Saturday, April 15, 2006

Advise to a young doctor

At a party I attended recently , I met a young consultant obstetrician who had just started practise. She was complaining about how ungrateful patients were, and how they refused to trust her. She had just seen a patient who had a missed abortion - a common pregnancy complication , in which the fetus dies in utero. Once the diagnosis is made, the pregnancy needs to be terminated. She had made the diagnosis, and had advised the patient to get admitted in the hospital, so that she could perform the surgery ( a dilatation and curettage) the next day. The patient agreed, and the doctor was pleased that she had provided good medical advise.
Much to her dismay, she got a phone call from the patient's family physician a few hours later. The family physician wanted to know what the diagnosis was, and whether the surgery was really needed. She did explain the facts to him; but internally she was very upset that the patient did not trust her. She was offended that even though she was a specialist ( and thus "outranked " the family physician in her field of expertise) , the patient still needed to talk to her family physician ( who was a generalist, and not as well qualified as her in dealing with pregnancy complications).
I feel this attitude just reflected how immature she was. Consultants need to understand that even though they are specialists, and technically very qualified, from the patient's point of view, a doctor is a doctor; and the patient needs a doctor whom they can trust - someone they have built a relationship with. This is often their family physician, whom they have known for years. From the patient's viewpoint, counter-checking with the family physician was not a slur on the specialist's abilities; but simple common sense, to confirm that the advise was right. Rather than taking offense at this, she should have taken this opportunity to educate the family physician about the problem, and thus provided additional value.
I also felt that she was not very empathetic. While a miscarriage is a daily "bread and butter" problem which obstetricians deal with daily, it's a major emotional setback for the pregnant woman;who needs a lot of counselling and hand-holding. Unfortunately, few specialists provide this, preferring to take a "cut and dried" matter of fact approach. Thus, while they deal correctly with the medical problem at hand, they provide poor medical care by failing to address their patient's emotional needs.
Unless this consultant learns to see things from the patient's point of view, she is not likely to do well in practise ! Her patients will be unhappy with her - and she will always remain clueless as to why they don't trust her.


  1. Most doctors are good in IQ but some still in learning stage for EQ management.

  2. Anonymous8:50 AM

    I agree with dr malpani here. Even specialists sometimes misdiagnose cases, and since the patient trusts her family physician more, she's probably only trying to re-confirm the necessity. Such ego is only working to the doc's detriment- what she's suggesting is that she's always right.
    and the other point about understadning what it means to the patient is also very valid, since this routine exercise for a doc, may be a life changing experience for the patiennt.
    I work in banking/ IT and we're givin a lot of awareness about EQ- I wonder if this is formally done for doctors in their training?


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