Friday, February 27, 2015
Friday, January 16, 2015
TREATING 'CELEBRITIES'
Whenever my classmates hear that I practice in the Western suburb of Mumbai, they are keen to know which celebrities I have treated. This is because most of the Bollywood live and work in the Western Suburbs of Mumbai and there is a higher than usual probability of any doctor encountering one as a patient.
Well the first point is: I have to disappoint my classmates as I cannot name any patient due to my very uncompromising stance on patient confidentiality. Secondly, they get disappointed to know that famous people are not very different from 'non famous' patients in any way. Like all other groups 70% are just usual people who need treatment while 30% are unnecessarily troublesome. And that they suffer from much the same illnesses, side effects and concerns.
I prefer not to treat famous clients generally. The main problem is: my time-management goes for a complete toss. Famous clients have round the clock comitments and they though they try hard to maintain control- sadly it is never possible. So the 6 o clock appointment becomes 7, then 8 then 9 and so on. Then for being able to accomodate their crazy schedules I have to reschedule other appointments- this I hate doing as I value all my patients equally. Well some famous folks feel very bad- and as they feel that everything can be set right by money and that is one thing they have in plenty- they try to pay the therapist an 'hourly charge'. But really its not about the money- the genuine therapist is also like a performer- I set an agenda for consultation and am eager to do it at assigned time. Waiting is like a 'false- start'- it causes me to lose the sharpness and interest in intervention.
Some famous people are pitiably foolish. They want their doctors and therapists to be in awe of them and wait at their beck and call. But this is very counter productive as medicine is a profession which requires human judgment based on objectivity. Maybe the famous person gets easy access to the therapist, can bully the therapist- but this causes subtle and sure harm. So we read about doctors who have been prescribing ever higher doses of sleeping pills because patient demanded, or got into relationships with patients because they were not able to assert their limits. The danger of thinking famous people are different is very real- both for patients and their doctors.
Well the first point is: I have to disappoint my classmates as I cannot name any patient due to my very uncompromising stance on patient confidentiality. Secondly, they get disappointed to know that famous people are not very different from 'non famous' patients in any way. Like all other groups 70% are just usual people who need treatment while 30% are unnecessarily troublesome. And that they suffer from much the same illnesses, side effects and concerns.
I prefer not to treat famous clients generally. The main problem is: my time-management goes for a complete toss. Famous clients have round the clock comitments and they though they try hard to maintain control- sadly it is never possible. So the 6 o clock appointment becomes 7, then 8 then 9 and so on. Then for being able to accomodate their crazy schedules I have to reschedule other appointments- this I hate doing as I value all my patients equally. Well some famous folks feel very bad- and as they feel that everything can be set right by money and that is one thing they have in plenty- they try to pay the therapist an 'hourly charge'. But really its not about the money- the genuine therapist is also like a performer- I set an agenda for consultation and am eager to do it at assigned time. Waiting is like a 'false- start'- it causes me to lose the sharpness and interest in intervention.
Some famous people are pitiably foolish. They want their doctors and therapists to be in awe of them and wait at their beck and call. But this is very counter productive as medicine is a profession which requires human judgment based on objectivity. Maybe the famous person gets easy access to the therapist, can bully the therapist- but this causes subtle and sure harm. So we read about doctors who have been prescribing ever higher doses of sleeping pills because patient demanded, or got into relationships with patients because they were not able to assert their limits. The danger of thinking famous people are different is very real- both for patients and their doctors.
Wednesday, December 10, 2014
THE NEW FRAMEWORK OF PRACTICE
Historically the medical profession has evolved from- faith healers, barbers and 'gurus'. Thirty years ago there was not much specialisation and the average doctor was required to treat all kinds of disorders and patients of all ages. Now is the era of specialisation. We have to become aware of our changing role in this context.
Doctors are supposed to carry on their work sincerely and quietly- active advertising for patients is forbidden. Though many doctors get upset with this rule- it is better that a patient comes out of his/ her own conscious choice. Patients come to doctors with many agendas- least of which is to recover from illness. This may vary from seeking reassurance, wanting certification, making enquiry, expressing concern and sometimes- even to size up the doctor. Doctor should therefore be alert to these undercurrents and not automatically presume that patient accepts everything that the doctor offers. So it is important to communicate clearly and explain to the patient about procedures in clinic- including the process of history-taking and proceed only after patient agrees.
Healthcare is called 'service-industry'. Only a fraction of patients need 'physical' service like injections, physiotherapy, dressing, surgery, etc. Majority of patients only avail of advice. Thus almost all doctors are 'medical advisors'. The doctor advises you about your condition, its treatment and also care to taken at home. The 'management plan' as it is now called- is different for every patient and is arrived at by collaborating with patient. So one patient of diabetes prefers to exercise in a park while another will go to the gym.
This is the essential change in framework of medical practice. A doctor can no longer pretend to be 'omniscient' provider of all solutions. The medical practice is never akin to laundry- where the patient drops his spoiled health and picks up freshly made one for a fee. Medical practice is more like a school where the patient receives guidance about how to solve the immediate problem and also how to prevent further occurence of problems.
Doctors should be conscious of this change and guide their patients about it.
Doctors are supposed to carry on their work sincerely and quietly- active advertising for patients is forbidden. Though many doctors get upset with this rule- it is better that a patient comes out of his/ her own conscious choice. Patients come to doctors with many agendas- least of which is to recover from illness. This may vary from seeking reassurance, wanting certification, making enquiry, expressing concern and sometimes- even to size up the doctor. Doctor should therefore be alert to these undercurrents and not automatically presume that patient accepts everything that the doctor offers. So it is important to communicate clearly and explain to the patient about procedures in clinic- including the process of history-taking and proceed only after patient agrees.
