Are we losing the relationship between a doctor and his patient — a subject of more than 8,000 articles?
Whatever happened to the family doctors of yesteryear? I am talking about the kind gentleman from whom we not only sought advice for our health problems but also for thevastmajorityoffamilyproblems?Frommarriages in the house to catastrophes with children, he stood firmly with us through our trials and tribulations. Even with incurable and dying patients, he sat with them till they passed from the world to beyond. Such behaviour is in perfect harmony with Hippocrates, the father of medicine and the oath that most medical students take on graduation.
But time has changed many a things. The HippocratesOathhasalsoundergonechangesandreplacements such as the Geneva Convention have emerged. Though philosophically similar, we are now dealing with a world of falling ethical and moral values. You have to only open any Mumbai paper to see the scams made on the tax payer’s money. Things which made our eyeballs pop out yesterday are being considered as passé today.
Nowadays, the house physicians ring to give a report and mentions patients by bed numbers or disease. We are losing the gentle art of remembering the patient. We now remember their diseases. But what has altered the patient-physician relation over the years? I think firstly that several physicians are now available and patients do what is calleddoctorshoppingforopinionsandsothepatient-physician relationship is really not that strong. The other complaint I repeatedly hear is that extensive investigations are done in situations where less could have sufficed. This is true but ever since medicine being brought into the consumer courts, physicians have started practicing what is called defensive medicine.
The concept of medical diagnosis is partly scientific but mainly an art. The probabilities are considereddependingontheevaluationofsymptoms and the appropriate tests ordered. There is no way of knowing on day one that the headache that seems to be from the sinuses is really a brain tumour. Defensive medicine encourages a physician to do head scans in such a patient for the purpose of being legally safe.
Physicians, who see patients after a physician has already treated them unsuccessfully, are not better. They are just wiser in hindsight and no one upmanship game should evolve from such consultation, worse still prodded by the patient. Another duty of experienced physicians is the sacrosanct duty to teach their juniors. The term doctor is derived from the Latin word docere that is to teach. I sadly notice that physicians who train abroad for short periods pay fees to their teachers for the exper is egained. More over, a hos to medical journals are found on the internet. But it is worth remembering that anything can be published on the internet, circumventing the peer reviews that are imperative for academic publications.
Doctors do try their best for patients and I do know that patients admitted to ICUs give their physicians no sleep as they are really concerned. Much of such nights, the doctor keeps wondering what else can I do to help my patient. I therefore feel affronted if the relatives of an ICU patient feel that the doctor has not done enough.
Doctors in this country deal with a vast number of patients and so their time is divided. This does not mean that he does not exercise adequate care in patient care. If there is one thing that irks doctors is several relatives calling for the same patient and that he has to spend his time to say the same thing repeatedly.A doctor’s mobile numbers is handed to relatives of patients by hospital operators who do not want to be bothered by inquiries of the patients’ relatives. Can you imagine the drain in the physician’s time if he has to answer repeated calls of various patients’ relatives?
Often this happens when he is in a process of making important life-death decisions and the ring of a phone tends to disturb an important thought process. Nothing upsets doctors more than corridor consultations, where patients stalk doctors in hospital corridors to show reports, often not really urgent, in the hope of saving time waiting in clinic lines.
The relationship between a doctor and his patients is the subject of more than 8,000 articles in medical literature. It is important that you trust your physician or else he will automatically find it difficult to make decisions. Well informed physicians discuss various therapeutic options during hospitalisation or out patient care and make you a party to clinical decision making.
What I find surprising is doctors being physically assaulted when patients die, especially at government-run hospitals. We must keep in mind that doctors do their best to save people . I would be delighted to see a doctor-patient relationship built on trust, where second opinions aresoughtinconjunctionwiththeprimaryphysician, also where the doctor does not play God and involves the patients and his relatives in therapeutic options, based not only on the databases of evidence, but also on the experience of the doctor.
Times of India
13 Aug 2013, Pune