Gomantak Times – Weekender, 25 July 2010

More often than not, the average person begins searching for a doctor only when illness strikes, which is not the best time to locate one, explains Orlene D’Souza

Sonia had just moved to Goa with her family, and like all people who change their residence, she took great pains in locating the best school for her children, getting house help, meeting the neighbours etc. However, she overlooked one important aspect, and that was to identify a family doctor.

One morning, Sonia woke up with high fever and a splitting headache. The stress of her new job and settling into a new place had made Sonia susceptible to viral infections. She needed to see a doctor, but unfortunately, she didn’t know any doctor.

Like most of us, she too didn’t bother to look for a doctor until she really needed one.

So, she picked up the yellow pages and looked out for doctors in her locality. She shortlisted a couple of names, but she needed more information, so she asked for references from her friends and colleagues. However, this didn’t help much. Her friends and colleagues gave her contradictory feedback, making her decision making process even more difficult.

Asking for recommendations from friends and coworkers is not always the best way to start; after all, we each have our own needs and expectations of our healthcare provider. Choosing a doctor who best fits our needs is a difficult task and is perhaps one of the most important decisions we make. After all, we put our life in the hands of this person.

Here are few factors you would like to consider while choosing your doctor:

DOCTOR DEMOGRAPHY

The age and gender of the doctor sometimes influences our choice. We all have our preference when it comes to age and gender of the doctors. Some women might be more comfortable discussing their health problem with a female doctor than a male doctor. The age of the doctor seems to be important too. An older person might prefer going to an older and more experienced doctor.

DOCTOR CHARACTERISTICS

All doctors have their unique styles of relating to their patients, and as patients we have different expectations of this doctor-patient relationship. Understanding the doctor’s style will help you find your right doctor. Some of us would need a doctor who is an attentive listener, while there would be others who might need some reassuring or others who need comprehensive treatment information.

HOSPITAL AFFILIATION

It is good to know which hospital the doctor is affiliated to. Find out if the hospital has the facilities you are looking. Is the location of the hospital convenient; is the support staff good, does the hospital pricing match your expectations?

DISTANCE FROM HOME

Another factor you would like to consider is how far you would need to travel every time you need to visit the doctor. This is especially true if you do not have proper transportation facility.

WAITING TIME

If time is a constraint for you, it is important to find out the average waiting time for an appointment. You need to find out whether you could get an appointment the same day you call.

CONSULTATION TIMINGS AND PUNCTUALITY

If you are a working family, consultation timings is something you would need to consider. Look out for a doctor who practices after your regular working hours and who is punctual in honouring appointments.

OTHER FACTORS TO KEEP IN MIND

The other relevant factors to keep in mind when choosing a good doctor should be proximity to chemists, pathology lab and the presence of courteous and helpful staff. Careful consideration of the above will ensure that your choice of a family doctor is better informed.

[The writer is a faculty at the Marian Institute of Healthcare Management, Panjim, and can be contacted at orlenedsouza@marianinstitute.in]

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 meena.sahib@marianinstitute.in