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Those who practice as physicians in our society are increasingly looked upon with some suspicion. Dig a little deeper and one is apt to find that they are more to be pitied than to be censured.

A physician is denied the fundamental right to some solitude. Even at a social gathering, she is likely to be surrounded by wannabe patients who are keen to seek her impromptu advice as to the latest affliction the party of the other part has heard about and imagines oneself to be suffering from the same.

Close relatives are not too considerate either. A distant relative could call late at night, skillfully steering the conversation from children’s career prospects to the current bout of migraine she happens to be suffering from. If anyone in the circle of friends or relatives happens to be admitted to a hospital, the physician ends up spending sleepless nights, adroitly juggling her official commitments and personal relations, often messing up both.

Latest advancements in medicine keep them on their toes. So does the competition from various streams of medicine, such as Homeopathy, Ayurveda, Unani, Siddha and many other local variants of each of these streams. Superstitions, local beliefs, religion, social norms are but some of the constraints which need to be kept in mind. Legal tangles, such as those apply to road accident cases, keep them on the defensive.

In advanced countries, they face tough customer care regulations. In emerging economies like India, they suffer humiliation – occasionally violent – at the hands of irate relatives and well-wishers if the latter perceive the medical service provided to their kith and kin to be deficient.

Return on Investment considerations

To be a mere graduate in any discipline of medicine does not amount to much these days. Even to become a graduate, the hapless souls have to experience at least five and a half years of the tyranny of the classroom, with the trauma of a stint as an intern thrown in for good measure.

Monetary rewards obviously vary depending upon their choice of a career. They could choose to be in their own private practice, or join a private sector outfit, or become a part of the public health delivery mechanism.

If public spending on health infrastructure is woefully inadequate, private players end up playing an important role in the medical education scenario. Many aspiring physicians opt for a private sector skill provider. As a consequence, hassled parents end up shelling out sackfuls of the green stuff. Return on Investment considerations then determine the choice of their career.

The blue-eyed ones

The resourceful ones set up their own practice. If the going is good, some of them end up laughing all the way to the bank, what with hefty commissions coming in from such allied medical service providers as marketeers of branded medicines and diagnostic clinics.

Those who happen to be associated with five-star private sector health facilities have tough business targets to meet. This is not to say that patient care necessarily gets compromised, but an overdose of medical investigations surely leaves the patient and her family deprived of mental peace and some hard-earned green stuff.

When the costliest of medicines and gadgets get recommended by physicians, stakeholders of pharmaceutical companies and those in the field of medical equipment laugh all the way to the bank. Admittedly, quite a lot of money gets pumped into research and development, but it is open to debate as to how much profit could be considered rational and socially justified.

Much like the marketing honchos in the private sector who bring in business and resultant moolah, such physicians happen to be the blue-eyed boys of any entity which boasts of being a corporate facility.

The grey eyed ones

Physicians who are part of the government healthcare delivery system and happen to be conscientious by nature are often overloaded with work. Monetary rewards are often not commensurate with the efforts being put in. The eyes of a majority of them would be a dull grey, revealing a soul which is tormented and has given up hope.

Besides having to publish research papers in peer-reviewed journals and making presentations at medical seminars, students have to be guided, examinations have to be conducted and internal meetings need to be attended. Administrative chores cannot be ignored.

Above all, routine patient care cannot be made to suffer. Patients, whether of the ‘in’ or the ‘out’ kind, descend in droves, all eager to jump the queue and catch the attention of the physician. The plight of those in most of the emerging economies is most distressing because the per capita availability of physicians leaves much to be desired.

Of Attitude and Inner Resilience

Much depends on the attitude of a patient. One could come across persons with a cheerful disposition headed for their second open heart surgery, relishing a deep-fried item with much glee. One could also run into those who worry endlessly over such transient ailments as a bout of common cold or sinusitis.

Physicians obviously deal with a baffling variety of patients with much finesse and aplomb. Nerves of chilled steel get deployed. A sense of detachment pervades their handling of a patient. Their inner resilience deserves to be applauded.

With such fine qualities of head and heart, one can merely admire the quality of their work which keeps upholding the reputation of their profession. The Hippocratic Oath might appear to be relegated to the background, but is surely alive and kicking.

In many streams of alternative medicine, the patient is taken as a composite whole and treated holistically. The inner resilience of a patient is accorded a higher weightage. Allopathy, the mainstay of masses in the times we live in, does it the other way round, where each organ is looked at and treated separately. In mathematical parlance, alternative streams could be likened to Integral Calculus, whereas allopathy could be likened to Differential Calculus.

Shoring up one’s inner resilience

There are indeed ways for patients to improve one’s inner resilience, so as to be able to handle the harsh slings and arrows of Fate in a more positive manner. A deeper inner connection helps. To achieve the same, regular introspection and meditation helps.

