“The patient’s VPCs have changed to APCs. He will be all right, but we need to watch him for a day,” was the cardiologist’s response to the worried questions put forth by the family of Mani, who had been hospitalised with chest pain. Mani and his family didn’t understand the significance of these alphabets. Obviously, it is not possible for our physicians to deliver a short lecture on every patient’s condition, but surely, a little more warmth and conversation in understandable terms would have come as a relief to the patient and his anxious family.
These days, cryptic consultations seem to be the order of the day. There was a time when a visit to the doctor was therapeutic in itself, because of the genial manner, the personal attention, and the concern that doctors once showed towards their patients. It is crucial that doctors communicate with their patients in a way that puts them at ease, because, unless a patient feels comfortable and relaxed, it is not possible for him to reveal all the symptoms and facts pertaining to his health problem.
Empathy helps
In fact, the American Medical Association mentions that empathy on the part of doctors not only promotes diagnostic accuracy but also results in therapeutic adherence and patient satisfaction. So, alongside their medical education, should physicians be trained to communicate compassionately with their patients?
Physicians should never underestimate the ‘placebo effect’, by which patients perceive an improvement or experience an improvement in their health through a medically inert treatment, out of sheer belief and trust in it. The placebo effect evokes a psychological response, good processes in the brain, as well as a physical response. The Scientific American mentions that placebos have helped alleviate pain, depression, Parkinson’s disease, inflammatory disorders and even cancer.
Remarks Dr. Lakshmi Vijayakumar, consultant psychiatrist, founder of SNEHA, who also works with the WHO on various aspects of mental health: “The placebo effect alone can improve a patient’s health by approximately 20 per cent. It comes from establishing a rapport with the patient and getting him to feel that the physician is truly concerned. It also comes from the confidence in the doctor’s ability. Physicians need to be humane professionals, ready with words of kindness, confidence, hope and trust.”
At the same time, physicians should refrain from mentioning things regarding which they themselves aren’t clear. “It is perfectly fine for a doctor to reveal that he is not informed about a particular aspect and that he would check up on it,” says Dr. Ramkumar, a senior general physician. Many physicians also fail to mention the possible side-effects of medication, which increases the chances of the patient not taking it and suffering a relapse.
Time constraint
There is, of course, pressure of time. “It is a challenge for many physicians to establish rapport, discuss the problem, convey the diagnosis, and give instructions on how it should be tackled, all in a matter of a few minutes. But this is crucial and very much possible,” says Dr. Lakshmi. “This is a skill that is intrinsic to some, but others have to work on it. However, it can be acquired with practice,” says Dr. R. Parthasarathy, a general physician. Now, there is a proposal from the Medical Council of India for including a module on listening and communication as part of the curriculum in medical education. A few colleges have made a start on this.
Dos and Don'ts
— Establish a rapport with patients, which makes them comfortable and relaxed, thereby helping them to clearly describe their ailment.
— Show empathy to patients which will spare them of embarrassment while revealing personal details.
— To the extent that it is beneficial, explain the medical issue to the patient.
— Have the patience to let patients present their case, this would encourage them to come up with details that might usually not surface.
— Check out if the patient is taking any alternative medical treatment.
— Take notes and confirm your understanding of the patient’s condition by summarising the details and asking for his approval of it.
— Stay clear of pre-conceived assessments and don’t jump to conclusions.
— Give clear instructions on how the medication is to be taken.
— Highlight the good effects that the medication and recommended lifestyle changes could bring.
— Mention the possible side-effects and how to handle them.
— Use the BATHE strategy (which deals with getting information on the Background, Affect, Trouble, Handling and Empathy) to increase patient satisfaction.
