The doctor-patient relationship: What makes it and breaks it
By Dr Manshi Kashyap
I am a resident-doctor, pursuing MD (Medicine) in a premier institute in New Delhi. Before the commencement of my session, I had come home to meet my family and friends. Among many people who congratulated me on my achievement of clearing the All India Post graduate Entrance Examition in my first attempt, I met a few who presented to me a very grim perspective of my noble profession. I was shocked at how a doctor’s image was totally tarnished by a handful of not-so-noble doctors. To a certain extent, I did agree with them. Stealing organs, keeping a dead person on ventilator for days together, ordering unnecessary investigations sure are not noble ways. But after a point, I realised that this issue is a bit more complicated than it appears.
Opinioted as we all are, most of the times, we are so biased with our own opinion that it is difficult to put ourselves in someone else’s shoes. Being a doctor myself, I wish to show both sides of the story. But before I begin, I would like to affirm that this article is in no way intended to “support” doctors. This isn’t a Doctor-versus-People War. Nor am I supporting or rejecting the policies and practices of the Government or the Corporate Hospitals. This article is just a sincere attempt to alyse the scerio from an unbiased perspective without being overly judgemental or sentimental about it.
A few days back, I visited a learned lawyer. He rrated to me an incident when his son was down with fever and cough. The following afternoon, the father called up a doctor, requesting him to pay a visit to his son at his residence. Apparently the doctor refused to come. It was already past 2pm. Instead, he said that since he was scheduled to sit in his chamber from 5 pm, he would see the patient then. The father was furious. He said to me, “The doctor didn’t come to see his patient even if that costs the patient’s life”.
Now here, I want to make a few points. For my own parents, even a minor fever is a serious condition. Why would it not? I am their beloved daughter. But eversince internship, we have been taught to grade the severity of a condition after listening to the symptoms. It is for the doctor (and not the patient/their escorts) to differentiate between those who require urgent assistance and who donot; who require in-patient treatment and who can be maged on out-patient basis. Now, fever with cough is certainly not a life threatening condition. Secondly, an ambulatory patient can be taken to visit a doctor rather than inviting one to his residence. We don’t know why the doctor refused or was uble to come. Maybe he had some prior persol commitment! Maybe he was tired after a night shift the previous night and genuinely needed rest?! Maybe he had promised to attend his child’s Parent-Teacher Meet! Or perhaps he really wasn’t dedicated enough! But did we consider all the possibilities before concluding that he wasn’t dedicated? No, we didn’t. Are we being too judgemental? We probably are.
The other day I met a retired ACS Officer who claimed to know all about raised uric acid levels and diabetes. Well yes, internet today is an indispensable part of our lives. But as the proverb says, “Little knowledge is dangerous”. Reading about a disease on the internet doesn’t mean one knows everything about it. Five years of studying the same disease under various subjects, from Atomy, Physiology and Biochemistry, to Medicine and Surgery, cannot really be summed up on Wikipedia to give someone the same knowledge as that of a doctor. Wish IIN (Idea Internet Network) could actually make a doctor out of a person!
During my internship in the Department of Surgery, I had the experience of an instance when an agitated relative came to question me on the ratiole of ordering a chest X-ray for a Limb Surgery. Chest X-ray when the problem lies in the limb sounds like a useless investigation, does it? Well, no! We need to follow certain treatment protocols, order certain diagnostic procedures before we can prescribe certain medications or interventions. Therefore, we need to think twice before getting annoyed and judging all doctors (even those who DO NOT specify any particular diagnostic centre) without knowing proper facts. I had, once, myself tried to resuscitate a brought dead person for about 20 minutes despite knowing the fact that he was dead; but just to save myself from the wrath of his relatives and from the blame that the doctors didn’t try, I did it.
Ninety percent of humanity cannot withstand the routine of a Junior Resident in a Government hospital. The pathetic work conditions; low monetary compensation in comparison to the limitless and laborious work being demanded; sheer intellectual, physical and mental labour for an average of 18-20 hours on a daily basis for years together; constant fear of being beaten up by ignorant relatives of patients, just scratches the surface of a plethora of problems faced by doctors.
Sure there are a few rotten fishes that do charge excessive fees, prescribe costlier medicines and unnecessary diagnostic tests, or do inhuman acts of stealing organs or illegal abortions after sex determition. But I have worked with doctors whose topmost priority is truly the wellbeing of their patients. I have myself skipped my meals several times and have seen my fellow batch-mates doing the same, only to buy us some more time to be able to attend to the insurmountable patient load in the Emergency.
Recently Dr Ram Prasad Sapkota, a doctor in Kathmandu, Nepal, didn’t run away even during the earthquake because he felt obligated as a doctor to keep the life of his patient on a higher pedestal than himself. There are so many of those unsung heroes. If I start mentioning each and every one of them, my answer will become longer than the Great Wall of Chi.
To all such dedicated doctors, I salute their dedication. But also, through this small attempt to uplift the gold-digger like image of doctors, I request them to be a little more patient in dealing with their patients and answering their queries. In a country where there is less than 1 physician per 1000 people (0.7/1000 population), it is human to lose calm once in a while. But a tolerant, forbearing and polite approach can go a long way in restoring the lost faith in us. Also, patients should be told the truth as well as about the adverse effects of the medications from the very beginning and also be given the choice of altertive treatment options, if available.
In addition, the healthcare delivery system should be properly channelized. Unlike in India where we directly visit super-specialists (Cardiologists/Diabetologists/Urologists) for simple ailments; in USA, it is mandatory for patient to visit a General Medicine Practitioner first. The General Medicine Practitioner treats the patient; and only in complicated cases which require expert advice, does he refer the patient to a super-specialist. For example, if a patient is suffering from high Blood Pressure, he first has to consult a physician and not a Cardiologist directly. The physician will refer him to a Cardiologist if such a need arises. As a result, there is a better segregation of patients based on disease severity and better division of labour. Hence a doctor is able to give more time to a patient and patients receive superior quality care. Another important aspect is the value of time. Isn’t it a sheer waste of time when one is given an appointment at 12pm and is seen by the doctor at 3.30pm? A delay of about an hour is understandable. But leaving all important work behind and waiting for his turn for more than 3 hours is harassment. The receptionist in charge of scheduling appointments should make note of that.
To all those people who unfortutely have come in touch with those money-minded, selfish doctors, who are a disgrace to the entire doctor-fraternity, I request them to be aware and cautious in future. At the same time, however, I also request them not to form a generalised negative opinion on the entire Doctor fraternity, because of a few disgraceful doctors. People’s appreciation fuels our desire to work and improve ourselves to be able to provide valuable service to the society. But such generalised negative views demoralise and discourage us. Atleast give us, the dedicated doctors, a chance to serve you better.
Last, but not the least, I request all not to forget the fact that the doctors too are human beings- made of flesh and blood. Hence, doctors too need food, water and unfortutely, some time to rest. And yes, even after being doctors, they can make mistake in one out of ten times. For that one time, kindly do not forget the other nine times that he did good work. Please help us to be able to help you!
(The writer can be contacted at: 919854028981 & email: kashyapmansi58@gmail.com)