THE BITTER PILL...

Hi all,

Every time i sit to write something on my blog i think of my experiences with my patients.. Later on i started to wonder what patients might be thinking about doctors. i wanted some patient to just come forward and tell or rather write.. This was made possible after i joined Indiblogger. Indiblogger gave me a chance to see thousands of bloggers all over india.. I was surprised to see the number of bloggers in india.. I started attaching my posts and while working on Indiblogger i came across various blogs, different topics, different ways of looking at life... The experience was thrilling! Thanks Indiblogger! 
We, Doctors generally see that patients above 60 years are depressed about something or the other. They generally isolate themselves... But here in indiblogger i came across a beautiful , well written blog  My clutter,My life.  i was amazed to see that this blog is being well managed by a senior citizen by name  Pattu Raj from Hyderabad. i found that she was a fun loving and cheerful senior citizen ( very rarely do we come across such great people) . I made up my mind and requested her to write a guest post for my blog which she graciously accepted. 
The next surprise was in store for me was the way she has dealt the subject. I had requested to write on "What patients feel about Doctors"  She managed to give me a beautiful post. The points in the post were beautifully handled. At the end of the post i really started to feel that something should be done to streamline medical profession. So here comes My interactions with Doctors by Mrs.Pattu raj


MY INTERACTIONS WITH DOCTORS - PATTURAJ

Visiting doctors used to be nightmare. In childhood, it was Ayurveda powders and Municipal Hospitals. Mostly Ayurveda, an old Doc having hair on his ears, and a scowl. His powders were all same color , but it healed I suppose.

Moving to a big city brought me face to face with young doctor experience. Younger formative years had a romantic view of medical personnel, their lives full of lofty service, inspiring me to join the profession. That did not materialise, I was scared of Zoology, a compulsory one to master those days for medical admissions, thus generating an unattainable glamour.

But when I went for a medical examination before a new job, the lady doctor( who did not even had a MBBS) with an unpleasant face performed some examinations, without me realising that she was shaming me . It was a thorn in the mind for many years. Another bold co-worker had the courage to object to such rude behaviours and got the examination stopped for all lady employees. A very bad experience indeed. Later I understood how her husband being on our office rolls, is the leverage for her to be on our office payroll. Way of the world we thought.

Her husband was a law unto himself. He would prescribe the same red tonic and Anacin for any ailment. In fact his tonic was so good ( alcohol content), which went by the name cough syrup, a favourite with many male employees who used to fill bottles, by posing as phlegmatic. We ladies stayed clear of him except when he would grudgingly give fitness certificate before joining duty from sick leave.

We also had a young doctor practicing near our home, in a garage. He was a kind person, and used to slowly explain, if asked. My dad used to accompany us, so he would talk to him. We did not have much interaction, but I remember he made us aware of penicillin and resistance. Antibiotics were slowly making appearances, but Doctors were not prescribing them easily.

The shock of motherhood, wailing baby, brought me face to face with paediatricians. A very kind and sweet doctor was recommended, who patiently explained what it is to take care of baby ( No knowledge of Spock at that time). For years we consulted him, and now heard that his son has taken over the practice.

Later , moving into our home in a newly developing area brought us in contact with an young Doctor . The rapport was admirable, we English speaking patients, young , he wanting to have a name and develop practice. We all grew together and he would simply write medicines which we would swallow get well, and recommend him to all and sundry. The area developed into a centre of its own. Our Doctor too prospered, increased his fees on the gold rate, and we did not mind. We were getting good care. He would come for old age care, answer calls, and he was good.

Years passed by, while Antibiotic was the norm of the decades for every illness, a new company product would be prescribed. Internet, medical articles in popular magazines, friendly advice from Overseas friends who were also doctors gave some insight into use of medications in India.

The doubts started creeping. Why so many medications?- a nagging question . The Doctor would give some convincing answers to calm us. As the years passed, we noticed that he would prescribe certain company medications, and insist that we use the pharmacy he suggests. We also knew he was charging more than other doctors. Still with due respect to his age, and experience ( it is 30 years and more). He went for some training certified programmes and started calling himself this specialist, that specialist. He is authoritative, therefore most of the patients are afraid of him.

He never thought patient should be informed about the medications that he prescribed or he needs them to understand the side effects. He hardly will communicate, and simply wave away the questions.

All our associations with him for decades, did not cut ice with him , one day. When I had a severe pain, writhing, at midnight, we did not know what was wrong, he refused to come home pleading he was too sleepy and we should look for someone else. That was a slap in the face. But we let it pass.

We also started noticing that he was prescribing too many medications for small illnesses. When we asked him he would forcefully say something or change the topic. We were getting more knowledge of medicines from the Internet. Over a period of time , we started rechecking the medications and find out whether it is really necessary to take so many antibiotics for one illness. He would slyly insist we need to buy medicines only form the pharmacist he recommends, and do pathological tests in places he would point out! We understood.. the game. However he was our GP and that was that.

There was another young man practicing, not so suave as the other one, but was willing to charge much less, a son of soil, attracting lot of clients. Initially he was fine, but over the years, a chance encounter with him showed his true face.

