Tuesday, June 14, 2016

Why don't Indian doctors listen to their patients ?

A very articulate patient was complaining to me that doctors in India just don't listen to patients. She had a  cyst in her ovary and had been to see 3 gynecologists. She said - Most of them don't even bother to take a history ! They refuse to answer my questions, or explain my options. It's usually - This is my advice - take it, or leave and find another doctor !

Why do patients feel that Indian doctors don't care about their perspective ? I think this is because doctors have such different worldviews about their patients.

Some doctors feel that patients are not very smart , and that they should just leave all medical decision-making about their disease to the doctor, who's the medical expert. They often get irritated by patients who do internet searches , and don't like having to answer questions put to them by patients. They hate patient who bring long lists with them, and will often put these patients in their place by either tossing their questions in the waste paper basket , or by patronizing them by saying things like, "Just leave everything to me, and don't worry about it."

At the other end of the spectrum are doctors who respect patients who ask intelligent questions , and they try to empower their patients with information.

Here are some reasons for the differences in these kinds of doctors.

Part of it is related to their training. Typically, doctors who have trained overseas are far more likely to be empathetic, and much more willing to respond to their patients' queries. Doctors who have trained only in India are often more paternalistic , because they absorb the behavior patterns of their teachers and seniors.

The patient population the doctor treats makes a big difference as well. Thus, if you work in a government hospital , or if most of your patients are poor, this colors your perception , because these poor patients are often treated as second-class citizens. Often, they're not very articulate or well organised. They may have lost their old records because they live in a slum, and often they cannot provide a cogent medical history because of poor literacy.  In government hospitals, there is a huge mass of patients waiting to be seen , which means that the doctor doesn't have the luxury of time to be able to sit down and have leisurely conversations with these patients .

I think the age of the doctor makes a difference, as well. Senior doctors are more likely to be patronizing, because this has been their default behaviour , and this is what they think their patients expect from them - to be told what to do. The younger generation of doctors is more willing to encourage questions.

The specialty of the doctor also makes a difference . Thus, pediatricians and psychiatrists are much more willing to spend time talking to their patients, as compared to surgeons, who would much rather be in the operation theater, rather than in the consulting room , listening to their patients' litany of complaints.

Finally, the doctor's behaviour depends upon his personality . Some doctors position themselves as being authorities , and will not brook any questions from anyone. Others are much more willing to learn from their patients, because they know that they are not omniscient.

I agree that this is an overgeneralization, but this framework will help patients to understand the differences between the different kind of doctors whom they see. Ultimately, patients get the doctors they deserve, so you need to find a doctor whose consultation style is in sync with yours , so that you're both comfortable with each other, and you can trust him.

Need help in finding a doctor who listens to you ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !

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