Wednesday, August 15, 2018

We need ‘azadi’ from doctor-patient disputes on this Independence Day: Dr KK Aggarwal on TEDx Talks

The doctor-patient relationship is facing turbulent times these days. Trust forms the foundation of the doctor-patient relationship and determines the outcome. However, this trust has corroded over the last few years and must be restored urgently, as it is crucial to the survival of this very important relationship.

This is how I began my talk that I gave at TEDxMansarovarPark in Rohtak.

TEDxMansaroverPark is an independently organized TEDx event operated under license from TED Talks to propagate its mission of “ideas worth spreading”. It focuses on local voices and local community.

Here is a gist of my talk.

The doctor-patient relationship too needs CPR to revive it. And, it is revivable, just as a dying person or a clinical dead person can be revived by CPR.

Doctors are professionals and are accountable to a code of conduct. As professionals, we have to be different from others. I am allowed to write ‘Dr’ before my name. The constitution does not allow me to prefix ‘Dr’ before my name. But the society has allowed me to do so and has accepted it. I always wear a stethoscope around my neck. These signs make me different from others so that I can be easily identified as a doctor in an emergency.

A doctor has only two purposes: absolute beneficence and non maleficence. So, it’s my job to always work in the interest of the patient.

We had conducted a survey of thousands of doctors and patients. Doctors were not happy. They said, “we are living in fear that if the patient dies, we will be beaten up”. The incidence of violence against doctors are increasing. When we talked to the patients, we found that they too were not happy. When asked why, majority said that doctors do not communicate with us.

When we started to analyze the cause of unhappiness, we turned to our Vedic literature to find out the types of patients. There are four types of patients: Ignorant, informed, empowered and enlightened.

·         Ignorant patients have 100% trust in their doctor with no questions asked.
·         Informed patients are aware of their disease and rights, but they usually accept what the doctor tells them. They say, my doctor is the best.
·         Empowered patients have several more questions for the doctor.
·         Enlightened patients want an explanation and justification of every information they are given.

Similarly, there are three types of doctors.

·         Doctors, who expect patients to accept what they say without questions.
·         Doctors, who give choices to patients and ask them to choose and
·         Doctors, who give choices to their patients, but take time and help the patients in taking a decision.

This is the discord and the number one cause of miscommunication and disputes. While the types of patients have changed very rapidly from ignorant to enlightened, doctors are still in the first phase, where they feel that they don’t need to spend time with the patient.

Non fulfillment of desires, expectations and aspirations is the main cause of anger. As a doctor, patient satisfaction is my priority. I have to live up to the expectations of my patient and heal him. How can I do this? The answer to this lies in the 18 chapters of Bhagwad Gita.

In the first chapter, Lord Krishna only listens to Arjuna, his concerns, his doubts. We must learn to listen patiently to our patients without interrupting or showing anger.

From Chapter 2, Krishna starts explaining to Arjuna, who is confused. Patients are confused as they do are not expected to have the knowledge that doctors have.  

From Chapters 3 to 17, Krishna explains in great detail, giving reasons for the doubts Arjuna had. He said that don’t worry. I am here, if you make a mistake.

In the 18th Chapter, Krishna revises everything with Arjuna.

So, the first principle required for a better doctor-patient relationship is to understand that I need to spend time with the patient, explain, reason out and review.

‘ALERT’ is a concept that every doctor and patient must remember.

·         Acknowledge: When the patient enters your office, greet him/her by name and introduce yourself or your staff who would be involved in patient care.
·         Listen to your patient.
·         Explain to the patient about the disease.
·         Review the information given with the patient to make sure that they have been understood correctly.
·         Thank you: This is most important. Doctors must thank their patients for giving an opportunity to serve.

Doctors must also spread the message of “sutras” or one-line messages e.g. “Foods of plant in origin have zero cholesterol”, “Anything which is green and bitter is antidiabetic and antiobesity.”

Remember the ‘Formula of 10’ to save a life by using hands-only CPR and ‘Formula of 80’ for living up to 80 without a heart attack and teach them to patients.

Formula of 10 is “within 10 minutes of death (earlier the better), at least for at least 10 minutes, longer the better (adults 25 minutes and children 35 minutes), compress the centre of the chest of the deceased person continuously (uninterrupted) and effectively (1½ inch) with a speed of 10×10 = 100 per minute”.

Formula of 80: “Keep your heart rate, LDL cholesterol, fasting blood sugar, abdominal circumference and lower BP below 80”. For this, “walk 80 minutes a day, brisk walk 80 minutes in a week and walk 80 steps in a minute; keep PM2.5/10 levels below 80, do 80 cycles of parasympathetic breathing in a day; sit under the sun for 80 days in a year; do not take refined carbohydrates 80 days in a year.”

There are many systems of medicine in India. We need to respect each other. Let the patient choose.

Any sound, which is a combination of a vowel and a nasal consonant, is a healing sound. Chanting vowels produces interleukin-2, a natural painkiller, which is 200 times stronger than aspirin. Chanting nasal consonants produces delta activity in EEG, which produces tranquilizers and which tranquilize the mind.

The purpose of a doctor is to health with minimum number of medications. For this, he/she needs the help of patients.

You can view the video at: 

Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Immediate Past National President IMA

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