“Why can’t the doctor be more compassionate, spend more time with patients?”

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“Why can’t the doctor be more compassionate, spend more time with patients?”

© Dr. Rajas Deshpande

Ms. Bonnie Wilson asks:
“When are doctors (not all) going to grow some compassion or least show some and listen to what we actually have to say and maybe spend just a few more minutes to get to know the patient a little bit???? Then maybe more patients would appreciate their doctor more. I’ve been fighting a disease for 16 years now and a lot of doctors don’t even spend five minutes with you. Only speaking from many years of experience as a patient”.

Dear Ms Wilson, thanks for asking this question, it helps me introspect.

Simple answer:
Give the doc a patient who pays as per time and skill required for the consult, and they will spend an entire day with that patient. Give the doc a patient who writes down “Doctor, I have complete faith and trust in you, do your best to treat me, I promise not to sue you or blame you if in the course of my treatment something goes wrong. I respect your intention, and know that you are a human being capable of mistakes, I will be compassionate to you too.”, and they will cross all barriers to help / satisfy that patient every which way medically feasible.
Also add “I will endlessly wait in the doctor’s waiting room till the earlier patient smiles and leaves”.

Not possible? There you are!
In the 15 years of medical training, we hear innumerable sermons about being compassionate and “Listening to and Understanding” the patient. We have always learnt and taught in medicine to “Listen” carefully, so most doctors attempt this in practice, not all keep it up. Some learn the knack to “extract” the correct info to work faster.

Now imagine the Doctor’s side.

How long is “Little longer”?
75% patients really don’t have the sense of time when they talk about their illness. Instead of being to the point and realizing that this is a “professional consultation”, they go on to recite unnecessary over description / umpteen repetitions of the same complaints, even after the doctor jots them down, with confused details of their own symptoms, changing them often. Some tell their own interpretations about each of the symptoms, and complete detailed conversations that they had with their family / other doctors about those symptoms. Many ask the doctor to repeat long explanations, then some relatives ask it again. Many revise prescription medicines at least three-four times, in spite of writing down correct instructions. Many keep blaming the doctors and crying in our cabin for “incurable” disease diagnoses, thinking that the doctor is hiding good treatment for want of more money! We sympathize and explain, but cannot go on all day, especially if other patients are waiting anxiously for their turn.

Many patients fumble, forget, come disorganized (this is super-exaggerated in India, where there is no unified health record system, and patients carry messed up bundles of test reports / case sheets from many different specialists). Most (even literates) come without even the list of currently ongoing medicines, then call their family from doc’s cabin to enquire about these, and then the huge discussion about spellings, content etc. consumes double the scheduled time of consult, while other patients wait and complain. There is total lack of awareness of one’s own health responsibilities, even those who spend hours chatting in the waiting room don’t organise their thoughts or make notes for the consult, wasting time with the doc in “recalling” things!

In the western world too, there are many patients who go on describing the “unnecessary detail”, some talk too much, some talk slow, take a long time to recall and answer, and mostly come “unprepared” for the consult, without noting down questions they want to ask, and symptoms / medicines they want to discuss. Then the innocent “recalling” in the doctor’s cabin is quite irritating for the overworked doctors.

The third and the most difficult category of patients: the “over-prepared” patients / relatives, who have hyper-googled every symptom, every medicine and then come with a huge (and mostly irrelevant) list of questions about their minor symptoms. Stupidest of the claims on the internet are then discussed unnecessarily, and the frightened patient / relative really test the patience of the doctor. They are seldom satisfied with anything or anyone.

At what price?
Enter medical insurance. Enter the “Charitable Labelling” of healthcare in India, where iPhone will cost the same as in USA and UK, but the superspecialist doctor trained in USA/UK/Canada/ Australia etc. (with his own life, merit and money) must charge as per the basic general practitioner and local socio-political expectations. So the doctor has no freedom to charge the consult as per time required.

Result: more time translates into less income, worldwide.

Reaction of the society: So what if you earn less? You are a doctor. You are a spiritual saint who just earns in goodwill and respect, converts that by magic into money and then we charge you everything including taxes in cash! We all can dream luxury and good life, you can’t!

