Offering choices to patients

A patient counsellor is a paramedical worker who helps someone seeking medical care understand the treatment options and what they signify. Often, the counsellor helps the patient and the patient's family ``with other aspects of the situation that they need to consider.''

WALKING THE corridors of many large hospitals these days is a new breed of health care worker: the patient counsellor. The health care establishment depends on the services of many types of people, ranging from hospital administrators to hygienists to medical technicians to physicians and surgeons. The increasing complexity of health care has resulted in a variety of specialisations outside the main practice of medicine, all of which offer interesting career avenues for those who are interested in health care but not in medical practice.

A patient counsellor is a paramedical worker who helps someone seeking medical care understand the treatment options and what they signify. Often, the counsellor helps the patient and the patient's family ``with other aspects of the situation that they need to consider,'' explains Seetha Anand, who recently began counselling patients at a paediatric cardiac centre.

Like counsellors in other areas, patient counsellors also deal with the social and psychological dimensions of health - in addition, they look at the interaction of these factors with the treatment regimen. ``For instance, in many respiratory or stomach ailments, the management is more in terms of making changes in the lifestyle or eating habits, and I help patients see that they can regain their health by making such changes,'' Seetha adds. Even where the patient requires medical or surgical intervention, the counsellor plays an important role in educating the patient to prepare for the treatment and its possible consequences.

Patient counselling is especially critical in paediatric hospitals, in cancer treatment centres and other specialised areas where the success of treatment depends a lot on the level of information that patients have and their attitude to the treatment. ``It's a lot about dealing with patient attitudes and giving them a broader perspective on the condition,'' explains Seetha. In many hospitals, patient counselling is emerging as an integral part of the treatment cycle. In others, it is a service that patients can avail of if they feel the need or if the treating physician feels it would help.

Most patient counsellors today are people who have either come into the field from a background in psychology or family welfare, and some as trained physicians with a specialisation in public health or social medicine. In the latter case, the physician doubles up as a counsellor. However, with the work pressure on medical staff increasing substantially in hospitals and nursing homes, most institutions are preferring to delegate the counselling function to paramedics who are in a position to handle it. It helps the counsellor to have a general understanding of medical practice, and usually this is acquired on the job. Most hospitals have their own training programmes for counsellors. While a basic degree is the qualification in most cases, many counsellors have postgraduate degrees in some aspect of social work.

Medical treatment is both complicated and expensive these days, and people often are bemused by the choices they have to make and the bills they are faced with. Most patients have little idea how to make their decisions, and in a majority of the cases, have to depend on the little information the busy doctor gives them during the five-minute appointment slot. ``Often doctors are so into their own specialisation that they are not able to explain clearly to a patient just what the implications of the treatment are,'' says Seetha. ``In fact many doctors feel that the counsellor can provide a more dispassionate view, and can explain things to the patient in a very simple way.''

The counsellor is also seen as someone who is ``outside'' the hospital system, in the sense that they do not have a vested interest in the course of treatment itself - their main interest is the welfare of the patient. Therefore patients may respond better to advice from a counsellor than from a physician.

``It's important that the counsellor is objective and is herself a balanced and happy person - because the people you deal with are under a lot of stress, both physically and mentally. You have to be able to deal with that,'' says Seetha.

In an era where medical ethics are constantly questioned, and when people are increasingly suspicious of the intentions of medical practitioners, the counsellor provides a balanced viewpoint that can help both the doctor and the patient. Occasionally, the counsellor is also well informed about alternative medical avenues, and can give the patient a broader view.

USHA RAMAN

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