Monday, February 06, 2012

Are patients dumb ?

I had a very interesting conversation recently with a friend of mine. He is a doctor who practices in a government hospital , and it was amazing how different our perceptions about the intelligence levels of our patients was.

I feel that patients are smart and very capable of making their own decisions for themselves. My worldview is that patients have a lot at stake and will do their best to understand what's happening to them and would rather make their own treatment decisions, rather than leave everything up to the doctor. I believe that if patients cannot understand what I'm saying the fault is mine – this means I'm not doing a good job with explaining , and need to try again. I have created a number of audiovisual aids and use these frequently in order to teach my patients about their infertility problems and the treatment options. Not all my patients are CEOs – many are illiterate and uneducated – and we try to teach everyone who comes to us.

My friend , on the other hand , believes that patients are not smart enough to understand about their medical treatment options. He feels that most patients would rather not break their heads trying to make sense of the complexities and nuances of medical decision-making, and are quite happy to let the doctor make these decisions for them

I think both my friend and I are reasonable, intelligent people - and yet we have such markedly different worldviews. The reason for this is that we deal with completely different patient populations. My patients are often articulate, smart CEOs of companies , who are used to deciding for themselves . They routinely exchange e-mails with me. He , on the other hand, has to deal with the masses of the unwashed majority within an outpatient setting in a public hospital where he has to see over 30 patients in the space of two hours.

I can sympathize with the pressures which he needs to work with. But just because his patients come from a lower social economic status does not mean that they are dumb ! In fact his patients are likely to be far more street smart. They live under conditions of poverty and deprivation in which I would not be able to survive for even one week. I think we need to give credit to the ability of our patients to understand for themselves ; and we need to acknowledge that is part of our job description to create educational materials for our patients. I think it's ironic that I spend so much time and money creating educational materials for my patients , who are already quite well informed and capable of accessing the Internet and getting tons more information if they want to . Isn't it tragic that he has not spent any time or energy in creating educational materials for his patients who need these far more, because they don't have any access to these materials at all.

He actually has the resources and the time and the energy to do so because he works in a teaching hospital and has lots of medical residents and medical students who work for him. I just wish doctors would accept that part of the job description involves educating patients and would be willing to spend the energy in order to do so.

Ironically, his creating educational materials would have a far better return on investment as compared to anything I can do , because he sees so many more patients ! However , he feels he's so busy providing clinical care to the patients he has to see on a daily basis, that he cannot find the time to do so. I think this is just a question of setting priorities and deciding that it makes more sense to treat patients as intelligent partners so that they will then be able to do a better job , rather than to complain about a paucity of resources. Let's not forget that patients are the largest untapped healthcare resource and we need to be able to give them the tools so that they can behave intelligently

I think the only reason doctors think that patients are dumb is because we treat them as being dumb; and we don't make any effort in order to try to get them to become smart. ( Or maybe smart doctors have smart patients and dumb doctors have dumb patients ?) This is a tragedy but it's actually an opportunity in disguise ; and I do hope that the next generation of younger doctors and entrepreneurs will take up this challenge !

1 comment:

  1. Anonymous12:54 AM

    Dear Dr,

    I agree that no patient is dumb even when they come from the lowest socio-economic status. I can tell you 2 examples. One is a taxi driver we met in Mumbai. When he understood that we have come to you for infertility treatment he really empathized with us. He too had faced infertility problem in his life and now has 2 children. For sure he had least education. Eventhough he could not understand our exact medical problem he wanted to help us in someway. He told us 'I will tell you something, you follow that- every month in female a balloon (follicle :)) will be formed. You should have intercourse at that time. That balloon thing is most important for pregnancy'. I enjoyed his explanation. Eventhough he couldnot say follicle, egg etc he explained in the most simplest way ovulation and its importance, in the language he knew. I really, really appreciated the person or the doctor who made him understand this.
    The next example is our servant maid. She was educated upto 3rd or 4th standard. The ease with which she uses a china-make touch screen mobile is just amazing to see. From camera to switching on the music, even my mom cannot learn. Why I have to tell it here is even if you teach an uneducated person the most complex thing in an interesting manner they will definitely learn quickly. But many doctors (i can't blame them too, 30 patients in 2 hours is simply too much) either because of their hectic schedule or simply due to lack of interest will not educate patients about their condition. I too hope that the next generation doctors will try to put patients first and not the passion to just earn money

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