As the Mother has said, the right approach would be to simply disallow negative thoughts to gain a foothold in one’s psychical system. Patients obviously need loads of patience to be able to put this advice in practice!

(Notes:

This forms part of an article which has appeared in NAMAH:

NAMAH_OCTOBER_2017

Inputs from Dr. Shivani Salil Dr. Shruti Bhatia are gratefully acknowledged.)

(Related Post: https://ashokbhatia.wordpress.com/2017/06/04/of-patient-satisfaction-quotient-motivation-and-kinds-of-patients)

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The Patient Satisfaction Quotient

It is well-known that the Patient Satisfaction Quotient is a function of various factors – the time spent with the physician, the quality of interaction had, the seniority of the physician in the system hierarchy, etc.

It follows that the following laws might apply:

Law #1: The more the time spent with a physician, the higher the level of satisfaction of a patient.

Admittedly, this law does not apply to those perched on a dentist chair. Nor does it apply to those facing a minor surgical procedure without the aid of analgesics.

Law #2: The better the quality of interaction, the higher the level of satisfaction of a patient.

This law is a direct derivative of the psychology of the individual. The more a patient is able to off-load her worries and anxieties onto the hapless physician, the happier she is apt to feel.

There are some exceptions here as well. A physician found making an inappropriate remark about the weight of a patient who is a member of the female of our species risks losing the latter’s goodwill.

Law #3: The patient satisfaction level is directly proportional to the seniority of the physician being consulted.

Amongst the well-heeled patients, the respect and admiration for a physician depends upon the amount of fee being charged, the waiting period to get an appointment, the seniority of the physician in the system, and the value as well as the rare availability of the medications being prescribed.

This one surely does not apply to the teeming multitudes who strive to keep their body and soul together day after day.

It follows that most patients using the public hospitals are left dissatisfied. It does not occur to them that the sheer exposure of such physicians is so very wide that the medical advice they dish out is much better. Superfluous investigations are discouraged. Medications recommended are often of a generic kind, saving the patient some precious money.

A Patient Motivation-Hygiene Proposition

Those familiar with Herzberg’s two-factor theory, popular in the realm of organizational behaviour, would notice a striking similarity between the situation envisaged in organizations and the one we are endeavouring to explore here.

In case of organizations, job satisfaction and job dissatisfaction are not part of a continuum. Absence of satisfaction does not necessarily imply presence of dissatisfaction. If the presence of Motivation Factors (respect and recognition on the job, for instance) improves job satisfaction levels, the absence of Hygiene Factors (such as physical working conditions, etc) leads to higher job dissatisfaction levels.

Likewise, satisfaction/dissatisfaction levels of patients perhaps tend to be independent of each other. If the treatment is effective in the long run, the satisfaction level improves. If the time spent by the physician is inadequate, dissatisfaction sets in.
In that sense, Effectiveness of Treatment would be akin to a Motivation Factor in the theory propounded by Herzberg.

However, the set of laws proposed above would be like Hygiene Factors, the absence of which would cause a patient dissatisfaction.

Patients of various hues

Patients obviously come in various body sizes, pocket sizes, shapes and hues. Amongst those who do not face a medical emergency, there are wide variations in temperaments. Here are some which might be of interest.

The Reluctant Ones

These are patients who believe that a doctor should be visited only as a last resort and that medicines need to be stopped as soon as the immediate problem is addressed. They believe that there is no need for any follow-up visit, till, of course, the next crisis strikes.

The Casual Ones

These are the ones who are casual in their approach. They may or may not follow either a doctor’s prescriptions or the food restrictions placed on them. Nevertheless, a medical consultation is akin to a pleasurable outing for the, so they shall keep coming back to see the physician. For a public service doctor, they happen to be a nuisance. For those in the private sector, they are a source of delight.

The Conscientious Ones

In this category fall the hapless and anxious souls who take their illnesses rather seriously. They take medicines regularly, and follow diet-related advice to the best of their ability. They tend to seek guidance at frequent intervals. Those who suffer from lifestyle diseases often end up forging a close bond with the physician, thereby replicating the age-old system of ‘family doctors’.

The Anxious Ones

Then there are the well-heeled hyper-anxious ones who take a magnified view of their afflictions, tend to be jumpy, worry excessively about prognosis, and keep troubling the physician concerned with inane queries from time to time.

