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Doctors are invaluable. But many Indian women feel disappointed with their doctors. How can doctor-patient communication be improved?
Veena Sunder*, 45, is not happy with the doctor treating her for arthritis – she feels he just writes out medicines and doesn’t explain things to her. Rohini R*, 28, changed her gynaecologist in the fifth month of her pregnancy because she felt the doctor wasn’t communicating too well with her. Sound familiar?
Have you ever booked an appointment with a ‘world famous’ specialist that everyone recommended, sat in the waiting room an entire evening only to end up with a five or ten minute meeting with the great man himself, a prescription in your hand and none the wiser about your condition?
Why do doctors not talk to their patients? Or at least, why do patients get this impression? Here is an attempt to explore the communication barriers between doctors and patients.
A new medical student is said to learn about 13000 new words in the first year alone. These are often, literally, Greek and Latin words. Technical terms or jargon soon occupy the vocabulary of the doctor to such an extent that they often know of no alternatives to these words. Many doctors continue to speak this way even to patients, often never realizing that the patient probably doesn’t get it. So if your doctor says, “We’ll have to marsupialize this cyst” instead of “We’ll have to open this fluid-filled swelling to remove the water from it” – you know what the problem is.
A doctor receives absolutely no training in the communications department.
Believe me, all the tomes a medical student has to read for a degree only deal with symptoms, signs and complications. The stress is on how to diagnose and treat various conditions. There may occasionally be words like “reassure the patient” but never any details on how. A doctor receives absolutely no training in the communications department. So once a doctor graduates, the way he/she talks to patients and explains things to them depends on their inherent communication skills, not on anything that they have been taught in medical school.
Let’s face it, doctors get busier as their practice grows. They get better at what they do as their practice expands, but it leaves them with little time for individual patients. This is the commonest reason for doctors not talking enough to their patients. Much as some of them would like to spend more time with each patient, the sheer numbers waiting outside deter them.
Some just love to talk and you may receive enough information to graduate medical school. Others are reticent and barely get by with answering the essentials. But the way a doctor talks is not a reflection on his/her skills, so you will find some of the silent types with a huge following.
When an ophthalmologist Dr.Rao’s* practice grew to an extent where he couldn’t give detailed responses to all his patients’ queries, he had systems installed to give information. So patients would consult with him, get their prescriptions and be directed to one of the systems to view detailed presentations, videos and FAQs. The response? A third of his patients were delighted, they were very happy to have their questions answered. Others often made their way back to him with even more questions. Yet others complained at having to see “such graphic stuff”. Some people politely refused saying the prescription was really all they wanted and some others just didn’t have the time for any explanations.
In healthcare, not everything is known – the reasons for many medical phenomena and the causes for many conditions are still unknown. While it is relatively easy to answer a question like “Can I eat cold foods?” there is no simple answer to a question like “I’m just 35, vegetarian, don’t smoke, lead a sensible life and meditate, so how can my coronaries be blocked?” And there are definitely no correct answers to questions like will I be better in two days (I have a wedding to attend), is there a guarantee for this operation and just where did I get this infection from.
And finally, doctors are just people like anybody else. They have to stand in queues, send their kids to school, deal with potholes on the road and see the dentist when their tooth aches just like anyone else. So even they have their good days and their bad days.
Throw in a little of each of the above and what you have is a doctor who appears uncommunicative and insensitive to patients. But communication between doctors and patients can be improved with just a little effort on both sides. Most people, when they get sick, want to know what has happened to them and, more importantly, the cause for it; knowledge that will help them take better care of themselves and prevent a recurrence of the problem. They also want to know what their options for treatment are, how they can expect them to work and any other precautions they will have to take. Not unreasonable at all.
…do your homework – it is your right and your duty to be informed of the state of your body and your health.
All that doctors have to do is use more common or plain speak with patients. They can get someone to counsel patients and answer their questions if they are too busy to do it themselves. Handouts with dietary advice and answers to common questions often save many a heartache on both sides. If a patient is net savvy, the doctor can help by recommending websites the patient can refer to.
As for patients, it helps to go prepared – don’t be longwinded with your symptoms, instead make sure the doctor gets all the information about your condition precisely, especially if your time is limited. Keeping in mind a list of questions you want to ask also helps. But definitely do your homework – it is your right and your duty to be informed of the state of your body and your health. Search the net, find out more about your condition and even check if you are being treated correctly but always make sure you get your information from reliable sources. If you find contradictory information, the doctor is still the best person to check with.
Above all, remember that only you know what your needs are. So find a doctor you are comfortable with.
*Names changed to protect privacy
*Photo credit: Alex E.Proimos and Hiking Artist respectively (Used under the Creative Commons Attribution License)
Dr. Lakshmi Ananth is a doctor and a writer who wields both scalpel and pen
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