The magic of a healthy doctor-patient relationship

The relationship between doctors and their patients has received philosophical and spiritual attention since the time of Hippocrates and still remains a keystone of care. But, unfortunately over the years, this special relationship has undergone a drastic transition. The onus for this actually lies on both the parties. On one hand, increasing number of litigations and the irrational use of social media has made the doctor fraternity more cautious while on the other, many patients claim that doctors treat them as consumers and the healing touch and warmth has gone.

Bobby Fischer once said “Nothing is so healing as the human touch”. As a doctor, it’s very important to counsel & interact with patients, so that their fears regarding the disease can be alleviated.

As a cancer surgeon, I feel that a healing touch is as important as a good surgical hand. Every doctor should make a sincere effort to strike a healthy relationship with their patients.

May the force be with you!!

 

 

 

(This was a card I recently received from one of may patient’s, whom I had treated for cancer)

Thank You Doctor!

bigstock-young-child-holding-thank-you-37152475The signboard which clearly stated that it was the office of ‘Dr. Nausheen Khan’ glistened after the compounder wiped it with a damped cloth. The nailed signboard was the only thing that made that ugly wooden door worth looking at. It was the 1st of July, 2016 and the cuckoo clock was readying itself to make that annoying noise that it always made when the time was 9.00 am.

The waiting area had already accommodated 3 patients and a kid who was busy saving Mario’s princess on his Gameboy. ‘Umair’ the sticker which was on the back of his Gameboy read. The wait of the patients didn’t last long and at 5 past 9, Dr. Khan entered her cabin. After a minute or two, the compounder came out of the cabin and told the woman who was combing the kid’s hair that she could go in and see the doctor.

The woman, who must be in her early 30’s told her son, Umair, that she’ll be back in 10 minutes and to not go anywhere. He nodded, without even paying heed to what had been said to him. 8 minutes passed since his mom went inside the cabin but Umair was still not able to clear the stage on which he had spent the past 30 minutes. He got irritated and reached for his bag which sat upright on the seat beside him. He threw the Gameboy inside his bag carelessly and started searching his bag for something.

He seemed to struggle with whatever he was trying to find and finally stopped when something purple in color fell from his bag. He kept his bag on the empty seat beside him and got up to pick up the thing wrapped in purple paper. Just as he bent to pick it up, something else caught his eye. Only a few steps away from him was lying a piece of paper which seemed more like a pamphlet. It had footprints over it, raising questions about its importance.

He picked up the purple thing and then directed his countable steps towards that paper which had been abandoned by someone. He picked it up and shrugged off the footprint from it. ‘Happy Doctor’s Day’ he mumbled to himself while carefully examining the sheet of paper. It had that day’s date and ‘Have you thanked your doctor today?’ printed on it. He heard the cabin door open and turned around to see his mother coming out.

‘You still haven’t eaten the chocolate? If you didn’t want to eat it then why did you create such a ruckus at the general store that time?’ She said in a condescending tone. She grabbed his hand and started walking towards the exit. Umair, with an innocent smile on his face, freed his hands and jogged towards Dr. Khan’s cabin.

Before his mom could utter a word to stop him he had already opened the door of the cabin and was greeted by an expected question from the doctor. ‘What happened son?’ She asked. With the innocent smile still intact on his face, he moved towards her and gave her the chocolate wrapped in the purple cover.

She took the chocolate with a surprised look and let her mouth speak her mind. ‘What is this for?’ She asked in a happy tone. ‘I just wanted to thank you for keeping my mom healthy’ and after a pause ‘Happy Doctor’s Day’ he gratefully said. Dr. Khan was awestricken and wasn’t able to find words for a reply.

She wiped a tear which purposely kissed her cheek, revealing the impact that gesture had on her. All she managed to say was ‘Thank you’ in very soft tone. Umair gave her a smile which revealed all of his 25 teeth and merrily walked back to his mom. Her mom, patted her son as he came and said ‘Come, let’s buy you another chocolate.’

They left the clinic and so did the footprint on the paper. Both left a lesson behind.

5 Ways To Step Up Your Patient Interaction

Communication between a patient and a doctor is a key factor in determining the course, duration and outcome of a medical treatment. When a patient approaches a doctor for help, it immediately places the physician in a position of power. Patients are supposed to open up with their most intimate details and shed their inhibitions for the physical examination. While this position of power and complete surrender of patient helps a lot of times in diagnosing the diseases and comprehensive examination, it also leaves the patient feeling exposed with a developed mistrust for the doctor.

When the doctor patient interaction is only one sided with the patient asking the questions and the doctor answering them, it leads to miscommunications and substandard treatment with unwanted outcomes.

Take for example MDR TB. On talking to doctors in government hospitals it was found out that due to insufficient time patients were not counselled properly. This led to an increase in defaulters who wouldn’t complete their course of medication. This has ultimately led to an epidemic of sorts of MDR TB.

