I was watching the episode 4 of Satyamaev Jayate (The truth prevails) (for those of you who do not know about it, it is a recently started much publicized talk show conducted by the celebrity actor Aamir Khan in India, addressing various issues that face today’s India). This episode really got the debate going because obviously though it had some truth to it, it was not the complete picture.
As I was thinking through this, I was struck by the fact that doctors are the most vulnerable group in the health care industry, be it in the United States or India. Doctors are at the disposal of everyone else in the ‘hierarchy’ of healthcare industry. Patients can sue them for bad outcomes or even without justifiable bad outcomes, employers can fire them for no reason what so ever, and if they own their own practice, they can get drowned in their own debts with all the ever-increasing overhead costs, and the public can criminalize, ridicule and metaphorically crucify them. It is true there are corrupt doctors, there are greedy doctors, and unfortunately so for the rest of them that are not. I am all for an outspoken criticism when the situation calls for it (like the criticism of health care that I think is well deserved and long overdue), and recognize that passionately fighting back at the critique is only going to protect the rotten and corrupt parts of the healthcare system. So we should let the spark grow because that is the beginning of the road to a fairer system. However, we should be mindful of what we could do to amend the broken parts on our side.
It is important for us doctors speak up in this is the age of connectedness, age of social media, where every one ought to have a voice. This is a thought process to address the issues that might prove potentially problematic, not just from the legal standpoint, but also from patients’ perspective. Here are some issues that I thought were important ways to address them. This is mostly what we learned during training, but so often forget to practice
Speak up, Team up, Educate, Protect yourself, Support – STEPS
1. Media misrepresentation of doctor-pharmaceutical relationships – This may be different in different countries. My experience says, it is probably a worse problem in India. There have been many regulations to disconnect the big pharma companies from doctors. However, we are missing the elephant in the room, the real and bigger problem, that lies in the high-end ties and relations between corporate lobbyists & ruling powers. Whenever and wherever you see this kind of content, debate the issue, draw the attention to where the real problem is. ‘Mounam sammati lakshanam’. (silence is a sign of agreement) If you keep quiet, it is not considered polite, but counted as guilt. And if you think you are in a slippery slope with a pharmaceutical company, seek help and get out! You will not regret it. Someday, we will have to use the same medications & treatments and we should be able to do so without worries.
2. Doctors are overworked – Bring up such issues in meetings and devise a plan for work hours and schedules. when you cannot work anymore, please stand up and say, “I am done for the day, I cannot work anymore” and leave. It is better for everyone. Although easier said than done, I have to admit. An alternative would be taking at least an hour break, either for some quiet time or a slow lunch which should revive you enough to keep you going for the rest of the day.
3. Doctors have lost trust – Again, bad events, bad outcomes get more publicity and taint the image of doctors in the public eye. Gain trust of your patients. Inform, educate, communicate, obtain consents — can’t be said enough. Show them their lab values, normal ranges, abnormal ones, graphs of trends, images and point to where the pathology is. Ask them to get an independent second opinion from another doctor of their choice. If it is different, discuss with the other doctor. It is ok if your first opinion was wrong on second thoughts. Do not forget to inform patients about risks, of everything that you do with their bodies. They have a right to know. Tell them what you are going to do, before palpating their breasts, or pressing on their bellies, or even listening to their lungs. Tell them what you find (sounds ok or looks fine) because they will be anxious about what you are going to find. Give them the assurance that you know what you are doing and if you do not know something you will find out. At the end of a visit, always ask if there is any other question you can answer for them. Do not leave them wondering what you are thinking. This may seem too trivial but very important contributors to what patients think of their doctors and how much they trust them, Convey to them that you are only as perfect as them and definitely care a big deal about their health. Remind yourself everyday that you and your patients are in the same team and are not opponents in a game where your win must mean patients’ loss. Work on gaining trust from your patients not by doing what they want, but assisting them with your expertise and help them make the best decisions for themselves. Tell them what they are entitled to know, instead of sugar-coating the talk and giving false hopes for incurable conditions. Keeping them informed of some bitter truths only makes them better prepared to face their struggles.
4. Employers giving you bad feedback based on what they ‘say’ they heard from patients about you. (while in fact it might be a purely administrative decision). It is a more malignant world than you think. An employed doctor does not have any protection against such kind of accusation, even when it is false. Unfortunately employed physicians are also the ones that depend on feedbacks for their future employments and growth in their careers. Do not let this affect you. Regardless of the kind of practice you have, provide patients with a website address (like vitals.com or health grades.com) where they can provide feedback, so you don’t get falsely accused of bad care. And with good feedback, you attract more patients and retain the ones you have.
5. Support your professional community. Do not discuss the perceived medical failures of your colleagues, or any other medical professional in front of patients. Firstly, you might not even have enough information only based on what patients tell you, that the care they received from another doctor was either wrong or unnecessary. Even if you know it is true, your objection has to be brought up with the other doctor and not with the patient. By not doing so, you are setting up a fertile ground that breeds mistrust. This where communication comes in handy, again. Obtain medical records, consult other physicians involved in your patient’s care. The time spent will save you time and even expenses sometimes.
Even after all this, it is not a cake walk being a doctor. It is quite a walk though, and we have to make the most of it!