Gomantak Times – Weekender, 18 July 2010
Advances in the field of medicine have made the detection and treatment of illness so much simpler. Yet, one feature is sorely lacking — the human touch. Meena Parulekar examines the need for this human element
Kuldeep Mishra, aged 54 years was diagnosed with a block in his right coronary artery a few days back in Mumbai and is advised to go ahead for a beating heart surgery by his cardiac surgeon after considering the severity of the block. Beating heart surgery is a special kind of by-pass surgery in which the heart is fully functional, use of heart-lung machine is not resorted to. Having undergone an angiography and angioplasty a few months earlier in January 2010, he is not sure of what he is heading for this time and needs reassurance from his doctor. The doctor advises him to choose between by-pass surgery or radiation therapy as there is not much time to lose.
For Mishra, however, there are other concerns like his feeling of discomfort with the stent post angioplasty and the nature and risk of bypass surgery. Is it asking for too much to have his doctor brief him about the nature and technique of medical intervention? Can his fears be allayed in some ways to prepare him physically, mentally and emotionally for the operation ahead?
HUMAN SIDE OF MEDICINE
Science and technology together have created wonders for mankind. Drugs and treatments that were thought impossible have today been discovered, tried and successfully implemented. The future is bright for molecular diagnostics, pharmacogenomics, stem cell engineering and the like. Medicine in itself is considered to be a noble profession and requires a certain amount of human touch to make the patient feel better. What, then, is human touch in medicine?
According to Dr Shobha Patkar, a practicing psychiatrist from Mumbai, the practice of medicine is both an art and a science. In the field of medicine, this very art is exhibited from the medical team in the form of empathy which goes much beyond mere words of sympathy.
Eg, “I feel sorry for you” – Sympathy.
“I feel your sorrow” – Empathy
This is precisely known as human touch and is displayed through the behavior of the physician.
Eg: 1) Attentively listening to the patient.
2) Trying to understand his feelings and attitudes.
3) Explaining the plan of action.
4) Allowing him to make choices if rational.
5) Creating an atmosphere of comfort, confidence and involvement to the extent required.
In short, human touch is nothing but genuinely being with the patient throughout his journey of sickness.
Earlier, the practice of history taking and complete clinical examination allowed the physician to know the patient and not merely know the disease. These days, after a quick initial dialogue, the patient is made to run to multiple numbers of experts, investigations and treatment modalities. In the process, the patient loses the primary anchor — the physician with whom he would have preferred to discuss the issues, clear the doubts and make decisions together. No wonder then, he feels not only exhausted, but rejected and helpless, too.
Advanced technology has not spared the doctors who rightfully expect the ‘humane’ approach from patients and relatives.
The so-called aware patient community who acquires information through advanced e-technology tends to doubt, disagree, and distress the doctor — forgetting that the doctor is a qualified and experienced person who has to be discrete and precise. In fact, many a time, a physician has to face legal consequences for not directing the patient to all possible and available diagnostic tools and treatment procedures, though medically not indicated in the opinion of the treating physician.
So, the patient and the doctor, both, have to be cautious and guarded just because mechanical culture is increasingly losing the human touch.
Dr Kalpana Chodankar at the NIO dispensary, Dona Paula, opines that advances in technology do serve as a boon in aiding the diagnosis, but should not stop the clinical examination of the patient, at large. A number of recent advances like mammography, CT scan are useful in terms of early diagnosis and assist in deciding the line of treatment for the physician. This is a huge benefit when one considers the severity of symptoms as manifested during a clinical presentation when it is too late.
IS HUMAN TOUCH NECESSARY?
It can be argued whether human touch is really required in medicine. In any civilized human society, we create, develop and nurture relationships as part of our social identity. In a virtual world, like today, where smileys take over real people in text messages, how much does the warmth of a real smile, a nice hug or a handshake matter?
Today, thanks to telemedicine, it is possible for a diagnosis to be made by a doctor while sitting in his plush cabin without actually having to go out and meet his patient in a remote village or a town in the country. It is technology that has made it possible to have a blood sugar test done in the convenience of our homes, or for that matter, the cardiac activity can be monitored by a simple device worn on the wrist of a patient. These are advances in the realm of technology that have surpassed our expectations.
For a healthcare professional, who has to deal with the human touch in such interventions, some issues that hold prime importance are: Nature of treatment or surgical intervention; availability of resources in the public or private setting; severity of symptoms/illness; co-ordination in terms of healthcare delivery with other services/service providers.
At the end of the day, a patient-centric approach is most desired for all interventions; however every situation/case has its own set of demands and constraints faced by the hospital administrators/doctors who handle their patients in a hospital.
For Kuldeep Mishra, the decision to go in for the beating heart surgery may be tough, but it may actually be the only best possible way to save his life.
The writer is faculty at the Marian Institute of Health Care Management, Panjim, and can be contacted at firstname.lastname@example.org