University of Health Sciences

Project Professionalism Punjab

Image Critical Appraisal, September-2015
The Need for More Communication and
Less Pills
Most people do not listen with the intent to understand, they
listen with the intent to reply.
These words of Stephen Covey are so true of the conversations of
todays doctors with their patients, and that too if we presume that the
doctors somehow listen to patients.
A hasty doctor, with a long list of waiting patients, tired from the
morning checkups of patients, worried about financial and familial
matters is now the norm instead of the exception.
Spend a day observing the everyday communication between
patients and doctors and you can easily discern the banal remarks:
Here is the consent form, read and sign it. And please hurry! We dont
have time for unnecessary queries.
I have written the medicines, take them from the pharmacy, you will
get well. (Implies: You can leave now. No more questions. Send in the
next patient!)
Its the only option you have. (Implies: Now, I want you to have this
treatment. My word is final. Lets just presume that there are no other
options for your disease just because I am saying so and I want you to
have this treatment).
Just tell me where your abdomen hurts and thats it. You can discuss
your blood pressure with a physician. I am a Surgeon and not a Medical
Specialist
You are surely in luck if you happen to overhear a conversation
that sounds like this:
Do you want to ask anything else about your condition? Please feel
free to ask.

These are your treatment options. I have explained to you the pros
and cons of each. Take your time, discuss with your family and then let
me know which treatment you opt for.
I can truly understand your situation in suffering through this ailment
and I will try my level best to alleviate your pain and agony.
Are you fully satisfied with the current medical care provided to you or
you have you have some grievances that we can address?
A shift from former to latter approach might appear to be
formidable but is not at all impossible.
Too often, a listening ear and an empathetic heart is all that is
required to cure maladies. But patient satisfaction, trust on doctors and
the quality of care provided continues to deteriorate due to this Say
No to Communication attitude of doctors.
Medicine has transformed from the art of listening, communicating
and healing by building patient centered relationships to a doctor
centered milking cow business, where patients are no more than robots
being dealt mechanically by being offered a piece of paper instead of
human comforting and empathy.
The words of Terry Canale that carry profound wisdom lie that
every doctor must imbibe:
The patient will never care how much you know, until they
know how much you care.
It goes without saying that the situation is in dire need of reform.
Doctors need to learn effective communication skills since they it is
an art not acquired simply by being conferred a Degree in Medicine.
Moreover, delivering a lecture or two on communication skills is
not the holy grail that will instantaneously cure all ills. The malady
needs healing beyond the classroom: beginning with the doctors that
the students take as their role models. The practice of do as I say and
not as I do needs to be abolished in toto. Once the students look at
their mentors pioneering the behavior, it will become second nature to
them. In addition, practicing good communication through role play

and feedback can contribute momentously to raising future doctors

that are not just prescribers but healers.
Simple acts of smiling cheerfully, greeting patients, shaking hands,
respecting privacy and answering patients queries and showing that
you understand patients perspective of the problem can add a whole
lot to patients satisfaction and relief---a feeling that can only be
discerned once the tables turn on you to become a patient at a
doctors clinic.
Dealing with difficult, mentally ill and physically disabled patients,
breaking bad news is no piece of cake. But with constant practice,
targeted and goal oriented teaching of communication skills and
appropriate assessments, not only can patient suffering be alleviated
but clinicians work related fulfillment can also be enhanced. Moreover,
chances of errors on clinicians part due to stress are reduced.
I cant help sharing with the entire medical community, the words
of this anonymous letter by a patient to a medical facility, which have
transformed my perspective of looking at a patient and which I wish,
can become a reminder for every doctor on the planet:
Never lose sight of the people behind your charts. Each chart
represents a person--with feelings, a history, a life--whom you
have the power to touch for one day by your words and action.
Tomorrow it may be you loved one-your relative or neighbor(or
worse, you yourself)who gets marked as a case number, a
green card, a name to be marked off with a yellow as done for
the day.
I pray that you will reward the next person that you meet at
your station with a kind word or a smile because that person
is someones dad, mother, wife, husband, son or daughteror
just because he or she is a human being created and loved by
Godjust as you are.
Dr. Munira Malik
Lecturer,
Department of Medical Education,
Wah Medical College,
Wah Cantt.