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.
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
college for management in noida
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