Three years back, when I was brimming with pride about my health staying in good stead despite 6 decades on the age front, a sudden onslaught of body heat, toe tingling, sore, tiredness, and fatigue urgently called for consultations., in the absence of GP. Surprisingly this doctor was grumpy and looked bored. My BP was very high. A big shock, to me and husband. My mind racing to the hectic months I had at home due to sever home cleanings, a strain of trips undertaken and guests care. I was ticking in my mind to stop alla dn take rest and be back to normal soon. The doctor was writing down sugar test, which made me exclaim, I never had this sugar problem so far! He smiled crookedly and announced," Where BP is the Sugar is sure to follow"!.

That remark was a jolt to my pride and senses. Is this the way doctors break news to patients about possible problems? Where are ethics, I was seething with confusion and frustration. I am sure my BP went a few notches in those moments. Meanwhile, the blood sugar test was conformed the high Blood Glucose levels.

Needless to say, I never went back to the said Doctor, to save my pride, and avoid his leering smile of I told you so.

We had another family friend, who is also a doctor and who was also a Type 1 Diabetic. He was consulted urgently and he prescribed some medicines. He advised use of sugar free, and less use of sugary stuff, and less rice, but otherwise continue living normally , with walks whenever possible. The problem was he was not living the city , he was also prone to high irritability which he concealed. I was not comfortable consulting him at all. He would direct my husband to inform me about my problems and solutions , which I was unhappy. I am the patient , why tell the husband?

The GP was back and I consulted him with the reading. He made some sympathetic noises and said, do not worry, I will look after you!. How comfortable I felt. He gave medications and I followed them reverently. The blood glucose level was in manageable levels, and I was back to near normal for a few weeks. Once again some complaints cropped up and I sought the GP's help. He increased doses, and forgot about me. I was very disturbed. Why are the doctors not explaining the side effects of medications? The long term consequences of Type 2 diabetes, meal plans?

That drove to the Internet Where I found similar questions posed by Type 2 sufferers all over the world. I found that one common medication does not go well for all patients. In the west, the Doctors are required to explain to the patients about the medications, side effects and about the illness.

I was at sea. My GP would not be open to discussions at all. He would brush aside everything saying 'oh' and change the topic. I was gaining the impression that he was prescribing remedies that would add to his collection and the pharma companies and diagnostic centres. I also gathered similar opinions from his other patients, who knew him since decades. That he was fond of over drugging., sometimes at the cost of the patient.

But we had fewer choices. He is nearer to the house. His timings are very good. We only need to needle him to get information. We know he over drugs us, now we are cautious.

Another incident reduced my trust in doctors. GP simply increased my dose of Diabetic medicine doubling the dosage. The first day, the effect was mild. Next day, I could not even get out of bed. I was utterly weak with nightmares in my sleep through 24 hours. My alarmed family checked the Internet and found that it could have been overdose. We called the doctor on phone since I could not move out of bed. He simply dismissed it by saying " ok revert back to your smaller dose"!

The experience of shoddy treatments, the careless dismissal of patients, the over drugging, all made me lose faith in today's GPs. Now I am more careful when I get prescriptions. I buy from reputed outlets, and look for all the side effect before popping them up. Meanwhile, I think of all those patients who flock to the Clinics, gullible, without any knowledge of side effects to their bodies, and despite medications , their deteriorating health . Sad.

I learnt a lot about Type 2, what I should do, and how to go about my diet. I bought books, found out about home testing blood glucose levels, buy my strips and keep a watch.

I feel for those who get attracted by big Diabetic camps, sign boards proclaiming doctors as " Diabetologists' mushrooming all over the country. Is it really ethical practice? Do the experts really give suitable wholesome knowledge for the chronic ailment and measures to curb, with suitable advices? I wonder.

A lot needs to be improved in patient care and communication between doctor and patients in India. The ignoring of patients requests for details, and the shoddy way the drugs are prescribed , tests conducted , leads to patient losing confidence in the doctor. Different patients perceive differently, but ultimately they are the ones to bear the brunt of medications. In major illness, the patient or their relative needs to be explained , certain facts of the illness and medications prescribed. Those well-educated patients who have idea of illness and medications are able to understand side effects and make choices while getting treated.

Out of fear of being critical some patients may not even say anything to the doctor, even though they have observed side effects and , have stopped taking the drugs. In such a scenario the doctor will continue to prescribe similar drugs and the patient will continue to suffer. Not having a channel of sound communication with the doctor , usually results in overdose and more side effects affecting the patients, In India, doctors largely lacks this patient communications skills.

Finally Wikipedia says:

"A patient must have confidence in the competence of their physician and must feel that they can confide in him or her. For most physicians, the establishment of good rapport with a patient is important. Some medical specialties, such as psychiatry and family medicine, emphasize the physician-patient relationship more than others, such aspathology or radiology.

The quality of the patient-physician relationship is important to both parties. The better the relationship in terms of mutual respect, knowledge, trust, shared values and perspectives about disease and life, and time available, the better will be the amount and quality of information about the patient's disease transferred in both directions, enhancing accuracy of diagnosis and increasing the patient's knowledge about the disease. Where such a relationship is poor the physician's ability to make a full assessment is compromised and the patient is more likely to distrust the diagnosis and proposed treatment, causing decreased compliance to actually follow the medical advice. In these circumstances and also in cases where there is genuine divergence of medical opinions, a second opinion from another physician may be sought or the patient may choose to go to another physician"