“Faith is a small word but has supreme implications. The problem with many is that, they have doubt in their faith and have faith in their doubts.” Dr. Vijay Surase
The reasons for these are multi fold. This is not only in medical field, it is everywhere. Some anecdotal cases rob away credential of that profession and put a stigma. You may consider doctors, policemen, law makers, media persons, politicians or for that matter anybody who suffer due to generalization and there is unnecessary development of hatred into the minds of society. This generalization should be stopped. First of all, people should not lose faith, regard and respect from these very responsible people of the society – Doctors.
Surely, no doctor would want his or her name to come into bad books of the society at any cost. At the same time, no patient comes to a doctor to cheat him. Only thing that lacks is attachment.
The times have changed. Some decades ago patients were just patients and doctors were just doctors. Nowadays the patients have become customers and some doctors have become businessman! There are definitely some reasons for this factual change and the reasons lay on either side.
Where there is good connect or attachment established, faith automatically builds up. This was how earlier medical practice used to work. People used to regard family doctors as family members and doctors were considered as idols of the society. Let’s take a simple example of fever. Earlier if a person used to get fever, he used to follow advice of the family doctor who used to treat the patient symptomatically by simple judgment without investigations. Agreed that fever can be a very simple issue but some fevers nowadays we have been seeing can become a dangerous issue due to complex underlying reasons if not investigated and treated on war footings. You all will accept that earlier people had time, patience and convenience. We know that 50% of the times fever vanishes on its own if it is just incidental or viral. Thanks to our immunity or bodily corrective mechanism which help us more with the supportive measures without requiring any specific drug. If fever persisted for more than 4 – 5 days, then people were advised to carry out Malaria tests and then given therapy accordingly. If fever persisted for more than 10 / 30 days, then Typhoid and Tuberculosis tests were carried out respectively and people also did accepted this policy harmoniously. But currently in this fast era, when the person cannot afford time loss due to pressing targets on heads, no medical leaves, plus lots of inconvenience due to nuclear families, people don’t want “Wait and Watch” regimes. They want fast battery of all tests for blood / urine / X-ray / CT scan etc plus consultation of super specialists and cross referral to various super specialists on request. In this they end up spending a large sum of money blaming super specialists for their heavy fee. At the end, they might have simple viral fever and go with one pill or no pill as advised after evaluation but will get a financial dent. Most of these who are having medical allowance from the employer will not have issues on this, but for this do not go well with those who pay from their pockets and frown seeing the bills. This is the time where the misconception and misunderstanding seeds in.
As a general common sense, when we go partying or on a vacation, we spend lavishly. When we have to buy supposing gold, a new house-flat or a car, we spend joyously because there is a pleasure associated. But when it comes to spending money for treatment of disease, then we all, who have hard earned money, won’t like to spend for health reasons because it is for sickness and pain you are paying for.
Whenever a person is diagnosed for the first time with a medical ailment what I see as an initial response is an upfront denial of a medical problem. People boldly and proudly say that until that point, that person was hale and hearty and never had a pill or injection, never seen a doctor, never done any tests how can he/she develop a problem? This is a second level for development of misunderstanding. Multiple aggressive counseling sessions are required to convince a person for investigations, hospitalization and further treatment as the person is not aware of the problem. In general, everybody fears the cascade of blood tests, ICU, surgical knife and hospital bills. People try to find out short cuts, which in turn, prove dangerous and they develop more complex issues. People in India fall in trap of quacks and follow nonscientific advises or suggestions of some neighbors or anybody who give them free advice.
Super specialists who are attached to 3 – 4 places and keep hopping from place to place are very busy. In metro’s like Mumbai where traffic snarls do not permit faster access to hospital for both doctor’s as well as patients, causes lot of irritation on both ends. Specialists cannot reach at the wanted place in time. This is third reason for friction. That’s the reason why people nowadays prefer hospitals in their vicinity but the entire wanted well known and skilled doctors are not available at every hospital.
Those doctors who are well known and busy find it difficult to accommodate unscheduled appointments/ cases like emergencies which take a lot of toll on the time. People travelling from long distance with a prior appointment get stranded and irritated, that’s natural. It irritates them more when some VIP”s just walk in, which is seen everywhere. Every hospital has to entertain VIP’s for smoother hassle free functioning. This adds to more irritation of all, that doctors understand but they are helpless. This is the fourth reason where heated arguments get up surfed.
Like any other person doctors too have their priorities. They have to primarily take up serious issues first as they come up. After performing best of the best job, (for example, a complex surgery) the patient and the relatives expect everything else also from the same doctor which is too much of a time robbing work. Like complete necessary scientific explanation, telling estimated cost, concessions, progress, reason for change in plans of treatment, day to day general counseling, explain about the problem from the specialties who were called upon as cross referrals .Some people expect that every bit of information like each and every tablet / medicines should be told by primary doctor only while getting discharged. This is the fourth reason where there is a scope for total misunderstanding.
