Friday, September 02, 2011

Through the eyes of a ‘consumer’: Health care in Delhi. Through the eyes of a ‘consumer’: Health care in Delhi

Here's a guest post from a class mate, Ela Ghose.


The past two years have been filled with ailments of various kinds: in some cases I have been the patient and in others the care-giver/ attendant. As a consequence I have met a plethora of doctors: gynecologists, orthopedic surgeons, gastroenterologists, gastric surgeons, cardiologists, endocrinologists, sleep specialists , oncologists to name a few. As you’ve probably guessed, the ailments have ranged from minor (knee pain) to major (stomach cancer).

Some of the doctors have been the epitome of caring and compassion, spending time with the patient to explain the disease and the alternatives. Others have exhibited what I would consider an inclination to cover all possibilities and make money in the bargain. As with most things, doctors fall into a spectrum and it is up to each of us as patients to choose the one that works for us.

By ‘choosing a doctor that works for us’ I mean choosing a doctor that is not only competent (most are) but has the social skills and empathy that is a personality fit. For example: when my father started his chemotherapy, he was referred to an oncologist in the hospital where he had his surgery. After a few visits, he realized that he was coming away from each visit feeling more disheartened and unsure than when he went in. He realized that the cut-and-dried, almost-offhand manner of the (highly competent) oncologist left my father feeling emotionally disconnected from the doctor. Having recently read a book by Norman Cousins (The Anatomy of an Illness) that postulated that cancer recovery is hastened when the oncologist also plays the role of an emotional anchor/ guide, gave him the courage to do what I believe every patient should: he switched to an equally competent doctor who was more empathetic. When it comes to doctors, like with everything else, I don’t believe one size fits all i.e. the best doctor may not work well with all patients. Since getting well is a matter of mind and body, the doctor has to provide the appropriate treatment for both.

I feel I “hear” my body better than anyone else so have a responsibility to take care of it (I only have the one!). So if there is something bothering me, I will look for answers that doctors might not easily see. For example, I used to feel quite tired during the day, even after I had slept for 8 hours. Most doctors put it down to that ubiquitous ailment that can be blamed for everything – stress. However, I felt that it might be sleep apnea and went to get a sleep test. When I went to the ‘sleep doctor’ he looked at me and told me I was wasting my time, as I didn’t fit the physical characteristics of typical patients – male and overweight. I had to persuade him to monitor my sleep for one night at the hospital. Much to his astonishment I did indeed have (mild-moderate) sleep apnea .

So what are my expectations of a doctor?

 Be respectful:
o Listen and ask questions to get a through understanding of the patient and the problem. Oftentimes I find doctors tend to box you into a type that can bias the conclusion they arrive at.
o Have eye contact and seem friendly.
o Be especially considerate to older patients. I have a lot of 70+ folks in my family, all of who live full, rich lives and most of who still work. Yet, because they are 70+, they are (sometimes) treated as if they can’t understand/ comprehend diagnosis/ instructions. This annoys them and has led one of them to switch doctors.
o Not get annoyed with questions. If the questions are too basic or take too long to answer, he could (as one did) suggest I look up the ailments on the net. Ideally, sites should be suggested.
o Tell the truth gently. In situations where the news is hard e.g. a diagnosis of cancer, if possible, work with the family/ care-giver to see how best to break it to the patient.
 Exhibit depth of knowledge:
o Have basic stats on the disease on hand. Example: How common is the complaint? What percentage has been cured?
o Provide information on contra-indications of any sort. E.g. if a cough and cold/ bodily stress increases sugar levels, then every diabetic undergoing a monthly check, should be told this. Ideally, the regimen for managing the disease in times of ‘normalcy’ and stress should be provided to patients. Again, if this will take too long, the patient can be pointed to websites/ brochures/ libraries/ help groups/ NGOs who can fill in the blanks.
 Empower the patient:
o Suggest alternative treatment routes and then let the patient decide. e.g. at the first meeting with the gastric surgeon we were given both the alternatives – what would happen if the cancer was removed and what would happen if it wasn’t. And the surgeon also gave us his view and suggested that we go home, think about it with the family and then decide. This was very empowering as the control of the situation was returned to the patient and, I believe, greatly in the very speedy post-surgery recovery.
 Be a partner in patient care:
o Contactable in an emergency. So they must provide their cell phone number. An exemplary doctor in this regard is the new oncologist: she not only provides her cell phone number to patients but gave us her preferred method of contact (SMS) and her standard response time (24 hours) and what to do if she hadn’t responded in that time (SMS again or call -depending on the urgency).

I have come across doctors who exhibit all these characteristics. I will go back to doctors that perform well on these parameters and advocate against doctors that fall short.


This is what the new Indian patient looks like ! The Indian patient has evolved - are Indian doctors going to keep up with them ?

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