Thursday, October 23, 2014

Please consult with the patient !

Conversation between doctor and patient/consumer.

When we talk about a doctor-patient consultation , we usually refer to the fact that when someone falls ill, they go to a doctor, who then tells them what to do. This is usually perceived as a one-way street,  where the doctor is the one in charge. He takes a history, does an examination, orders tests and makes a diagnosis and provides treatment .

However, a key component of the consultation needs to be the fact that doctors need to consult with the patient as well. Unfortunately , this is something which is often forgotten !

Thanks to advances in medicine, patients today have lots of choices . Each patient is different,   and depending upon their personality, world-view, religion and culture, each will select a different option. There is no single right answer, and doctors are not mind readers. They need to factor  in the patient’s personal preferences, and they can only find out what these are by talking to the patient.

Doctors cannot afford to guess – and they shouldn’t try to impose their choices on the patient either ! They need to be non-directive and non-judgmental, and allow the patient to decide. They need to ask the patient which treatment they would prefer. This is not a sign of weakness on the part of the doctor – it’s actually a sign of strength !

Sometimes patients get confused when the doctor asks them for their opinion . They believe that this means the doctor is confused and doesn’t know what to do , which is why he needs their advice ! In reality, this means that the doctor is a good professional, who is being respectful . He understands that it takes two to tango , and that patients need to provide inputs so that doctor can help them to make a decision which is right for them.

The only way to have a healthy doctor-patient relationship is when both contribute ! This will help the patient gets the best possible medical care . This might seem obvious , but it's amazing how rarely this advise is followed in real life.

The problem is that doctors are often so full of themselves , and have big egos - especially the big specialists in the big towns , who are brand names . They think they have all the answers and are happy to dish these out to everyone who comes to them. After all, when you have a hammer in your hand, all you see are nails !

In fact, this is a setup where problems are much more likely to occur . Specialists have a very limited perspective – and for a cardiologist, every chest pain originates in the heart, because he doesn’t understand anything about the stomach ! As long as everything is fine, patients have been socialized to meekly agreeing with everything the doctor says. They are passively compliant , but when things go wrong ( as they are bound to do in any complex biological system), they become angry and vengeful.

Medical decisions needs to be made on a shared basis, where both doctor and patient provide their inputs ; and take responsibility  for the outcomes. Sadly, many doctor’s still believe that shared decision making means -  Here's my decision, let me share it with you . Doctors need to respect their patients and their choices !

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