CHANGING PATTERNS IN PATIENT DOCTOR RELATIONSHIP

CHANGING PATTERNS IN PATIENTS AND PRACTICE

Today unusually I was in the out patient block seeing patients. I have been quite busy over the past few months. Doing many cases daily forces me to see most of my out patients in a room adjacent to the operating theater.

A mid thirties smart man walked in to the room and for convenience I will call him Joe. Joe was well dressed, a fit and articulate young man. He announced that he had an anal fistula. He came to the hospital last week and ordered on his own an MRI of the wrong end of his gut for confirmation. His ordering MRI on his own surprised me as this is an expensive test and a fairly new one to most of the surgeons ;…… also how did  hospital do this without any doctor authorizing it.

I assumed by now that he was an IT (Information Technology person from computers) man…. well informed folks these are. By now, Joe wanted me to read the MRI x rays and tell him if this necessitated an operation. This was most unusual as you normally pay the doctor to examine you first, and then to advice you!

As  a medical trainee from Christian medical college and later on, as a surgical trainee from the same alma mater, I was always trained to ask, “ What is your main problem?” “Fistula in ano”, said he and looked at me in wonder as if I was a moron!

When I persisted, “How does it bother you?” He said, “Not at all”. Now it was turn to look at him and return the compliment. He further surprised me saying that he did not want me to touch him and examine him , but just to look at his x rays and give an opinion! What an extra ordinary request!

I explained that generally I needed to examine him first for an opinion…. “No … no … no examination, just your opinion,” was his comment. Well, I decided to take him to the x ray suite and show his films to the radiologist for his actual comments.

The walk to the radiology was an eye opener for me. Joe had initially consulted an Auyervedic practioner for many years before seeing doctors. He had consulted even a colorectal surgeon for this ailment and when he advised surgery, he did not trust him. Well why should he trust me I asked….He had also googled me before coming. He had no belief in doctors. The reason?....His father who had suffered from stroke was not treated well by a well known neurologist. Joe also added that the doctors who had seen him for the present complaint never had enough time for him.

By now we had come to the end of our walk and arrived at  the x ray department. As luck would have it, radiologists were away at lunch and a young radiographer opened the x rays on the console panel and I explained patiently that the condition was a mild one. Since he had no symptoms, he might well use medical measures initially. I then offered to wait for the radiologist to return from lunch so that we can discuss with him also for a final opinion.

By now Joe appeared totally satisfied and said that he was happy with whatever I had done for him. He in fact said that no further opinion was needed and thanked me much for my time.

When I look back at the situation, I do not see an enlightened IT person. I just see a young terrified man who is scared that his surgeons have no time for him, that his doctors make mistakes in diagnosis. I wonder if the fault was really on his side or the physicians who saw him earlier. One is trained to inform and inculcate confidence in patients. This may take time, explanations and a great deal of patience. I know Joe may have upset his surgeons by his questions due to his anxiety and past experience with physicians. Had I not walked with him to the department of radiology, I might have completely missed it too!

He does not want surgery now but medications;  that  is all the advice he needed along with enough time for him to digest. He appeared satisfied…. Did he? Only time will tell!

Who knows… he might even let me examine him next time!

Goodbye Joe!

( Picture is "The Norman Rockwell image of the doctor-patient bond)