The wisdom of discrimination
© Dr. Rajas Deshpande
“You are next to God, doctor. You make the decision for us”.
“Most Doctors work heartlessly only for money”.
Both these sentences are heard equally commonly.
Many patients from all socio-economical classes come prejudiced to the hospital / doctor. These patients have red flags and suspicion about everything that the doctor advises or speaks. Scary media headlines run on the screen of their minds as they enter the clinic or hospital, and their body language, facial expression and words all make the treating doctor quite uncomfortable, with the hanging sword litigation at a wrong word or deed. It becomes very difficult to make choices of investigations, advice and treatment decisions in such cases.
But there also are many who come over for the resolution of their health issue with genuine faith and respect for the doctor. They have heard the blaring news too, but have still made a decision to invest their complete faith in the treating doctor. They will do all the necessary tests, take medicines as advised, and not suspect that the doctor intends to deceive them for want of more money. They are also mature and open to the fact of a doctor being a human, and graciously forgive doctors for minor or major mistakes, convinced that the doctor is acting in good faith.
However, always juggling busy schedules and overworked, many doctors learn to maintain a “safe distance” from every patient, and justifiably treat every patient as a potential litigant. Many of us actually assume an artificially compassionate, overly cautious and rudely technical approach in a hope to find the right mental vein of the patient or to get him / her into the comfort zone of “workable enough trust”.
While this usually works in most cases, it also turns off the many genuine, trusting (usually poor and illiterate) patients who come expecting a friendly doctor who they can relate to. They want to pay, they want to comply with what all the doctor advises, but still find the doctor remote, technical and aloof. They fail to understand why the doctor did not reciprocate their warmth, smile and openness. It takes many more interactions for both sides to understand each other.
‘Discrimination’ is mostly used as a negative word in the modern world. However, it means ‘differentiating one thing from another’(e.g. His tact and temper, his dexterity and discrimination, enabled him to do good service). The law discriminates facts from allegations, true from false. We must discriminate between good and bad, between harmful and harmless. The media must discriminate between a good and bad doctor. The patient must discriminate between what is good for their health and what is not.
Medical teaching presumes that every student automatically learns human behaviour as they interact with thousands of patients while learning medicine. Most senior, experienced and intelligent doctors can tell a “RED FLAG” patient in the first few minutes of interaction and turn ‘ON’ the caution button within. However, the young and less experienced doctors are often shocked with the sudden change in the attitude of a patient they tried to do good to, thereafter losing their faith in every subsequent ‘customer’, and adopting a policy of distant, cautious, careful interactions with them.
It is high time that doctors and patients both learned wise discrimination. The patient and doctor should both meet each other openly, with the customary intent of doing good and having complete faith in each other’s intent and innocence. At the first hint of suspicion, disbelief, questioning of intent or legal language on the part of the patient, the doctor should turn on his guard and avoid informal discussions / reassurance and initiate a technical-legal approach, and involve fellow clinicians, obtain second opinions.
At the first instance of a doctor being wrong, the patient should directly and openly talk to that doctor and seek explanation, then if dissatisfied, obtain a second opinion, or approach higher authority (Medical Director of the hospital or Civil surgeon, NOT media or police). There is no compulsion on any patient to continue treatment with some doctor, and at the first hint of mistrust about any doctor, the patient can avail services of another specialist / hospital. There is no justification for gundaism, abusive language, violence, irresponsible rumour spreading or defamation.
In cases of emergencies where there is no time to change the doctor or the hospital, and less time for interaction and explanations, the treating doctor / hospital must have a separate “emergency treatment consent form” to be signed by the relative / patient, wherein the doctor is given the authority to do what he / she thinks is the best with available expertise and facilities for the patient fearlessly, without any threat. If the relatives are not willing to let go of the police case and abuse / violence / media defamation threats, the doctor / hospital should be able to decline emergency treatment for their own safety. This by no means gives any freedom from medical negligence litigation to any doctor / hospital.
Because of some bad doctors, most good doctors suffer. Because of some bad patients/ relatives, almost all good patients and relatives suffer.
We must discriminate wisely, but this discrimination should not be based upon caste, creed, sex, nationality or financial status. It should be based upon behaviour and faith, because the good patient who still has faith for our profession must not suffer.
© Dr. Rajas Deshpande