It was late night and the last patient has just been wheeled out of the operating theatre. I smiled at the patient’s relatives who have now gathered around the patient. “The surgery went well as discussed before. He will stay in this recovery room for the next 24 hours. You can give him something to drink after two hours. The nurse will guide you,” I told them.
“Doctor, can we give him some fruit juice,” asked a young man who was standing close to the patient’s bed. “Of course,” I said. “Doctor, is it okay if I can add some ice to it or should it be plain,” he made another query. “Without ice is better, I think.” I answered patiently.
“Doctor, apple, orange or watermelon… which one would be better?” Now a major spine surgery has been performed to your family member. Would this tirade of questions be your priority in this instance? “Any juice is fine. Just let him take rest for some time. I will see him later again.” I cut short the conversation and moved out of the cabin.
In the present era, more than comprehending the intricacies of various diseases, managing the complex human vibes of the doctor-patient relationship forms the key. Long gone are the days when the irate doctor can just shout at a non-compliant patient who missed his medications. Despite troubled by a set of irrelevant questions or repetitive similar questions from the patient or his relative, the present-day doctor is expected to keep his cool and answer them calmly. While most patients are considerate of the doctors’ time and unpredictability of disease and treatment courses, there are a group of patients and relatives who harry the poor doctor and in turn make their own treatment complicated. Such complex patients can be broadly classified into three types: suspicious, inquisitive and defiant.
The suspicious are the most bothersome and pose a serious threat for themselves. They have strong suspicions about the genuineness of the nurse, junior doctor, anaesthetist, surgeon, physician. They often do not divulge their full medical history including the previous treatments and investigations undergone by them. They would like to check the diagnostic acumen of the different doctors by comparing their observations and prescriptions. They often google their symptoms and come up with a pre-fixed diagnosis when they meet the doctor. They seek multiple opinions for their health problem and these opinions may involve doctors of different systems of medicine such as allopathy, Siddha, homeopathy and Ayurveda. Seeking a second opinion and getting another expert consultation is fair and appropriate, but a suspicious attitude towards the treating doctor can backfire on the patient. Ceasing appropriate medical care while the treatment is on, and switching over to a different school of medicine can result in unwanted side effects. Suspicious patients also strongly favour natural cures to many serious illnesses such as cancer, fractures, heart attack, hypertension and diabetes, and often end up in a critical situation.
The second group is the inquisitive one. These patients usually list their queries in a sheet of paper and start reciting it when they meet the doctor. They get a cue for these questions from the Internet and bombard the doctor with a barrage of questions every time the doctor meets them. These questions will usually be repeated to multiple personnel involved in their health care, and then they develop a consensus on their own. These questions are predominantly trivial and may unnecessarily prolong the treatment provided to the patient. The human anatomy and physiology are not the same for every patient and the disease pathogenesis also varies widely. So, doctors lose connect with such banally inquisitive patients. They start despising such patients and soon avoid meeting them or start answering them in monosyllables.
The defiant patients form the third group. The defiant are the antithesis of the suspicious group, and lack any interest in knowing about their disease and its seriousness. They do not acknowledge the doctor’s entry into the room and remain glued to television or some electronic gadget. Most of the time they remain mute or just nod their head during healthcare conversations. Often, they miss appointments, skip medications, refuse investigations and abscond from surgeries, but present again to the doctor with the same problem after a hiatus. They don’t keep their previous medical records safely and keep changing their doctors as per their whims and fancies. They remain stone-faced when the doctors explain the problems of incomplete treatment, and they just seek an immediate relief from their discomfort.
The doctor-patient relationship has already hit a rough patch and unfortunately might deteriorate further in the coming days. A lot has been discussed in terms of spiralling healthcare costs, increasing patient expectations, mounting paper work and in general, the conversion of medical care from an act of healing to a business service, as the plausible reasons for this decadence. While a majority of patients still believe in the probity of the Indian healthcare system, the above-mentioned groups of patients can seriously affect the fragile doctor-patient relationship. A decent understanding of the disease, limitations of current medical technology, realistic expectations from a treatment, understanding the workload and time constraints of doctors, and being an abiding patient will help a long way in improving the bonhomie between doctors and patients.
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