Doctor is your friend and your friend is a doctor!
Long post alert! Please bear with me!
These are some personal experiences which have been generalized; I am sure that many of my doctor friends would have faced similar experiences.
Most of the times since lets say a doctor is a specialist with expertise in one area; and gets patients who have been seen by other doctors and treated for the same until the treatment either does not work or the doubts from the patient is increased!
When such a patient comes to him or her; they usually click bait telling him or her that the other doctor did not treat properly! Or his or her charges and fees are more (or sometimes less!)
This happens too often in private practice and also when patients go to government hospital and then consult you!
I have seen doctors announcing grandly how the other doctor got the diagnosis wrong and in this rat race world; it is a common issue! or Proclaiming that his or her treatment modality is wrong!
There has been a old saying going around for a long time, ‘No two doctors would ever agree on a common diagnosis or a mode of treatment!’
It does not help that there are too many options now for both doctors and for treatment modality!
Added to that there is also a huge pressure to keep everyone happy!
But in the quest of all this; a single comment from any doctor can put the whole medical community in jeopardy!
This has already happened in all parts of the world and the faith which patients have or had on doctors is reducing day by day.
There were times when just a single opinion from your friendly neighborhood GP would solve all your doubts and now even the recommendations from the topmost doctor of the biggest hospital of your area is seen or treated with mistrust.
Of course the return of faith of patients to doctors is a long way now, but what we doctors can do is at least not put down our own brethren.
Coming back to the patients referred to the specialist; Just read these three small incidents
The other day the doctor saw a patient referred by a senior pediatrician who informed the patient that he has polyps in the nose while on examination he knew that they are something called the Inferior turbinate Hypertrophy which are normal structures and treatable by medication. He explained to the patient that it is a Polypoidal mass only and that the doctor was right in finding it and sending him to me! He could have easily announced that he or she is wrong (which was his first primal instinct)! Then he saw that he or she did not do any wrong intervention or give any medication which was harmful to the kid. In fact most of the treatment for both is similar.
It is the same with ear wax or something within the ear; So many times we receive referrals after the start of an ear drop which was either not necessary or incorrect. But most ear drops are safe; they do have immediate calming and analgesic effect and most are sterile. So all we do is gently tell them to stop the drops and continue with our treatment. Even in the case of foreign body in the nose or the ear sometimes the first doctor manipulates and the whole field is full of either blood or secretions. Even then we give some medications for the temporary relief and make a point to state that in emergency it does not matter and the first treating doctor had only immediate relief of the patient in mind. Finally the nose cavity or the ear drum can be healed. We can manage any complications in the long run so no need to worry!
In the giddiness management; the most common cause is BPPV where the management is a simple positional maneuver and not medication. The medication also would almost always be under prescribed or incorrect dose. Since the medications are usually under dosed; it really does not make any difference and we simply say that we would be giving the same medications but in a different dose. We would also add that the doctor would have started a lower safe dose initially and now we can start the actual higher dose!
This can happen to any doctor like if the said doctor refers the patient for a physician or cardiology consultation when he finds something in the ECG!
Now these three are only simple examples on how we can still change the treatment and not put the previous doctor at fault since there are two basic principles which we must follow!
One is that anyone and everyone can make mistake; However good or knowledgeable the doctor or surgeon is! My chief used to say that if you do not have failure in your surgeries then it means that you have not done enough surgeries!
Second and most important is the law of Karma! Your patient may still go on to another doctor or you may have to refer a patient to another doctor. At that time you would want that doctor to give you the respect you gave to the previous doctor!
More important is that nowadays even if the patient has come to you for a second opinion; it is not necessary that he or she has come to you for a different opinion! You can still agree with the previous doctor and the patient will have a healthy respect for you! I am sure that most patients would not want one doctor cursing or blaming another doctor in the long run! If you do not agree with the doctor you can still tell that there are different options and no options is wrong!
I have so many patients who come to be with proper complains against another doctor but even then I try to support my brother or sister however strong my feelings are. I would tell how at that particular time, the doctors decision or recommendations would have been apt which is true most of the times!
Of course that does not mean you support gross proven negligence of a doctor in which case, I would simply not comment since I am not in a position to do so anyway. Even then everyone must remember that even doctors are human and they make mistakes! The only difference in most cases is that the mistakes of the doctor haunts the doctor and the patient for life!
I would encourage my colleagues to think about a few points before commenting against another doctor.
You do not know the condition or the situation of the patient or the doctor at the time of diagnosis or the findings. So instead of informing the patient that the diagnosis is wrong you can very well say that it was only the initial diagnosis and of course it can change after further test and examination. I still remember how a patient with sinusitis diagnosed and treated by me wrote on a public platform that my diagnosis is wrong and that he had teeth infection! I informed him that he can have both! But by that time the damage had been done since the comment was placed after giving negative rating!
In the days of rating; it is even more important to be very careful on what you comment to the patient.
When it comes to different options such as a new medication or whether surgery is indicated or not you can give options to the patient with pros and cons of each option since even the best modality of treatment has its positives and negatives and in modern medicine sometimes the treatment is not right or wrong but only a choice made at that time.
Most important is to avoid silly statements like, “You have got a wrong treatment or diagnosis” or “Your treatment was started late” or “It was diagnosed late” or “This test should not have been done!” or “this test should have been done!”
As far as tests are concerned; every test can either be done or not! It all depends on the situation! If you think a particular test must have been done by the doctor before then why cant you think that the doctor did not want to burden the patient with additional tests! There are still doctors like me who would like to think that a good clinical history and examination is most of the times enough to reach a diagnosis rather than a battery of unnecessary test!
Of course the opposite is also true when you see a patient who has undergone all possible test and now feels that the doctor has done unnecessary test!
I remember Edison’s statement here, “I have not failed 10,000 times—I’ve successfully found 10,000 ways that will not work.”
So I simply tell the patient the truth, “one more normal test will put your mind at ease that’s all!, it does you no harm and you have the additional benefit to know that you are more sure or healthier by one more test!”
When you get a case from your juniors with some error then try not to point out the error to the patient or make a big deal out of it; you can still make it positive in such a way that in spite of being a junior the doctor has made some right choices in terms of treatment or diagnosis. Remember you were a junior at one point of your practice too!
When you get a patient seen from your senior with old school or thoughts or old modalities of treatment you do not have belittle his or her experience but can gently mention that he or she is an experienced doctor and of course now we have some more options as smoothly as possible without sounding arrogant or insulting since remember that you will one day be someone’s senior!
The most common attitude problems I see is the way specialists and seniors treat the general practitioner and the Physicians who see the patient initially. Do not forget that the bulk of the patients are seen by them and for them to diagnose and treat your area is an added bonus. In spite of that they are kind enough to refer them to you!
I still remember how my Chief used to write personal letter of gratitude to the most simplest and junior most of the doctors just for the simple reason that he or she had referred the patient to him!
Finally I would like to remind both the doctor and the patient reading this; in the end both the doctor and the patient would always want the patient to get better. No doctor would ever want the patient to worsen. Only when the patient is happy can the doctor ever be happy!
The biggest happiness for a doctor is when the patient comes back and says that he or she is better with the doctor’s treatment! That is the only primary reason every doctor gets up in the morning to go to his or her work place!
Reading this I hope one doctor would make his or her brother or sister feel good about himself or herself tomorrow!
Just like how only a diamond can cut another diamond; only a doctor’s words can cut another doctor’s reputation…
Would love to hear your comments directly or at drsriramnathan@gmail.com
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