LEARN INSURANCE

" Guiding patients to better online sources of medical information should be a new physician responsibility for the digital age. Not only should doctors expect and be receptive to questions patients raise from Web research, they need to proactively engage patients online in order to dispel falsehoods and guide them to legitimate sites."

This is why I feel every doctor should have their own website ! It forces them to search for reliable health websites ( to which they can link) so they can guide their patients intelligently, rather than getting upset when patients come with many sheets of internet printouts ! Even better, it will encourage thoughtful doctors who are not happy with the quality of the information they find on other sites , to publish better customised content on their own website, thus helping lots of
other patients !

There is a shortage of doctors. This is true all over the world because of many reasons. Medical training is expensive and arduous, and not many people are capable of surviving the grind. Also, doctor are unevenly distributed, which means that there are too many in large cities, but not enough in the villages. Finally, a lot of the doctor’s time , energy and expertise is wasted in handling problems which do not really need their expert attention. These are problems which can easily be handled by the patient and his family himself.

The standard solution to the chronic shortage of doctors has always been the standard knee-jerk response - train more doctors ! This solution comes in many different flavours - open more colleges; or create a new cadre of barefoot village doctors. However, these are just short-term fixes - and the problem recurs every few years, because doctors create a demand for their own services. This means that churning out more doctors will never help - it will just exacerbate the problem !

The solution is surprisingly simple - empower patients to take better care of their own health !
How can patients figure out when they need to go to the doctor ( and when they can take care of themselves as home ? ) How do they determine which problems they can solve for themselves and which should make them seek medical attention ? Is this headache a migraine ? or a brain tumour ? Is the fever because of a viral URTI ? or is it TB ? How is the poor patient going to figure this out ? Isn’t that what you need a doctor for ?

Right now the standard response for all patient queries is - Ask your doctor ! ( Isn't it ridiculous that most books and websites on fitness and exercise have this disclaimer - Please check with your doctor before starting an exercise program ! ) All we end up doing is making patients more dependent on the doctor and unnecessarily increasing the doctor's workload ! What we need to do is make patients more independent, so they can fend for themselves !

The trick to making patients do all the work is to develop clever tools which will help the patient to make sense of what is happening to them so they can communicate clearly with their doctor. The vast majority of health problems are self-limited and just need reassurance. They can easily be managed by a phone call or an email.

Doctors can learn a lot from retailers. In the past, customers went to the shop and the shopkeeper would have to physically carry the selected objects and then pack them and bill for them. The shopkeeper was the major bottleneck - and had to do all the grunt work. The new supermarkets make the customer do all the work, thus allowing them to service a much larger number of customers - for much less ! It's true that the retailing ecosystem had to change to allow this evolution to occur ( better packaging; better shelf displays; better branding; and more customer education), but this has now become the standard - and the retail industry is doing very well for itself, thank you !

Here's a simple example . A lot of the doctor's time is spent on taking a medical history. Many busy doctors do not have the time to do this themselves, which is why they get an assistant ( who may not be very competent !) to do it for them. We make our patients do this themselves by making them fill a very detailed and complex form ( see a copy at www.drmalpani.com/malpaniform.htm)

This has many advantages. It saves me time. It ensures the history is complete and that I have not overlooked any important information. Even more important, it helps to educate my patients ( because they need to do their homework to be able to fill in the form intelligently !). It also ensures they are better organised, because they need to collate all their medical test results and summarise their history !

Please note that I do not expect patients to make their own diagnosis ! However, patients are the experts on their problem, and helping them to help the doctor will help everyone !

I had just finished seeing a patient who came to me from Bangalore for IVF treatment , and before leaving the room, he turned around and said - " Thank you so much for taking the time to listen to us so patiently ! "

I was flummoxed ! After all, isn't listening to a patient a part of the doctor's job description ? Why was he thanking me for doing something which is so routine and mundane ?

When I asked my next patient why I was being thanked, he said - That's because you are so different from most other doctors, doc ! Most doctors just rush like automatons through a long line of patients. It's like they are just processing an assembly line of people - and they have 7 minutes in which to listen to you . They are always rushed and harassed - and it's very hard to have a decent convesration with them. Most of them are focused on the medical issue at hand - while some only speak medicalese, so it's hard to make sense of what they are saying. It's a pleasure to meet a doctor who can have an intelligent conversation and is interested in me as a person.