My question: What’s in it for the doctor in spending more (extra) time with the patient?

It is a pleasure for the good doctor to spend more time, explain in detail and compassionately listen to each patient, but then he/ she returns home to piles of unpaid bills and an unhappy family. Most Indian specialists don’t even afford their own home by the age of 40! Most western doctors are frustrated by the dictat of insurance companies that for a decent earning, they must see higher number of patients. No insurance company pays a good doctor better.

As for Compassion issue:
I have some really innocent questions to ask patients / society:

1. When any doctor was prosecuted for medical negligence in some case, how many times has any patient openly said “This doctor was very good to me”? Many doctors prosecuted must have saved hundreds of lives. Who stood by them when their careers were ruined by single mistakes? How many patients whose life they saved offered to help with the compensations the punished docs had to pay?

2. How many times did society / luminaries / media show compassion to the needs / plights of medical profession? Underpayment and Overwork, Victimisation and Insecurity are universal in this profession. Who showed any compassion ?

3. Can you be compassionate to someone who is being a “Customer” with the right and threat to sue you for an amount that will ruin your life, reputation, career and family? Can you be compassionate to someone who suspects every motive of yours, cross checks everything you say, argues with you, threatens you, does not have faith in you and will forget you the day their health problem is over, only to return when they need you again?

4. Can you be compassionate to someone who records your words of reassurance and uses them against you as a legal proof of “misguiding”? Can you talk nicely to someone who treats you arrogantly, mannerlessly and looks down upon you as a “Money maker” rather than a respectably educated hardworking Doctor?

Indian Docs carry the whole burden of the country’s mismanaged healthcare system upon their shoulders. Millions of poor, unaffording patients are RIGHT NOW being treated by thousands of doctors FREE. Most patients get better than not.
But
When the uneducated filmstars rubbish the whole profession to prove themselves tall, some movie claims that doctors treat dead bodies to earn more money, no one speaks a word against it. Why?
When senior doctors who spent lifetime serving the poor are wrongly suspended by politicians without any enquiry, not a peep from the society.
Why?
When doctors are killed, attacked upon, and abused, media justifies / glorifies such events.
Why?
Some of the senior doctors cannot stop talking ideal, even at the cost of their children’s lives. “Spend more time with the patient, be more compassionate” they say. I agree.
But we never hear from them when a doctor is killed. They are never seen defending those doctors who faced 12 crores worth compensation punishments, when laws like PCPNDT send young and old doctors directly to jail for documentation errors. It is very fashionable and hip to be a hypocrite and speak what people like. To understand any issue, there is a simple formality: think of both sides. Who thinks about the Doctor’s side of the story?

There is a worldwide notion: that doctors are guilty of earning more money by wrong means like hurrying. For those who think this, I have one question: Which Doctor in the world has more money than the price of YOUR life? If they save you, they are blamed for high charges. If they don’t save you, they are sued for unbelievably stupid compensations. This is the paradox: that lost lives have become costlier, saved lives don’t matter anymore.

There of course are a few greedy doctors, who need to improve. These are few and a shame.

The real tragedy of our faithless lives is this: Nobody ever thinks that a doctor may really be working faster and harder to help more patients rather than to earn more money!! He/ She may be struggling with his / her loans, sacrificing his/her own health and family time, fighting frustration, but still listening day-in and day-out to crying, complaining people merely out of the wish to relieve their agonies.

What price is the time you are away from your family? What price is years of sleepless nights? What price is the mental trauma of seeing dead bodies every day? What compassion did any doctor get for these, from media, judiciary, society, anyone?

© Dr. Rajas Deshpande

PS: Less time does not mean wrong diagnosis or approach. Mostly it means “Cut off talk to bare minimum interaction necessary for this consult”.

@ Bonnie Wilson, thanks for the opportunity you created for me to answer this concern. While this is not a personal reply, I agree with you that more time and compassion will go a long good way, but then both sides need to introspect and change.
RD

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