Healthcare is called 'service-industry'. Only a fraction of patients need 'physical' service like injections, physiotherapy, dressing, surgery, etc. Majority of patients only avail of advice. Thus almost all doctors are 'medical advisors'. The doctor advises you about your condition, its treatment and also care to taken at home. The 'management plan' as it is now called- is different for every patient and is arrived at by collaborating with patient. So one patient of diabetes prefers to exercise in a park while another will go to the gym.
This is the essential change in framework of medical practice. A doctor can no longer pretend to be 'omniscient' provider of all solutions. The medical practice is never akin to laundry- where the patient drops his spoiled health and picks up freshly made one for a fee. Medical practice is more like a school where the patient receives guidance about how to solve the immediate problem and also how to prevent further occurence of problems.
Doctors should be conscious of this change and guide their patients about it.
Sunday, October 5, 2014
The Referral Note
The message sent from one doctor to another, requesting an examination/ opinion is called a referral note. The referral note has to be properly written to elicit a proper response from the other doctor.
I have encountered referral notes which are not only incomplete, but grossly offensive. For example- while I was working in CGC at Wadia hospital in Mumbai I used to be called with a note saying ' Dear CGC, Come and see ...... patient, he does not have any problem found by us'. And I have answered with 'CGC building cannot move or cannot sign on this call- there is no person here called CGC- therefore this call is being returned to your Consultant for review'. But one must be careful as patient is the ultimate sufferer in this fight of wills. It is the duty of every medical teacher to properly teach their students how to write a referral note (provided they know it). At least my teachers in B J Medical College, Pune did so with due deligence.
Every Referral note must begin with a proper heading- referred to so and so, Department/ Ward, etc. It should have the date and time of writing referral. It should begin with proper address such as 'Dear Doctor' in case of a colleague, or 'Respected Sir/ Madam' in case of senior faculty/ colleague. Write clearly the patient's name, age and current working diagnosis. Also write for what you are referring the patient. Is it for second opinion, interpretation of reports, taking over- etc? Finally sign off with a legible signature and mention your full name with contact details under the signature. This is important as sometimes the other doctor may need to contact you for clarification. Ward referrals should always be followed by a request to note the referral and write down when the doctor will visit the ward. This helps you to plan to be present when the doctor visits; an invaluable experience of learning.
Nowadays referrals, at least in private practice, are made by email or text message. It is not feasible to write very formal long referrals. But still clarity and politeness should not be compromised.
Young doctors should inculcate techniques of professional communication right from the beginning of practice. Refined communication will make your work easier and efficient and you will gain respect among colleagues- other doctors will appreciate working with you. It also gives a message that you are serious about your work, and communicates an expectation of equally sincere work (from colleague). When you are so thorough about your referral your colleague also feels accountable to you. All this is important to be able to manage your patient properly. Medicine is not only about diagnosis and treatment; it also involves management of case.
Incomplete and improper referrals are confusing and off-putting. They can irritate or even antagonise the other doctor. The ultimate sufferer is the hapless patient. I think we should not make the patient's condition like 'a frog between two stools'
I have encountered referral notes which are not only incomplete, but grossly offensive. For example- while I was working in CGC at Wadia hospital in Mumbai I used to be called with a note saying ' Dear CGC, Come and see ...... patient, he does not have any problem found by us'. And I have answered with 'CGC building cannot move or cannot sign on this call- there is no person here called CGC- therefore this call is being returned to your Consultant for review'. But one must be careful as patient is the ultimate sufferer in this fight of wills. It is the duty of every medical teacher to properly teach their students how to write a referral note (provided they know it). At least my teachers in B J Medical College, Pune did so with due deligence.
Every Referral note must begin with a proper heading- referred to so and so, Department/ Ward, etc. It should have the date and time of writing referral. It should begin with proper address such as 'Dear Doctor' in case of a colleague, or 'Respected Sir/ Madam' in case of senior faculty/ colleague. Write clearly the patient's name, age and current working diagnosis. Also write for what you are referring the patient. Is it for second opinion, interpretation of reports, taking over- etc? Finally sign off with a legible signature and mention your full name with contact details under the signature. This is important as sometimes the other doctor may need to contact you for clarification. Ward referrals should always be followed by a request to note the referral and write down when the doctor will visit the ward. This helps you to plan to be present when the doctor visits; an invaluable experience of learning.
Nowadays referrals, at least in private practice, are made by email or text message. It is not feasible to write very formal long referrals. But still clarity and politeness should not be compromised.
Young doctors should inculcate techniques of professional communication right from the beginning of practice. Refined communication will make your work easier and efficient and you will gain respect among colleagues- other doctors will appreciate working with you. It also gives a message that you are serious about your work, and communicates an expectation of equally sincere work (from colleague). When you are so thorough about your referral your colleague also feels accountable to you. All this is important to be able to manage your patient properly. Medicine is not only about diagnosis and treatment; it also involves management of case.
Incomplete and improper referrals are confusing and off-putting. They can irritate or even antagonise the other doctor. The ultimate sufferer is the hapless patient. I think we should not make the patient's condition like 'a frog between two stools'
Sunday, July 20, 2014
Thursday, May 15, 2014
Getting doctors to quit cut-practice
eid=31804&articlexml=Medical-council-to-fight-commissions-140520140050714052014005071
MMC has been sending 'do not do cut-practice' letters to all medical associations. That's great.
MMC has been sending 'do not do cut-practice' letters to all medical associations. That's great.
MMC notice to Kokilaben hospital for cut-practice
http://epaperbeta.timesofindia.com/Article.aspx?eid=31804&articlexml=Med-Council-shoots-off-notice-to-hospital-over-13052014005040#
Please read detailed article on above link.
Great job, MMC!
Please read detailed article on above link.
Great job, MMC!
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