The patient relatives don’t believe in second and third level hierarchy of the organization. There are different people to handle different-different issues. Even on medical side what appears simple issues to a doctor is a very big issue for that particular patient and the patient’s family. If some other second level staff counsels on particular issue, again that is cross checked with the primary doctor and this invites too many things for that doctor to do. For a patient his/her doctor is the only one to answer everything they feel but they forget that there are many such similar ones for whom he has to answer. The quality time of the doctor goes into solving these issues which can be deputed to or handled aptly by the others whom patient’s families usually don’t entrust. And people forget that doctors are equally worried and concerned about their patients and their condition is reported time to time by observing junior staffs and nurses and then orders of responsible doctors are followed up meticulously. Expert doctors pick up issues to be addressed themselves with responsibility. For avoiding major lapses they see the patient clinically once in 24 hours and even more frequently if serious. Patient relatives who are available keep changing at the bedside and want to understand everything about patient only from the doctor without getting proper over information from their previous attendant or junior doctors. This is fifth level where issues of unhappy patient’s relatives may crop up.
We as doctors frequently see new -new relative’s bedside of the patient who are emotionally attached and who want first hand info from doctor and keep entering into consulting room or where the doctor is seeing the other patients on rounds.
Unless urgent, doctors don’t expect routine calls on mobile. Most of the doctors freely comprehend on phone in only morning time. But as the day becomes busier they find addressing lengthy issues on phone very difficult. Patient feels he/she is the only one phoning his doctor, but he/she forgets that the doctor must be getting calls from many more such similar patients. Doctors are not resistant to questions provided they are asked at once, not again and again and by a person who is responsible for subsequent communications. This is another level where people develop wrong impression about medical men.
When patients are admitted for major or semi major issue the problems keep getting better and better with treatment, support, nutrition and general nursing care. During rounds after major surgery what is expected is healing and rest all things are part and parcel of recovery unless something/new problems are picked up by the doctor or relatives. On rounds generally at glance specialists can pick up issues to be addressed. The visit charges of doctor shouldn’t be challenged as patient needs doctor supervised nursing care which might not be possible at home. When doctor is supervising it might not be seen. What is seen is doctor on rounds for few minutes but actually constant update, telephonic orders, inter-departmental communications with other specialists for same patients treatment, report analysis is all done by the doctor which is not overtly seen. Doctor cannot charge for these activities so logically bedside charges are fixed to average out many other issues which doctors handle on treatment fronts effectively. This charging is perceived as too much by some of the patients and here is again a scope of misunderstanding.
In many illnesses it’s not switch off or switch on phenomena / response to treatment. It takes time for drugs to act and benefit but relatives want faster results where doctors have no control over. Patients and their relatives have right to understand what’s going on and should expect righteously proper explanation. But in some situations science cannot answer everything and upsets everybody. Here is again one level where medical men can become soft targets.
Money earning is not a sin. Doctors are not commercially driven as perceived by the misunderstanding at this service mission of multilevel. Doctors advise all for better stress free life but in India they themselves are very much stressed out working for more than 12 – 14 hours a day as there are too many things for them to do.
To establish proper doctor patient connect all of us should logically think how this can be successfully established. I have some genuine suggestions to doctors as well as patients (customers/clients).
1) Working under one roof- A specialist should not take up too many attachments and should dedicate maximum working hours at one place or at one major institute.
2) Establishing qualified hierarchy- To have proper second – third line up people, administrators, counselors, dietitians, rehabilitation person to identify themselves and answer to patients queries or proactively brief about their role which is also very important.
3) Putting priorities- Emergencies should be dealt with first and in early morning hours. Before 10 – 11am every day the rounds should be taken up with other responsible persons in a group and keep deputing different-different jobs to different persons giving clear names and contact details of other supportive team staffs so the responsibility is properly shared and smoother functioning happens.
4) Time giving -Give more time at the inception and clear out all things mostly at the beginning only leaving no room for patients to get a feeling that a particular thing or matter was not touched. Keep time for daily briefing in evening with a responsible relative.
5)Consider Economy-If asked, admit the patient in the lower- most / economy class as patients relatives might not be aware that there are such facilities and they can save on cost. Patients come in emergency situation where they don’t understand initially about the hospital policies about admission classes and bills. Doctors should guide them about their economy class facilities if the patient appears financially low.
6)Doctors in making- To all my colleagues doing PG/ Post PG super-specialty courses plus working 24 x 7 in very adverse living conditions , I have very special attachment to you all because I have gone through your phase. Always remember what Mahatma Gandhi has said “You are not doing any favor to the sick patients by serving them, it’s the other way round. They are doing favor on you by giving you an opportunity to serve”. Whenever you serve at high volume Government-Municipal organization you are lucky that you are getting countless chances to learn new-new things on day to day basis. Express your thanks and gratitude to these patients. Please be sensitive towards these poor pupils of God and act with compassion. Treat them as you want your parents-relatives to be treated. Talk to poor people in a gentle way; don’t shout back on their being poor and illiterate. Remember, they are not there by choice but you definitely have chosen the medical field to serve and learn to become good doctors of the society. Unlike other fields we the doctors get respect by default but we just have to maintain it.
Dr Vijay Surase a young Director registered with Ministry of Corporate Affairs (DIN No 0250463) is a multitasked-multidimensional personality & a lead Cardiologist at Jupiter Hospital (Thane). He is being rated as one of the best Interventionists in Thane & ranked amongst the top few renowned cardiologists in Mumbai & the State (Leading Forums/ Times Survey).