I love talking to my patients ! They come from all over the world and have interesting stories to share ! I am naturally curious and love learning new stuff. Doctors tend to get very inbred and talking shop to other doctors can get very boring and monotonous. Listening to patients talk about their professions helps me to get a better understanding of what's happening in the rest of the world and broadens my horizons. Patients are smart and intelligent and are happy to talk to their doctors . They are a great source of intelligence - and I am not just talking about hot stock tips here ! They teach me about what's happening in the online world and help me to keep my website ( and my wits) sharp and clear !

Patients have a lot to teach doctors - I just wished doctors opened their hearts and minds and took the time to listen and learn ! Doctors need to be reminded that they are uniquely privileged in being given a ringside view to a person's innermost desires and struggles when their patients are battling with some of the life's most difficult moments. A smart doctor can learn a lot from his patients - both how to live and how to die when the time comes - he just needs to be willing to do so !

Like all professionals, doctors have a certain image about themselves . Similarly, patients have expectations of their doctors and expect them to conform to their mental model of how a doctor should behave.

Life was much easier in the past when both patients and doctors expected doctors to behave as demi-Gods. The doctor was a shaman who was considered to be a healer who had been inspired by divine powers which he could use to help the sick to get better.

In modern society, however, things have changed considerably; and few patients will treat their doctors as God-like figures ( and I feel most doctors would also be very uncomfortable in this role !)

What roles do doctors adopt today ? These are primarily three, as articulated so well by the British economist, Julian Le Grand. We perceive doctors act as:
Knights ( when their major driving force is virtue);
Knaves ( when driven by rigid self-interest ; or as
Pawns ( when they feel they are just passive victims of their circumstances.

All doctors play all three roles at various times in their life – but your primary avatar will depend upon your life experiences and your self esteem. We are Knights as we care for our patients. Always acting in the best interest of our patients is our primary professional role, and society holds us in high esteem for that. However, many healthcare activists take perverse pleasure in painting doctors as being self-interested and greedy; and paint all doctors as having Knave-like qualities ( an unflattering image some doctors help to reinforce when their primary focus seems to be on grabbing money ). Finally, in this day and age of insurance paperwork and governmental regulation , many doctors have simply given up and play the role of a bitter passive victim who is overwhelmed by demanding patients and squeezed by corporate hospitals. However, society is not kind to Pawns !

If we as doctors want society to regard us with the respect which we feel is our due, we should be aware of societal perceptions and foster a regard of doctors as Knights, and not as either roguish Knaves or helpless Pawns. Remember that society will treat us the way we expect to be treated and we will get what we deserve !

So how do you behave as a Knight and get your patients to trust you ? By proving that you deserve their trust – and you need to earn this, by being generous with your knowledge; showing your patients that you care; respecting their time; and fulfilling your promises. The hallmark of doctors who have been elevated to the status of being treated as trusted advisors by their patients is that the doctor places a higher value on maintaining and preserving the doctor-patient relationship itself , rather than on the outcome of the current consultation.

Establishing a history of reliability is one way to build trust. For example, if you tell the patient you're going to call with lab results, make certain that you do just that. Doing this the first time will show your patients that they can count on you. Doing it again and again will build trust. To win your patient’s trust, you have to behave as a professional – someone who will place the patient’s interests before his own – so that both of you benefit in the long run ! This is why senior doctors valued their reputation so much – it was built on the foundation of a lifetime of hard work – and even though it is intangible, it represents the fact that patients have trust in you.

The Trust Equation , as defined by David Maister, is simple.

T = C + R + I/ S, where

T = Trustworthiness
C= Credibility
R= Reliability
I = Intimacy
S= Self-orientation

Credibility = can your patient trust what you say ?
Reliability = can he trust your actions, confident that you will act honorably ?
Intimacy = is he comfortable discussing his feelings and emotions with you ?
Self-orientation = can he trust your motives, knowing that you care about him, and will act in his best interests ?

Professionalism is one of our core competencies , and we need to encourage all doctors to behave as Knights in the care of patients. Being a physician is still one of the greatest privileges society offers anyone, and we should always remember how fortunate we are.