The Customer and The Patient.

The Customer and The Patient.
© Dr. Rajas Deshpande
“I have seen the patient. In my opinion she has multiple lesions (injuries) in her brain because her nerve fibre coating is destroyed. You will need some tests, and an MRI of brain.” I told the family.
Affluent, educated and polite. Patient, her parents, brother and an uncle.
Then there followed a 30 minute viva. All of them asked me questions about her medical condition. They had extensively googled, and had over fifty questions about the causes, types, her symptoms, diet, lifestyle, job, exercise, physiotherapy, marital life, treatment options all over the world and what not. I am proud of my patience, but when the questions started repeating, I politely reminded them not to.
This disease being my specialty, I was only too glad to be able to answer every question. As I wrote down the investigations, they looked at each other as if they had planned a surprise for me. The brother went out and brought in a huge bag. © Dr. Rajas Deshpande
There were consultation notes of at least 5 other neurologists, two from my own town. Repeated tests were done. Four of the five had diagnosed her correctly, and had also written the standard tests and management.
“We were very upset at the earlier neurologist. He did not have time for consults at all. And she was not happy with his attitude. So we wanted to know if he was right. That’s why we didn’t mention it earlier.” said the mother.
I kept my poker face on. As all tests were already done, I reviewed the results and wrote them the treatment plan. There was further screwing about the side effects of the medicines (I want your personal number in case I have side effects) etc. © Dr. Rajas Deshpande
The father spoke. “Yes Doc. I am working as a senior govt. officer, and we have free tests and medical consultation. If you want to repeat any tests, we can get them done at any hospital at low rates”.
They got up. I noticed that the uncle was fiddling with the smartphone. Alarmed, I asked him, “What is that? Were you recording?”
“Yes doctor, we don’t remember the conversation so we keep recording every time we meet anyone” he said without any change of expression.
I lost my patience but did not react. I was not scared of the recording, but they had to know it is wrong to record an informal conversation without the doctor being aware. But there was no time. Outside, they fought with the receptionist about my fees, and demanded that they be included as govt employee category (which has to pay @ 52 Rupees as a specialist consultation fees).
I declined. The first consultation and a second opinion can be free for such govt patients, not the whole medical hopping and shopping.
The next patient came in. a lively and smiling software professional with her father. He had obvious signs of Parkinson’s disease and was having too many side effects of medicines. As I changed his prescription and informed him of possible complications, he smiled and said “I am in your hands, Doctor. I know you are not God, but you are like a God to me. I accept all the risk. I know my illness is not your fault. Do what you think is best for me. We are not very rich, but we will try and do whatever you say”. © Dr. Rajas Deshpande
The first case went down in my mental diary as a “Customer”. The second one as a “Patient”.
There is a lot of difference that the doctor has to opt for when dealing with these two categories. In case of an arrogant, suspicious, accusative patient / relative, the doctor automatically turns his medical safety switch on. These patients will require more documentation, longer consults (hence more fees), more tests (courts always ask for proofs), safest, low profile medications that may take longer to act, and lowest reassurance. That because a simple “he should get better” is being recorded and “you said so“ will be questioned in future. So the doctor, even when asked in front of the patient, has to frankly tell all the bad possibilities about the patient’s illness. That further depresses many patients, especially the elderly and anxious. Most of these “offenders” are usually continuously dissatisfied, whatever you do for them.
One cannot put a gun to a doctor’s head and then expect him / her to be loving, compassionate and perfect. As many doctors will have realised, medical optimism is dangerous. © Dr. Rajas Deshpande
The doctor wants the outcome for each patient to be the best too: which doctor would like to be a failure?
One can easily deduce that the patients will also make such categorisation as “Doctor versus Businessman”. That is true too. But the difference is that the “Businessman” doctor is still an educated, qualified person who is trying to do good to the patient in most cases.
A judge can knock his hammer and shout “Silence” and punish the misbehaving. A policeman will lock you up if you misbehave or offend him. A minister or a government officer will have you thrown out by his security. A performer or a musician will not tolerate disturbance. There is no other profession where you tolerate insults and demeaning behaviour. © Dr. Rajas Deshpande. The nobility of a doctor (or a nurse) is that he / she will still try to do good to their offender.
Once the complete and genuine trust is felt, most doctors go out of the way to help the patient. Many will never realise, but almost every doctor has over hundreds of non paying patients: relatives, other doctors, teachers, poor patients, maids etc., hospital staff and many more. Add the forced free patients: politicos, govt. employees, and the pseudopoor.
Every “Doctor” wants to treat “Patients”, and this sacred relation still exists, although waning. I feel it is more of the doctor’s responsibility to improve this relationship. For their own good, as much as for their patient’s good.
As for the “Customers and Businessmen” mentioned above, I think they complement each other, and the true “Doctors” and “Patients” should avoid both of them.
© Dr. Rajas Deshpande

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