Friday, January 11, 2013

Why don't doctors do a better job with educating their patients ?

One of the key roles of a doctor is to educate his patient. This is important , because it allows patients to understand exactly what their treatment options are; and why the doctor is recommending a particular course of action, so that they have realistic expectations of what is likely to happen. This is an integral part of treatment ; and also helps in risk management .

Even though providing information to the patient is such an integral part of the consultation , the fact still remains that most doctors do quite a shoddy job at educating the patient. We need to ask ourselves – Why is this so – after all, aren’t doctors intelligent and competent ?

There are multiple reasons for this.

Firstly , I think all doctors labour under the delusion that they do a good job with educating their patients.
( Remember that all doctors feel their personal bedside manner is beyond reproach – while his patients may strongly disagree ! ) The only reason doctors think they do a good job with educating their patients is because they have never bothered to check whether their patients actually understand anything they tell them !

Secondly, it's not that doctors are trying to hide information from patients – it’s just that sometimes doctors are not very good at doing this ! This is one of the skills which is often not taught to them. Doctors are so used to talking to other doctors using medical jargon , that some of these bad habits continue even when they talk to their patients . As a result , a lot of what they tell the patient goes over the patient's
head , without the doctor ever realizing this.

Thirdly, doctors are always pressurized for time . They are worried that if they spend time on educating patients and answering their zillion questions, they'll start running late – and will never be able to see all the patients who are waiting for them. If they spend time talking to their patients, how will they be able to complete their clinical duties and go back home on time ? This is why they try to cut down on some of what they feel are the “ bells and whistles “ of a consultation , so they can become more efficient and effective. Since you cannot cut down on the amount of time it takes to actually do a clinical examination or take an ECG , the first thing which gets sacrificed is the amount of time you spend talking to the patient . Face to face time with the patient is one of the first things which gets curtailed when doctors are under pressure of time - and the sad truth is that most doctors are always pressed for time . They seem, to be on a never ending treadmill ; and they just don't have enough time to be able to spend talking to their patients,  even though they would very much like to do so.

One of their other concerns is it that if they educate their patients , they will then start asking a lot of irrelevant questions  - and this will eat into their time even more. Some doctors also believe that a little knowledge is dangerous. After all, if the doctor knows exactly what to do , and the patient is in safe hands, then what’s the point in educating the patient about the technical intricacies of selecting the right dose of insulin when treating his diabetes ? After all , it's the doctors job to provide medical care ; and if they do this well, then what is the value add in educating the patient ? What difference will it make ?

These  doctors continue to have a very paternalistic approach. They feel that since I know all there is to know and I am the expert , all the patient needs to do is to follow my advice ! After all, I have successfully treated thousands of patient without bothering to educate them, and they have done well, so why should I change my habits and adopt all these new fangled approaches of empowering the patient ? They underestimate the thirst which patients have for information; and feel medical information is too technically complex - I took eight years of medical school to master this, so how much will my patient understand in five minutes ?

Some doctors assume some patients know it all, because they have read the stuff on the internet and have come armed with printouts. They feel they do not need to educate these patients, because they’ve done it for themselves ! Similarly, there are some specialists who expect the family physician to educate the patient and will delegate this task to him.

Some doctors will do a poor job educating their patients because the find the task very boring and repetitive; while others would much rather be doing more interesting stuff, like inserting endoscopes or operating !
Finally , patients are not very assertive and they don't proactively ask the doctor for information . If patients don't express their dissatisfaction with the amount of information they are given , most doctors will continue to do what they have been doing.. They feel that they have doing a good job with educating their patients and will see no need to change. “ I've been doing this for 10 years and it works absolutely fine for me and if my patients are happy then why do I need to change anything I’m doing ? “ This is one of the reasons why the status quo continues .

One effective solution to this problem is to make sure that it's not necessarily the doctor who has to educate the patient during the consultation. Thus, a lot of this can be done online , both before and after the consultation . It could also be done by nurses or assistants. This way, not only do patients get the information which they want , the doctor’s precious time is not tied up in doing something which can be effectively delegated, thus creating a win-win situation from which both doctor and patient benefit.

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