(This story was first published on 3 April 2017 and has been reposted from The Quint’s archives in light of the incident where doctors were allegedly attacked by a patient’s family at Mumbai’s JJ Hospital.)
“My mother has been in the hospital for two days. There is no improvement in her condition. You have done so many tests and given so many medicines. It is of no use.”
When they come to a hospital, patients and their families expect doctors to become magicians. They expect that as soon as the patient is wheeled in, he or she must undergo two-three blood tests or a scan. The doctor must then walk in and share an easy-to-understand diagnosis like ‘typhoid’ or ‘dengue’. The patient must then be given two-three injections, and at least one bottle of saline and sent home in 24 hours. Preferably free of cost.
Let me admit to the fact that no such ‘magic’ is taught in medical schools.
Remember that we are fighting on the same side as you. No doctor wants to intentionally harm a patient. Inadvertent mistakes can and will happen. We, as doctors, are just as human as anyone of you. We, too, have our good days and bad days. JUST LIKE YOU.
Here are my set of guidelines for being a good patient/family member of a patient:
1) Be Patient
A diagnosis takes time. Response to treatment also takes time. If your symptoms are worsening, by all means bring it to the notice of your doctor. But harassing us about test reports and discharge will often get you nowhere. It often leads to unnecessary tests and unnecessary drugs, which will only harm you in the long run. Most patients have symptoms for years together, but no sooner they reach the hospital than they expect a diagnosis and a cure on the same day.
2) Responsibility for Health
You are a cumulation of all the things you have done in the past. Remember all those pegs of whisky you knocked down last week, all those courses of antibiotics you took as self-medication, all those doses of insulin you forgot to take and all those symptoms you ignored because there was no time to go to a doctor? That is what brings you where you are today, with liver failure or a bad infection with a resistant bug. Your health is both of our responsibility. NOT just the doctor’s.
3) Own Up Financial Distress
Very often, families bring in patients requesting to do everything possible and when the bill comes, they struggle and often end up blaming the doctor as a way to avoid paying the bills.
" Remember that most of your healthcare costs are not going to the doctor. They are for the tests, medications and use of the infrastructure. "
If you truly have financial difficulties, tell us. We will try doing the best we can for you. It may mean cutting down on tests. Remember that it can lead to missing a diagnosis or an incomplete evaluation of the patient. But that is a chance you will have to take. We will do our best in the backdrop of such a limited setting.
4) Communicate Effectively
Remember that doctors are also humans. We too have feelings. If you are always hostile towards us, we will respond by putting our defences up. On rounds or in the OPD, we will be reluctant to see you, we will have less motivation to see you getting better. And trust me, word gets around.
Most doctors give a heads-up about hostile patients or family members to their colleagues. You may think that by being so hostile, you are getting better treatment, but more often than not, this also translates into unnecessary drugs or unnecessary tests.
Do address your anxieties and concerns if your family member is not getting better. But do it in a way that acknowledges that you know we are on the same team, fighting for the same thing.
5) Understanding the Limitations
There are many illnesses that modern medicine despite all its fancy trappings cannot diagnose, let alone cure. We as doctors are taught to always look for treatable causes.
What about the hundreds of tests that we order? It is in the hope that one of them comes positive, and we MAY be able to relieve you of your symptoms.
Often, patients or their family members complain that so much money has been spent on performing tests, yet the patient’s condition is not improving at all.
All those tests have been conducted to look for this 'treatable cause' in the hope of curing the patient. It may or may not exist, but it is our job to look for it.
I would also like to make it clear that just because you have spent ‘so much money’ does not mean you or your family member is going to get better or get cured. More money spent does not always translate into better treatment. It depends on what type of illness you’re suffering from. If it was dependent only on money, the rich would’ve never faced death.