(Notes:

This forms part of an article which has appeared in an issue of NAMAH:

NAMAH_OCTOBER_2017

Inputs from Dr Shivani Salil and Dr Shruti Bhatia are gratefully acknowledged)

(Related Post:

https://ashokbhatia.wordpress.com/2017/06/19/an-armchair-view-of-physicians-and-patients)

 

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As we celebrate this year’s Doctor’s Day, one’s thoughts inevitably turn to the string of doctors who have treated oneself as also near and dear ones at some point of time or the other. A word of gratitude is surely in order. For these are the people who show us light when we are enveloped by the darkness of ill-health. They give us hope when we need it the most. They have the capacity to ease our minds, make us worry less about our sickness and do their very best to lessen our pain and suffering.Doctors Day

They have to necessarily cope with patients of all sizes, shapes and temperaments whose income and curiosity levels also vary. Some patients are content with merely following instructions, whereas others who believe in self-medication and suffer from ‘Googlitis’ merely come to see a doctor to get a confirmation of the sickness they already believe they are suffering from. If the doctor comes up with an unfamiliar name of illness, orders a new test or prescribes a hitherto unheard of  medicine, such patients go back quite convinced that the doctor is a ‘good’ one!

If one has a complaint, it is only that they work too hard, often neglecting their own well-being in the process. One silently admires their chin-up attitude; despite remaining surrounded by human misery in possibly its worst form, they continue to smile and keep their focus on the task at hand. The poor souls have family responsibilities just like all of us. However, for a vast majority of them, patients are always the first priority, virtually 24X7.

The Angels in White

Same can be said of the nurses, technicians and other para-medics who are eternally vigilant in taking care of the patients under theirFlorence_Nightingale charge. The angels in white uniforms ensure that the right medicines are being taken at the right time. They also grapple with issues facing several patients at any point in time, coordinating with each of the doctors concerned and ensuring that relevant instructions are rigorously followed.

Nurses play an important role in maintaining the morale of the patients as well as the relatives at an appropriate level. Often, they have to bear with patients who have a foul temper. A caring and compassionate nature, coupled with a high Emotional Quotient, helps them to handle their complex task.

The Patient Patients

It is rather baffling that while we celebrate a Doctor’s Day (July 1 in India, March 30 in US) as also a Nurse’s Day (May 12 internationally), we do not spare a thought for the hapless patients. Their contribution to the field of medical science is no less; the entire medical fraternity owes its existence to patients! Moreover, besides being sick, they have to show remarkable patience while undergoing the trauma of getting treated – in getting an appointment with the doctor, endlessly waiting in queues to see one, pushing around to get all kinds of diagnostic tests done, rushing back to the doctor to get medicines prescribed and then going through the whole treatment.

In case a surgery becomes necessary, the immediate family gets involved. In these days of nuclear families, the support of theCartoon Dr Patient family’s social network becomes critical. The fear of impending surgery gnaws at the inner being of the patient, whose energy gets all the more depleted in the process. The fact that the he/she is causing so much trouble to all near and dear ones goes on to add to his/her agony. Post-surgery, pain and trauma have to be faced to which all others can only be mere spectators. Back home, an endless routine of visitors starts, with some of them making uncharitable and insensitive comments which make the poor patient suffer even more mental anguish.

The Silent Sufferers – Attendants

And what about the hapless attendants? They have to practice multi-tasking no end. Answering calls from anxious but distant relatives while procuring medicines is only one facet of the challenge. Organizing food which strikes a delicate balance between what is wanted and what is needed by the patient is another one. If admitted to a hospital, lot of formalities and paper work may become necessary. Round-the-clock surveillance becomes necessary. Skills in house-keeping come in handy, because prior to the scheduled visit of the doctors on rounds, the nurse with a stiff upper lip keeps nagging the attendant till the time the patient is in a ‘presentable’ condition and the room is tidy and orderly. Naturally, the fairer of the species fit into such roles with much ease!

For an attendant, PR skills are a sine qua non, because an endless stream of visitors has to be managed. In most cases, patients treatMother_Teresa_memorial_plaque the number of visitors as a clear measure of their personal popularity index. Nothing would cheer them up more than to keep a tally of the kind of fruits and goodies brought in by various visitors, so the favor may be returned at some future date in a proportionate manner. On their part, some of the visitors leave the hospital in a cheerful mood, thanking the Divine for not putting them in the patient’s predicament.

One would propose that as a caring society, we seriously consider declaring days earmarked to celebrate a World Patient Day as well as a World Attendant Day. The European Union has already taken a lead in this direction, with May 15 being observed as a Patient’s Rights Day. One sincerely hopes that other forward-looking countries would not only declare Patient Days but also honor the nameless attendants who silently slog and bring some relief and succour to the ailing patients. This would ensure an equitable treatment to all those who play a crucial role in the well-being of Homo sapiens!

Medicine-related blogs on this site:

  1. 1.   ‘A First Hand Experience in Medical Tourism’, published December 14, 2012
  2. 2.   ‘The Miracle of Alternative Therapies’, published March 31, 2012

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