Levels of awareness

Doctors meet people from all walks of life and social strata in their day to day practice. And, these patients have different levels of awareness about their illnesses. Broadly speaking, patients can be classified as either “aware” or “unaware” about their illness. But, this is a very simplistic classification.

There are four levels of awareness – ignorant, informed, empowered and enlightened. These levels have been defined based on the ability of the person to retain the knowledge or information that has been taught or given to them.

·          Ignorant patients depend on the doctor to make their decisions about the necessary interventions and treatments, with no questions asked. They are ignorant of their disease and do not participate in decision making.

·          Then there are informed patients. These patients have some information about their disease and will have few questions for the doctor following which they usually accept the line of management as suggested by the doctor.

·          The next level is empowered patients. These patients have several more questions for the doctor, they cross check facts and are an equal partner in decision making regarding their treatment.

·          Enlightened patients seek the opinions of many. They experiment and are only then convinced about the proposed line of treatment. Realization takes time for patients with this level of awareness. There will be multiple sessions of counselling, before these patients are convinced.

Patients can also be classified on the principle of “suno – samjho – jano - karo” given by the sages. This means hearing, listening, knowing and wisdom. We should hear, listen, understand and convert it into wisdom. Hearing means that you hear anything but listening means that you should learn its meaning. Understanding means you should understand its value in your context and wisdom means you should practice it, re-practice it and learn intricacies of its implications

The Bhagavad Gita has described four types of devotees comes from Bhagvat Gita where Krishna says to Arjuna (7.16) “Chaturvidha bhajante mam janah sukrtino rjuna, Arto jiijnasurarthasthi jnani cha bharatasabha”.

This means that there are four types of beings who worship me: those who are unhappy, those who are desirous to have knowledge, those who desire worldly objects, and those who have acquired knowledge. In the next shloka, Krishna says that among them only those who have acquired knowledge (wisdom) are the best because they are always engrossed in worshipping me. He said those who have a knowledge love me, and I love them. A true Bhakt is a person who asks his guru the same question again and again till he understands and implements it.

Rabbi Dovid Rosenfeld, a known scholar has classified four types of students in a different way. He describes them as a sponge, a funnel, a strainer, and a sifter according to their ability to retain the knowledge taught to them.

• The sponge retains everything, but is unable to distinguish between correct and incorrect points or between significant and insignificant ones. He is devoid of Viveka, the power of discrimination.
• The funnel brings in on one side and brings out on the other side. So, a funnel is the one for whom information goes in one ear and out the other. He has no focus on the lecture. His hearing and the mind are in different directions.
• The strainer discards the wine – the significant material, and retains the lees – the incorrect or insignificant points. He’s the sort who remembers all sorts of trivial or useless details of the material he studied. Most students try to remember the foot notes of a book and forget the common things.
• Finally, the sieve retains the fine flour – the significant material, and discards the dust – the inconsequential details. He is the one who understands the lecture by its main five points and remembers them in the form of sutras.

There can also be three types of doctors. One, those who expect patients to accept what they say, second, who give choices to patients and ask them to choose and thirdly, there are doctors who give choices, but help the patient to choose the best option.

Miscommunication is at the root of many doctor-patient disputes. 

When counseling a patient, the doctor has to understand the level of awareness of his patient and his level of awareness has to match with that of his patient to avoid any discordance in communication.

(Inputs from Dr Ved P Mishra)

 Dr KK Aggarwal

National President IMA & HCFI

Recipient of Padma Shri, Dr BC Roy National Award, Vishwa Hindi Samman, National Science Communication Award & FICCI Health Care Personality of the Year Award

Vice President Confederation of Medical Associations of Asia and Oceania (CMAAO)

Past Honorary Secretary General IMA

Past Senior National Vice President IMA  

President Heart Care Foundation of India

Gold Medalist Nagpur University

Limca Book of Record Holder in CPR 10

Honorary Professor of Bioethics SRM Medical College Hospital & Research Centre  
Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand
Editor in Chief IJCP Group of Publications & eMedinewS

Member Ethics Committee Medical Council of India (2013-14)  

Chairman Ethics Committee Delhi Medical Council (2009-15)

Elected Member Delhi Medical Council (2004-2009)

Chairman IMSA Delhi Chapter (March 10- March 13)

Director IMA AKN Sinha Institute (08-09)
Finance Secretary IMA (07-08)
Chairman IMAAMS (06-07)
President Delhi Medical Association (05-06)