Counselling the patients and relatives

It is not an easy thing to counsel the patients and their relatives who are having morbid fear and anxiety, due to the illness, treatment, cost or the potential outcomes. For very minor issues like lipoma under the skin (excessive collection of fat cells under the skin) which is a common and not a serious condition, some people get extremely worked up. It is a condition that will not be cured with any medicines, indigenous treatment or prayers.

Only treatment is removal by doing a minor surgery, which is usually done by giving local anaesthesia to numb the area and patient sent home soon after. The moment the word “surgery” is mentioned, some people start having a panic attack. The alternative is just leaving it alone, as most of them do not cause any significant problem. Patient is afraid of keeping the lipoma as someone might have told them that “lump” may turn into cancer.

It is true that a small number of lipomas can turn malignant over time. There is no way one can predict what will happen over time. One must take a decision whether to keep it, observe and have it removed only if having any warning symptoms. Otherwise, have it removed straight away. It makes the life of the doctor difficult; if he/she says, leave it, they worry about cancer; if he/she says remove it, they worry about the “operation”!!

Doctors are having to invent new names like “procedure” to avoid triggering the panic attacks. Another word that triggers anxiety is “biopsy”. When the doctor says we are sending the tissue for testing, people equate with cancer. It may well be cancer. Most of the time, any tissue removed from the body is sent for testing these days to avoid any surprises in future. People keep asking in their anxiety or ignorance, what do you think the report is going to be?! If the doctor knows what the report is going to be, what is the need to do the test in the first place!!

Removal of lipoma under the skin is smallest of the operations. For something like that, some people make a big hue and cry. When someone is undergoing a major operation or having treatment in an ICU with serious illness, the counselling becomes even more difficult.

One of the problems contributing these days, is the variety of treatment options available in terms of types of procedure and type of anaesthesia. Another compounding factor is the choice of doctors and hospitals. Doctors tend to have their own opinions and preferences for various reasons. The difference in opinion and choices available are increasing the confusion of patients.

These days doctors are not supposed to be patronizing. Doctors should inform the patients about various treatment options available, the pros & cons of different options, give their recommendation and help the patient choose the treatment they feel is correct for them. It is called “informed choice”, which is the buzz word in treatment philosophy these days.

It is a joy to discuss the treatment options available with a patient who is level-headed, understands what is being told, discusses logically, makes an informed choice and participates in the treatment process. Such a thing happens only rarely in our society, where the predominant emotion usually is morbid fear and anxiety.

Sometimes even after adequate counselling, patients or relatives deny having been told about adverse outcomes. Most of the times it is due to the doctors not counselling in a way the patient or relative can understand or they not understanding what the doctors said or denial, where the mind preferentially ignores bad. Rarely it is the patient or relatives trying to outsmart the system and trying to get some compensation.

Patient is the center of the healthcare industry. Everyone who is in healthcare industry and allied industries should keep that in mind and have a “patient centric” attitude. Most important emotion doctors and preferably all healthcare professionals should have, is empathy. However, in modern healthcare the patient centric attitude is getting increasingly challenged.

We as individuals or groups have a variety of characteristics, emotions, priorities. When one feels secure and strong, he/she will be willing to and be able to help others in a better way. The way things have taken shape in our society, doctors are not feeling secure, with regard to personal safety, litigation, loss of job etc.

Whether it is the hospitals or the allied industries, everyone is pursuing exponential growth in their balance sheets and expanding their businesses to increase the market capitalization and share value. They are afraid of their own survival. At all levels there is insecurity and fear in the society. This needs to be addressed. Growth should be based on the healthcare needs of the society, not the other way round. Hospitals and doctors should feel secure without the fear of balance sheets and profit margins.

Good number of patients do not help themselves. Out of ignorance and fear, they sometimes get many consultations, investigations and treatments which are totally unnecessary. Some are too smart for their own good. Population should be educated properly, (not haphazard, half-baked knowledge through media and internet), so that they have correct perspective about disease and realistic health goals.