Patient centric doctors: an endangered species?!

In the previous posts we looked at some of the issues in the healthcare industry. Anyone in their right mind would like to be treated by a patient centric doctor. However, with the changing scenario, it is becoming increasingly difficult for the patient centric doctors to survive in the system.

Patient centric doctor has the following characteristics. 1. Honest with the patient about the disease, discusses the treatment options and the possible complications & outcome. Tries to educate the patient and guides through the treatment process. 2. Does not prescribe unnecessary tests and medicines. Does not do unnecessary procedures/operations. 3. Where payment is involved, tries to minimize the costs without compromising care. 4. Keeps up to date with the latest knowledge and emerging treatment options. Tries to review his/her results, do audit/research where necessary and changes the practice as per local circumstances. 5. Tries to keep the professional charges less. 6. Keeps cordial relationship with colleagues & hospital administration, seeks help when necessary and tries to help the patient wherever possible to overcome the difficult period in their lives.

All this sounds fantastic, isn’t it?! You may be thinking why all doctors are not like this. First, a good number of patients & their attenders are so naïve and conditioned by fear/dogma/misinformation, they expect unrealistic things from the doctors. When the doctor is trying to tell them something, rather than listening to the doctor and following the advice, they come up with several things that are a mere waste of time.

Just a few examples: where a test/procedure/operation is not required, they want it to be done, “just to be on the safe side”! When an antibiotic is not needed, they want it. After an operation, people want tablets to hasten the healing. Healing is a natural process and takes its own sweet time. At the most, one can take vitamin and protein supplements.  Other than controlling any co-existing diseases, there are no magic pills that hasten the healing.

When the doctor is honest and says, “I do not know”, they are bewildered. Doctors are supposed to know everything! As mentioned earlier, doctors can only give an educated guess about the possible outcome but can give no guarantee. Before a procedure or an operation, if the doctor tries to tell them about the possible complications, most people do not want to listen. All they want is false reassurance that “Everything is going to be fine”. There should be no risk involved and successful outcome is to be assured.

On one hand they expect the doctor to know everything and on the other, they cling to their own dogmas. Quite a common dogma after an operation is the notion that one should not move, lest the sutures will not heal. This is a dogma that has its origins several decades back, when the suture material was not as good as it is now. There are several factors that can adversely affect the wound healing. When the sutures do not heal for whatever reason, while confronted, it is much easier for the doctor to say that the sutures have not healed because you moved or coughed or sneezed, rather than elucidate the reasons for failure in wound healing.

When instructed to get out of the bed, people come up with all such dogmas. These days early ambulation is the key to prevent several complications. Most common these days is the information gathered from internet and media. It takes a good 10 years of training for a person to practice independently. When you meet a doctor with more than 10 years of training and experience, should you listen to the doctor or educate the doctor by telling your dogmas.

It is quite alright to mention once to alleviate your doubts. But arguing with the doctor simply saps him/her of the energy. Rather than keep educating a person who is mired in fear and dogmas, it is much easier for the doctor to yield and give whatever the patient wants! Or keep the communication to the minimum and be authoritative. This is construed as being secretive and not divulging information. All these lead to further dogmas, fears, and misinformation amongst patient/relatives/general public.

When the doctor is judicious with tests/medicines/operations, it is not conducive to the business of the healthcare industry. When the market forces and patients are driving for tests/medicines/operations, for different reasons, it is exceedingly difficult for the doctor in the middle to be patient centric.

Not all people are like this. Some still have common sense, have some understanding of the body mechanisms, and observe their bodies. Some may try different things and come up with their own observations. As long as the fear & anxiety is removed from the equation, these people actually help their doctors in giving better treatment. If the doctor is receptive, it may better their practice too.

In addition to the above issues, these days, doctors are worried about their own safety and survival. There is something called “masterly inactivity”, where one needs to just wait. In order not to get into trouble or wasting time in explaining, most doctors are not using this option and are going with the flow, doing extra tests etc. Unless people realize the issues and take remedial action, patient centric doctors are an endangered species.