6) Awareness About Risks & Side Effects
Any drug or procedure that you choose to take or undergo comes with its own risk. Most doctors will apprise you of the risk when it’s a high-risk medicine or procedure. That is our duty. But be aware that even something as innocuous as paracetamol can be a health hazard for some. It is just like crossing the road. You can choose to take a stride and accept the risk that someday someone might run you over or you can choose to stay inside your home for the rest of your life.
7) Criticise with Care
I read an online post by a lady who said that her doctor told her that she only had viral fever and two days later, she went to a different hospital and they diagnosed dengue and started her on antibiotics. She went on to criticise her doctor for both missing the diagnosis and for the delay in treatment. Here’s the fact: dengue IS a viral illness.
In this case, the unnecessary antibiotics probably would have done her more harm. Do trust your doctor. Understand that for most of us, it has taken anywhere from six-12 years to even start practicing. If you have any concerns, please tell us about it. Don’t judge us based on the half-knowledge you may have.
8) Violence Is Not the Answer
The recent spate of events prompts me to write this. We are often overworked, underpaid, and constantly stressed out in the course of taking care of our patients and tackling anxious families at the same time. Remember that doctors are also humans. We will make mistakes. If we do not give you much time or we are harsh with you, forgive us. It doesn’t necessarily make us bad doctors.
This is not to say that there are no bad doctors at all. There are doctors out to make money at the cost of the health of the patient. But if in the midst of targeting those doctors, even one sincere, innocent doctor is beaten up, then it is unacceptable.
Remember, especially in the heat of the moment, you are not the best judge of a doctor’s actions. Choose a legal route for redressal if negligence has been committed. It may seem long-winded, but it is the only way to ensure that the innocent are not punished.
Doctors Have Expectations Too
What I would like to see in the OPD:
a. You know that the doctor will be able to devote limited time to you. Come organised. Bring your reports filed neatly. Bring all the current medication you are on.
b. Do address what brings you to the hospital this time. You may have come because you have a worsening cough for the last five days. You also would like to take care of other nagging issues like the fact that you had loose stools for one day, and you had slight back pain for two days or one year ago. While it is important to let your doctor know all your symptoms, make sure you highlight what troubles you the most.
c. Don’t do the ‘hand-on-the-doorknob’ question. As you are about to walk out of the door after a twenty-minute detailed consultation, don’t say “oh, by the way, I have noticed some blood in my stools for the last two months.” Discuss all that you want to and have a clear plan before you leave the consultation.
d. I have no problems with a patient reading something on the internet.
" But do remember that if you have a list of ten rare diagnoses you have already made from the internet, I need to spend my time listening to that instead of taking a good history from you and coming up with my own diagnosis. It would be more worthwhile to ask a doctor what to read after he listens to your problems and makes a plan for you. "
e. ‘Doctor shopping‘ is when a patient goes from a doctor to doctor with a single complaint and follows each advice partially. It is often useful to go back to your doctor if your symptoms persist. We will try to conduct more tests/change your medication to help you relieve your symptoms. But when you go to a different doctor, you again start from scratch. Second opinions are always welcome but come back to your primary doctor and let them know if there is a difference of opinion. A good doctor will always take a different diagnosis into account.
f. Be precise in your complaints. It helps us to narrow down our diagnosis and saves you unnecessary tests. Having a fever? Take a thermometer and chart what the temperature was each time before you visit us. If you have diabetes, for instance, maintain a diary of all your blood sugar readings and show it us during your OPD visit.
g. Be frank. Don’t hide the use of any drugs, including over-the-counter drugs. Tell us if you have had multiple sexual partners. Do not hide anything relevant. It is in your best interest.
h. Be cognisant of the time you take in the OPD. Do not ask us if your niece who we have never seen, can take a particular medication or not. There are patients waiting outside. They will be angry if kept waiting for long.
i. Be pleasant. We know you are sick and it’s been a long wait. But you will cheer us up much more than you can imagine when you flash a smile and thank us as you close the door.
( The writer is a doctor at St John’s Medical College, Bengaluru. This is a personal blog and the views expressed above are the author’s own. The Quint neither endorses nor is responsible for the same.)
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