Some responses to the article, “Do doctors listen to Patients or computers” (Open Page, The Hindu, January 15, 2012), suggest a perception that the author was decrying the use of technology and quality control tools. Nothing can be farther from the truth. What is required today are not incremental changes, but is a radical transformation of healthcare, and to achieve this, state-of-the-art, cutting-edge technology needs to be deployed.
The question is when, where, why, how and at what cost. This needs an in-depth technical knowledge and the ability to quantitatively measure the expected alterations in health outcome, deploying technology vis-à-vis the natural history without intervention: for example, a 2cm meningioma incidentally seen on a CT scan done for a head injury may not produce problems for many years.
Observation is certainly justified. However, most patients want a definitive treatment immediately and look askance when doctors decide against intervention. Sniggers ensue when a CT is not advised for an inconsequential head trauma. Reeling off voluminous statistically validated “double blind, randomised, controlled studies” that a CT will not alter the outcome is of no use. A specialist opining that nothing need be done is unacceptable.
How many patients are satisfied when antibiotics are not prescribed for fever, cough? When a patient is told, after a thorough clinical history and physical examination, that anticonvulsants are not always indicated for one single seizure, he goes in utter disgust to a street-smart doctor, who gets an MRI done, reassuring the patient that it is normal!
Mahatma Gandhi once remarked that a customer is the most important visitor on our premises. He is not dependent on us. We are dependent on him. In the real world, whose bread you eat, his song you sing. The science of healthcare is different from the art of healthcare. Efficient healthcare requires informed doctors and informed patients. Is a patient also the problem? By promoting health literacy better care could be ensured at reduced costs. Patients today are often uninformed, anxious and non-compliant with healthy lifestyles. The word “trust” is slowly disappearing from the vocabulary of both patients and doctors. This sometimes translates into unnecessary investigations.
Ten million post-hysterectomy American women had pap smears as part of screening for cervical cancer! The uninformed patient is a universal phenomenon. A study of 10,228 people from nine European countries revealed that 89% of men and 92% of women overestimated the benefit of PSA (Prostate Specific Antigen levels for detecting prostate cancer) and mammography screening hundredfold. Why don't people know or want to know, particularly when Dr Google is available? Infant mortality reduces with the mother's educational status.
Patients also need to take responsibility for their health. DIY (Do it Yourself) has become commonplace. Do we not do net banking and print our own train and air tickets? Why can't we be more proactive in looking after our own health? Why not wear helmets, instead of complaining that ICU management for head trauma is expensive? Health care is more than diagnosis and treatment. Why are only doctors faulted always? Why not the entire health care-eco system?
Medicine is not mathematics. It is neither black nor white but shades of grey. Notwithstanding the hullabaloo about evidence-based medicine, the uncertainties offer scope for different treatment options. It is impossible to do away with a “conflict of internal interests” when there is a fee for service. Unconsciously, one will use arguments that would influence a patient to choose a proposal of benefit to the doctor. Studies have shown that worldwide, indications for surgery differ in the salaried group of surgeons! Practice variation in tonsillectomies, hysterectomies and prostatectomies is fifteenfold in the U.K. and the U.S. The Dartmouth Atlas of Health Care 2010 concluded that “Geography is Destiny.” Sir Muir Gray, Chief Knowledge Officer, NHS U.K., in a book, Better Doctors, Better Patients, Better Decisions, calls the 21st century the century of the patient, stressing that providing authenticated valid health information will create a well-informed knowledgeable empowered public.
Patients are also in a stage of transition — with easy access to information often associated with embellish ments and hyperboles, keeping up with the Joneses could be a status symbol. Unless the Right to Health becomes a fundamental right, there will always be bickering between the haves and the have-nots. Machiavelli said in 1513: “Never waste the opportunities offered by a good crisis.” Challenging the status quo is mandatory. The 21st century problems cannot be solved with 20th century solutions. To achieve this paradigm shift, patients need to be as much part of the decision-making process, sharing accountability and responsibility.
(The writer is a Chennai- based neurosurgeon and telemedicine specialist, and is a past president of the Neurological Society of India and the Telemedicine Society of India. His email ID is: drganapathy @apollohospitals.com)
Keywords: patients, doctors, health care sector, medical education
Mathemetics is not medicine. Medicine is a dynamic process and you can not expect the result of 1+2=3. Very often teachers of medicine and planners in public health field put maths affront than human individual varient factors. Doctors are to be bold enough to survive in the computerised era of yes or now; black and white to grey area of thoughtful decision making.
How true and thoughtful. More such eye openers should be published for public consumption. There is a need for a renewed approach towards doctor-patient relationship with a key emotion called TRUST being the corner stone.
Very true, Trust is gone within the family members in the present world , then how can one trust the person who is treating him ,he does not want to know about his health truly speaking , he comes because the company pays or gives the medical allowance,why not utilise it? So one day , the "chicken have to come home to roost" !!!that's what happens in the medical tratment,the medical education need to be revisted and make the necessary changes,also in the recruitment process makes sure that you are identifying the right choice of a medical or paramedical personnal ,more than all these things the individual should have the commitment , and responsible attitudes towards the patients,ofcourse not every time the doctors are the paramedics should be blamed ,but govt and private sectors [hospitals]need to concentrate on creating an awareness in the field of medical.do not buy the education!!!hope most of you got what i am trying to mean.
That is very true. Another example of the patients' paradigms regarding medicine is that no patient feels satisfied about consultation with a doctor unless he has been examined and 'listened to' with a stethoscope if though it may be absolutely unnecessary! The media is also partly to blame. They often use doctors as instruments of rather facetious comedy and the patient comes out as the smarter, better man who was narrowly escaped being mistreated. There are quacks admittedly, but the patients' trust in doctors as a whole suffers due to wrong, buffoonish depictions. On the other hand, more effort must be taken to improve health awareness, the quality of health education in society and the the attitude towards truly dedicated persons in the medical field.
This refers to the highly readable articles by Prof. K. Ganapathy on the paradigm shift in the medical scenario (Open Page, The Hindu, Jan. 15 & 29). While ignorance of the patients, as is made out by the author, is a cause for inappropriate heath care, the growing section of information overloaded people is too responsible for over-investigations and over-treatment. The tech-savvy patient, loaded with 'Dr. Google' information suggests to the doctor a 'relevant' workout for other possible diagnoses to the great pleasure of both, as the bill would be reimbursed by the employer ! So, a laundry list of investigations and treatment options would be handed over as "whose bread you eat, his song you sing" ! This "singing of the song" is proved to be in vogue in research and academics also, the tune being called by industrial bosses of pharmaceutical and medical concerns. The bottom line in the present medical scenario is "money rules the roost."
well said, doctor! The 21st century may be one of patients. It then automatically becomes that of the doctors also...Knowledge is a tool. Becoming aware, being able to question and be responsive & responsible simultaneously are the requisite basic elements of life.
But we are in a neo-liberal era that makes things even more complex and complicated. The ethics or the work culture of every other practitioner (medical world included)is dictated by the profit-driven system that proves a challenge to individuals to hold on to human values. On the other hand, patients are victims of fears rather than sane perspective, again conditioned by this system. That explains multiple opinions sought in a row until the desired, but unnecessary surgery is performed.Salutes to you doctor as a part of genuine practitioners who continue to read, write and react on value based medical services.
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