A Confused Patient Doctor’s Diary
By Dr SC Sundriyal |
Sun, 09 -Feb, 2014
"You are suffering from lumbar lordosis and intervertebral disc prolapse at L3 & L4.’’ The patient was a young man in his mid-30s. He was an affluent businessman and hardly had time for carrying out his routine activities. His business and domestic interests clashed and he had no idea how to tread on the thin line. This resulted in stress which led him to a psychiatric consultation. The counselling sessions of the psychiatrist were not very rewarding. The patient was a friend of mine and since he could not understand the treatment of his back pain, he had come to me, so that I could listen and talk to him. The psychiatrist was very busy and had a huge waiting list. He was unable to attend to patients and instead of answering queries, wrote prescriptions because the next patients in the queue always pushed the patient’s sessions forward. The doctor ended up prescribing anti-stress medicines and a small discourse on changing the lifestyle of the patient. In the counselling sessions, the doctor discovered that this patient of mine suffered back pain and promptly ordered an X-Ray of the back. After having read the reports, he referred the patient to an orthopaedic surgeon. ‘’He has lumbar lordosis with an intervertebral disk prolapsed.’’ The busy surgeon contemplated the ominous looking black grey film on the lighted view box and told me quickly. I understood what he had to say between the lines. Patients with new fractures in intense pain, old operated patients, jostled around him and he sat helpless watching the melee. I sat in front of him, demanding to know what he meant, but the surgeon was tired, helpless and lost in the crowd. Since he was my colleague and best in the town, I relied on him. ‘’Get a lumbar MRI done and take pain killers till then. And if it doesn’t work, then we will go in for fusion surgery.’’ I moved out of the busy OPD and this friend of mine demanded to know what was wrong with him. The patient was frustrated and more confused and I could not say what needed to be done! His back pain persisted and was real. I did not hear from him for nearly two weeks. One day he rang me up. ‘’Going in for alternate therapy from an Osteopath.’’ I had nothing to suggest at his choice of treatment. When doctors don’t have time to explain diseases to the patient, then the problem arises. Patients get conflicting opinions on the remedy for their problems and usually switch on to alternate medicine. That’s what my friend did. ‘’He guarantees a 100% cure,’’ he told me over the phone and it surprised me. How could anyone cure an intervertebral disk prolapse, if surgery was needed to repair it? But the patient had already made up his mind. It is a new trend nowadays. Affluent or well educated patients, when confronted with an illness having conflicting opinions, turn around and start browsing the net. Unfortunately, the information available on net is more than a patient can handle. Many websites offer panaceas and claim cent percent cure rates with testimonies of ex-patients in favour of their healing centres or doctors. My friend also landed up with one of these best doctors for his back pain. He did not listen to me or his people at home. Admitted to the centre, he underwent primary traction of the spine more than was prescribed. The spine sustained traction injuries and he developed paralysis of the lower legs. In this moment of panic, the emergency call came to me and I learnt about him and the doctor in the nursing home. An FIR was lodged and the police found fake degrees of the doctor subsequently. The patient was admitted to a multi-speciality orthopaedic hospital and had three corrective surgeries. He was bed ridden for nearly 6 months and was able to walk back home on callipers. Whenever I saw him working in his office in the wheel chair, I was always reminded of that big weakness in us as doctors- not listening to patients and keep them guessing and confused. We never listen to patients and try to presume their diagnosis before they finish telling their complaints. As competent specialists, doctors have many patients and the vicious cycle of patient-time debt starts. They do not give enough time to their patients because they don’t have it and most of the time, they are not listening. An average doctor spends about seven minutes with his patient and most of the time, the doctor is not listening. Many a simple diagnosis has been missed on this count. Patients do not understand medical language or technical jargon and get easily bewildered. They are never told about multiple options of treatment available for a disease on the pretext that they will get more confused. In fact, if doctors tell their patients clearly about illnesses and treatments, then clarity of decision can be made very easily. And, perhaps, as doctors we need to infuse confidence in patients and not to confuse them.