
  
  
  
• Hospital dean agrees to file and FIR
• Bouncers are hired for the protection of the Doctors
• Outrage starts on social media after newspaper reports (mostly because of the bouncers photos)
• I fail to see sense in these steps
• I write this post!

I'm not going to get into what should have been done and who was at fault. Simply because it doesn't matter. Violence is wrong and always will be.

The boy was unwell for three days. He had apparently been taken to some private hospital and this was their last ditch effort. They were apparently informed about the lack of an ICU bed. They apparently consented for admission into the general ward. They were allegedly warned about the high risk. Technically, everything was done, spoken and documented. It still happened. Are you surprised? I'm not!

I've been through an assault during my residency. Almost a decade ago. We, too, went on strike. We lodged a complaint. We carried out alternate OPD's for the patients (this is where we made make shift opd's outside the hospital premises to cater to the seriously ill patients). We were promised better protection, better conditions, better staff, the works!

Nothing has changed and frankly we didn't expect it to. 10 years on we have bouncers in the hospital.

How ridiculous is that? It's wrong on so many levels but mostly on the fundamental premise that it is only going to worsen the already deteriorating Doctor-Patient Relationship. How is a patient ever going to trust a Doctor who is going to hide behind bouncers to explain anything to him? What is to stop the guy beating the doctor outside the hospital premises? Where is the method to deal with the rage? Where is the training to avoid the rage in the first place?

The answer is communication. Not more Doctors, not more beds, not less patients, not more money/salary, not better infrastructure. All of these have a very minor role to play, of course! However, if the residents are not taught communication etiquette's we're not going anywhere for the next 10 years. Again! 

No matter what the condition of the hospital, the number of beds, the number of Doctors, the infrastructure, if a patient dies, there is bound to be a reaction. The art of controlling this reaction from the time of admission is what will avoid this in the future. Empathy, a kind ear, some small explanation, taking the relatives into confidence, documenting everything with signatures (not just obtained due to lack of options but after explanations), a good bedside manner, giving some time to a serious patient even though you're overworked (it's doable, we do it in private practice even though we're busy), offering some sort of grief counselling, breaking the news gently.....All of this will change the way the relative will react. I've done it. I know it works. I've been through everything these residents have.

Let me tell you a little known fact about civic and govt run hospitals. Most residents think no end of themselves while treating a patient. They have a bad attitude, most dismiss relatives thinking they won't understand anyway so why make the effort. They talk badly, show that they have no time, and are generally dismissive and uncaring. It's part of the situation but it needs to change.

That is the only way this will stop. Change is constant. Just look at some of the discos that have traded bouncers with hospitals for drips and skeletons.