Saturday, August 13, 2011

Using Information Therapy to fill the Communication Gap

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Mrs Bhatia’s physician informed her that she had arthritis. While prescribing her the usual course of medicines, her doctor did not provide her with a list of the possible side effects. Mrs Bhatia, on the other hand, also did not tell him that she had a very sensitive stomach. Inevitably, the medicines took a toll on her system, leading to undesirable side effects. Frustrated with her doctor for not warning her, Mrs Bhatia began to criticise him, posting comments on forums about his supposed ‘incompetence’. This greatly unsettled her doctor, a genuine, caring person with a good reputation in the industry.

Every doctor wishes to see his patients get better. The strong, unwavering urge to help and heal others is the primary driving force for choosing medicine as a profession. It is the ultimate service profession, and since it entails a one-on-one relationship, good doctors devote a lot of their time and energy in keeping their patients happy. Apart from making doctors feel good about themselves, patient satisfaction also makes immense business sense. Contented patients are the best source of new patients! Word of mouth marketing goes a long way in expanding a doctor’s practice. This is why happy patients make for happy doctors!

Unfortunately, not all patients respond well to treatment. Medicines do not always work, and the human body is unpredictable. I am an IVF specialist, and no matter how good a doctor I am, once I have made the embryos in the IVF lab and transferred them into the uterus, I have no further control of the proceedings. Sadly, most embryos do not become babies, which means IVF cycles are more likely to fail than succeed. This is a fact of life, and we do our best to educate and prepare our patients for this possibility. Hence, we are transparent and show patients photos of their embryos (even when things are not going well), and we prescribe large doses of Information Therapy, so that patients have realistic expectations of what we can do for them.

Our patients appreciate our efforts, but when an IVF cycle fails, patients are understandably upset. If an IVF cycle fails to yield results, the right thing for a smart patient to do is to analyse the cycle in tandem with the doctor. What went wrong? What went right? What can we do differently the next time? Sadly, not all patients adopt such a mature approach. They are angry and need to vent their frustrations, and a doctor is an easy target! Some get abusive (both in real life and online), and others may even get violent. Rather than sit dispassionately with their doctors, they often end up bad-mouthing them and damaging their hard-earned reputations. Thanks to the internet, it has become easy (way too easy, I feel) for patients to post anonymous complaints online about their doctor. While it is important to allow an effective redressal mechanism for patients, I do not think anonymous complaints are the right way to do this. If the patient has a complaint, he should also have the courage to stand up and identify himself, so the doctor can explain what happened.

I have been at the receiving end of anonymous online complaints, and I feel betrayed. We pride ourselves on our patient-centric skills. Even though we devote so much time towards the well-being of our patients, counseling and educating them, it is highly upsetting when they badmouth us, without giving us a chance to provide an explanation. The most sensible thing for a doctor to do is ignore such patients, but it is hard for me to do this, because I care about my patients, and I am unhappy when they are unhappy. It is hard for me to detach myself and not take it personally. This kind of unfair criticism really hurts since there is a lot of sincerity in my approach towards patient care and satisfaction.

What’s worse, this sets up a negative vicious cycle. Doctors who have been abused by angry patients often start becoming angry and resentful. They start practising defensive medicine and distancing themselves from patients to protect themselves. Also, doctors talk amongst one another, gathering from other doctors’ experiences that patients can be vengeful (for no fault of the doctor’s), and that doctors need to protect themselves from their patients!

It is so tragic that affairs have come to such a sorry state. A lot has been written about how the doctor-patient relationship has deteriorated in recent times. While many people are happy to blame doctors for this, unfortunately, no one has highlighted the role that patients play in damaging this relationship. Any relationship is a two-way street, and a doctor who has been sued or abused is no longer going to be the same person he was before the ugly episode.

It is a vicious cycle – unhappy patients create unhappy doctors, which in turn again creates unhappy patients, since such doctors do not take good care of their patients and often end up disrespecting them and providing poor quality care. The tragedy is that insensitive doctors, the ones who are mercenaries and uncaring, really don’t care what their patients think about them. Criticism from an unhappy patient falls to deaf ears, and they happily ignore it. Good, empathetic doctors, however, are hurt when patients are unhappy with them, since they have worked hard in order to assist the patient on the road to recovery. They feel cheated and let down that the patient has abused them rather than tried to talk to them and resolve the problem. Their attitudes towards other patients harden, and the doctor-patient relationship starts deteriorating and becoming adversarial!

As a professional with years of experience in this field, my advice to patients is this – if you are unhappy with your doctor, please do let him know so he can try to fix the problem. You owe this to your doctor, to yourself, and to his future patients! Of course, if he does not do anything to solve your problem, then it is fair to look for ways of getting back, but please refrain from blaming doctors for factors outside their control!

Many studies have shown that patients do not sue a doctor simply because of an undesirable outcome. Most patients do understand that doctors are not Gods, and that medicine is not an exact science. However, if the doctor does not bother to communicate effectively with the patient after such an outcome, this is the equivalent of adding insult to injury. Patients then get angry and find outlets to express their anger. The best way to prevent this problem is to ensure that patients have realistic expectations. However, doctors are often too busy to be able to sit down and talk patients through all possible outcomes, and most doctors do not want to scare off their patients by talking about risks and complications!

This is why providing Information Therapy through websites and videos is such a great way of obtaining informed consent. It allows patients to understand what the likely outcomes are, at their own pace, in an unhurried, relaxed manner, so they have the time to think it through and make decisions accordingly. It saves the doctor time too, since he does not have to do the entire process himself with each patient. It ensures that all possible outcomes have been properly discussed (after all, sometimes doctors may forget some points too, when in a hurry!). Finally, from a risk management perspective, clever websites that take informed consent online allow documentation of the fact that all risks and complications were properly explained to the patient, thus protecting the doctor in case of a lawsuit. Effective communication helps build relationships, and goes a long way in building a healthy doctor-patient bond that is mutually beneficial.

- Dr.Aniruddha Malpani,M.D.
Founder, Health Education Library for People

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