So how can we improve patient interaction? Read through to find out.

  1. Listening rather than asking:
    A patient comes with a lot of apprehensions and more often than not they have a lot to tell the doctor about their problems. This leads to doctor dismissing a lot of these as unnecessary talks. A streamlined approach towards a problem is undoubtedly required but a patient is not a problem to be solved. Listen to them instead of cutting them off mid way.
  2. Addressing patient query rather than dismissing them off as trivial:
    Patients come to you for help and have a lot of doubts. Let them ask their questions and be content. Disregarding their questions would make them feel inferior and you might shut them up from asking any more questions in the future.
  3. Giving ample time:
    Give time to the patient you are examining. Yes there is rush and you are busy, but the patients are exposing their vulnerabilities to you. Let them feel wanted and not just another problem on your conveyor of patients.
  4. Dress to impress not intimidate:
    Dress according to the patient population you are catering to. If working in a modest neighbourhood, dressing up demurely would help to build confidence. Also it’s time to ask ourselves if the white coat is enhancing doctor patient interaction or intimidating it.
  5. Use simplified language:
    Chuck the jargon of medical science in front of patient. Don’t use scientific terms, patients are more comfortable with laymen language. They have a red patch not erythema, swelling and not oedema. The big words make the patients feel like they are on their deathbed. Please don’t tell a patient he has pharyngitis, just say it’s common cold. And of course don’t forget the Smile Language!

This article is written by Dr Prerna Motwani. You can read more such articles here.

Shocking case – Mastectomy done for an 11 yr old girl!!

Every day brings a new surprise in the life of a doctor but there are some cases which just make you feel angry & helpless and today’s case was exactly the same. Our receptionist had fixed an appointment and when she told me that it is for a 11 year old girl, I probably thought that she is going to turn out be a case of juvenile hypertrophy (enlargement) of the breast but what I saw when I examined the patient left me in a state of shock.

This sweet looking 11 year old kid walked in with her parents and they started telling me the history that she underwent a surgery of the right breast to remove a benign lesion (fibroadenoma) 2 months back and they came to our unit because the girl had noticed another lesion on the left side. Breast surgery at 11 years is usually not recommended as it hampers with the development of the breast during puberty and I immediately knew that something will not be right when I examine the patient. Examination of the girl turned out to be quite shocking. The surgeon (who was actually a gynecologist in a rural set-up) removed not only the lump but also the entire breast tissue on the right side leaving behind just a long scar on the chest (image). It took me a couple of minutes to get in terms with what I was seeing and multiple thoughts started running through my head after that:

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1. My initial reaction was that of anger towards the doctor who had done such a surgery without properly examining the patient or documenting it. Her notes before surgery mentioned no examination findings and the only thing written was ”work-up for surgery”. She had fortunately not examined the other breast, which also had a small lump and I am sure had she examined it, she would have done the same thing on the left side as well.

2. I felt sad for the girl & her parents very well knowing that there is going to be no development of the breast of the right side and the patient will probably have to go for an implant later on in her life.

3. This case reinforced the fact that breast surgery needs to come up as a dedicated branch in India, in order to prevent such cases. Also more awareness needs to be created among people regarding this branch and the fact that it does not deal with only breast cancer. Benign breast diseases are often ignored by patients and they usually approach local doctors for their treatment.

4. This case also reinforced the point regarding proper notes & documentation in all patients. This patient can easily take the doctor who did such a surgery to court and that doctor will have nothing in her defense

5. This case was a real eye opener with regards to the lack of knowledge which general practitioners/ general surgeons / gynecologists have regarding breast disorders and this needs to be addressed by proper refresher courses for these doctors.

 

New meaning of ‘Trust’

Skydiving in UK

Skydiving in UK

Like most of us during childhood, I also wanted to fly and as I grew old I thought that Sky diving is the closest I am going to come to flying. During my visit to UK for my MRCS convocation ceremony, I decided to pursue my dream and booked a jump at Hinton Airfield (close to London).

The whole skydiving experience was amazing but it taught me a very important lesson about TRUST, which I felt was applicable during cancer treatment as well. Although comparing skydiving to cancer treatment would be like comparing apples to oranges but I would try to draw some comparisons to make my point.

Jumping from an airplane at 14,000 ft strapped to an instructor whom I had met for the first time that morning was a terrifying proposition but to fulfil my dream and I  had to trust him. I was completely dependent on him to make it a ‘once in a life time experience’ and MORE IMPORTANTLY get me to the ground ALIVE. Similarly, a patient diagnosed with cancer approaches an unknown doctor (unless the patient comes from a family of doctors) to help them battle the disease and help them live. Trust in both cases is of paramount importance. In my personal experience, I have seen patients who have trusted the team of doctors doing well and suffering from less anxiety and side effects as compared to patients who shop for doctors and delay their treatment because of that.