Healthcare is a Blackbox

Every country’s healthcare system needs significant overhaul. More so for large countries, and even more so for large, developing countries like India.

While many fundamental, structural changes might be needed to bring about this overhaul, I can, with my experience with amma, only talk about one aspect in which an overhaul is definitely needed – patient education.

If my experience in the last ten years – ten hospitalizations, and visits and consultations with over 25 different doctors at 15 different hospitals and clinics, mostly in and around Chennai – is anything to go by, doctors need to provide far superior education and awareness support to their patients or caretakers, especially those with complex and life-threatening ailments like amma.

The cardiac specialty hospital in which amma had her first aortic surgery and many further hospitalizations certainly had saved amma’s life more than once. I consider myself and amma fortunate to have chosen this hospital. But even here, the quality of doctor-patient communication was quite average – in most cases, they just wanted us to follow their recommendations.

I have rarely met a doctor in this or any other hospital who, after seeing amma, spent even five minutes, either himself or through his assistant, to explain in detail each and every drug on the prescription clearly, along with its benefits and side effects. Some doctors surely have been patient, but that is not the same as being useful.

Doctors may have genuine reasons for their reticence. In some cases, patients with little education or those who are too old to comprehend may not be able to fully understand details of the medications. For these cases, blindly following doctor instructions with periodic visits to the doctor might be the best approach.

But where the patient herself or her caretaker is well educated, doctors have no excuse at all not to have detailed education and awareness sessions on drugs and treatments prescribed. Especially for complicated and risky conditions like amma’s.

It is important that doctors adopt a more patient-centered communication model compared to the physician-centered approach they adopt right now, at least in India. A paternalistic,  physician-centered approach might have worked when the patients knew little and when physicians actually had enough time and bandwidth for each patient. 193

Today, patients or their caretakers across the world are more informed and educated. At the same time, doctors in large hospitals can hardly be said to have the deep, paternal care that doctors of yore had. Medicine is today far more a business than a service it was in earlier times.

Under such circumstances, if a patient can get only limited attention from a doctor and only at discrete time spans, the patient or the caretaker should be enabled such that they are able to support themselves in the best way possible while they are outside the hospital.

Medicine is a profession too. It has its own compulsions, and so do the doctors – they have the next patient waiting in line, and they also have a family who wants them home by 9 PM at least!

But we are talking about life and death here. Something has to change.

Fig 57: What should be the doctor-patient communication model? Should it be paternalistic or patient-centric? That depends on the complexity of the ailment and the education/comprehension level of the patient or the caretaker. Like most things in life, there’s no one solution that fits all.

Living to a 100 <= Healthcare is a black box => A template for doctor-patient communications

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Notes

193. Arriving at an ideal template for patient and family education could be quite difficult, as this detailed 2014 study shows – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4346059/ . But a start has to be made which takes it from zero currently to at least 5.

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