Monday, July 11, 2011

Should I be operating or talking to patients ?

One of my friends is a highly skilled cardiac surgeon. He spends most of his day in the OT, and while his technical skills are superb, his patients often complain that he is brusque and has poor bedside manner. When I was talking to him about the importance of good doctor-patient communication, he got visibly irritated .
“ Really , what do people expect me to do ? I am a highly skilled surgeon and I should be spending most of my time in the operation theater , helping my patients to get better. I have spent over 12 years learning how to do surgery and am extremely good at my job ! Should I be operating in the theater or should I be sitting and talking to patients ? I operate all the way from 8 o’clock in the morning to 8 o clock in the evening. How could I possibly find time to sit and chat to patients? And if I do sit & talk to them, who will actually do the operations ? I agree communication is important , but I don’t think it is sensible to expect a surgeon to pay more attention to communication over providing direct hands-on surgical care. Doctors need to set priorities & providing clinical care to patients is far more important than just holding their hand and talking to them. After all there are many people who have the skill to be able to talk to patients. But there are not many people who have the surgical, technical virtuosity to be able to operate in the theater like I do. Wouldn’t it be an actual misuse of resources if I was forced to spend time just sitting and talking to patients rather than operating on them and fixing their problems efficiently ?

What my surgical colleague has to say has a grain of truth. Of course , because he is a much better surgeon than he is a talker, he would rather be doing surgery than talking to patients, and this makes sense. But it is right to make optimal use of his scarce skills; and society should make the best use of his valuable resources by allowing him to spend as much time in the theater , doing what he is best at.

However that does not mean that he can shirk his responsibilities & not talk to his patients. What he needs to do is develop alternative means to make sure that his patients are adequately informed before, during and after the surgery. The good news is that there are many ways of doing this. He can use assistants to do some of these tasks; and even better, today he can use a lot of online technology and tools ( such as videotaping his advise to patient and uploading this to his website) to make sure that patients have realistic expectations and are well informed.
I think rather than create a confrontational, either-or approach, we need to create a win-win situation, where the doctor can focus on what he does best (operating ) ; & also makes use of tools, both human assistants as well as technological tools to make sure his patients are well informed. This is important for his patients – and him as well ! This way they have realistic expectations , so that even in case a problem occurs , they do not reflexively accuse him of negligence. A well-informed patient is far more likely to be understanding and charitable, even when there is a bad outcome, if he knows that everything which could possibly have been done was done.

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