Non Clinical Approach To A Patient
NATIONAL JOURNAL OF HOMOEOPATHY 1996 Nov / Dec Vol V No 6.
Asrani C H.
How often you have wondered, that a particular doctor has very limited clinical knowledge, yet a wonderful practice & very good results. What is the secret? What is his approach to the case? Well! He is a wonderful communicator. He can get from his patient what he needs but much more important than that is the fact he can convey to the patient. THE right message that he cares, that patients well being is foremost in his mind. This the same teacher, studied together, same clinical approach, same Repertories, same remedies, one is very successful & the other is struggling to make both ends meet.
What then is Communication?
Its a two way dialogue, between a doctor & a patient where they both try to put their points across, in the shortest possible time without compromising on the content or quality of message.
Communication is of 2 types : VERBAL.
NON-VERBAL.
VERBAL COMMUNICATION (VC) : is what you say to the patient & what he tells you. Well here we are concerned with what you say or do not say; language then gains paramount importance helps one to have a command over a variety of languages, especially those of the area where you practice. For a practitioner in Maharashtra, not to be able to converse in fluent Marathi, is almost unforgivable. Also the language you speak should be lucid. We have to be able to converse with a millionaire, an executive, a driver and a maid servant with all of them feeling very comfortable. When ever command a language is not possible, one should gather terms denoting common symptoms, so that in the absence of a translator, some treatment can be given E.g. "SARDI" in Malayalam means "VOMIT" and not cold. .
Where all is verbal communication help?.
Getting proper history.
To explain problems & their solutions.
If a particular disease is going to take longer to treat.
When recommending major life style changes or pronouncing a disease with poor or grave
prognosis.
To explain the necessity, whilst ordering an expensive investigation.
Following points are important in course of VC:-.
1. What you say?
Always speak the truth. Truth can not be hidden for long and there are enough competitors out there to nail your lie.
2. What you do not say?
At times this is more important than what you say, especially in Homoeopathy, where you treat families. Care should be taken that information divulged to you in confidence by one member of the family should be accorded the status of "MOST CONFIDENTIAL".
3. To whom you say it?
News or information of significance, whether positive or negative, should only be the patient or a responsible relative. Even if a neighbour or friend is accompanying the patient we must take patients permission before talking to them. Keep in mind - patient has a right to PROFESSIONAL SECRECY and we can be sued for divulging such information.
4. How you say it?
Our only task duty is to treat the patient. We have no right to glorify, condemn or moralize a patients actions. Eg. if a patient has been a prostitute or is having illicit relations with your another patients spouse. It is not our job to moralize or condemn him. We can at the most explain to him the risks involved and continue to do our duty off treating him.
A mention must be made here of EVASIVENESS. This quality (sic) is a physician can destroy his practise. If you dont know something, accept it gracefully. Patients know science is changing very fast and it is not possible to keep abreast of the situation. If you feel you are able to fool the patient & hide your ignorance, I am sorry patients (and the people accompanying) have powerful antennae and your evasiveness is a sure sign of your ignorance.
NON VERBAL COMMUNICATION (NVC): Unlike VC which is in our total command, NVC is involuntary and difficult to control or alter even with great effort.
What is NVC?
Body & facial movements, as an accompaniment to speed, highlight he spoken word. Alternatively gestures, postures, speaking distance & emotive signals tell much more than thousand words.
Generally medicos consider themselves demigods. They never realize what impression they are casting on the patient and his family. NVC conveys the patient about the confidence or lack of it, your nervousness, command of situation or lack of knowledge.
Take an example. You are treating a HIV +ve case, either you are hesitant to examine the patient or your hands tremble or your compounder, while giving medicines, puts it on table or does not take money in hand. Patient knows two thing - his ailment is general knowledge you are not very confident in treating him or you would rather like that he does not come again.
Once you have mastered the Art of communication, next on the list are Bed side manners and Etiquettes.
Manners are proper way of behaving when dealing with a patient & Etiquettes are formal rules governing behaviour especially in a profession or proper way of carrying on your profession so as to maintain sufficient dignity for self & profession.
HONESTY.
U.
HUMOUR.
DIGNITY.
L.
I.
MODESTY.
Y.
A detailed dialogue itself may run into pages. Few highlights:.
Significance of each is self understood. Their application in daily practice although difficult is not impossible & definitely rewarding.
Some Other pointers:
- Manner of dressing - decent, clean attire. Jeans, T shirts are acceptable but shouldnt be torn, jagged etc. Anything that distracts the patients like 6" long ear decoration, intricate bindis are impasse.
- Manner of questioning about intimate problems especially to a member of opposite sex. Ask only pertinament questions without any undue interest facial expressions of glee or sorrow etc.
- Manner of examining a patient of opposite sex - this is more of a problem for female physicians than males. there are males around who drop their pants in a jiffy to show non existent lesions. They must look immediately their face & say "that will be all" but first call out to the compounder or assistant.
- Tendency to patronize for status, money, physical characteristics - It is very easy not to charge a politician, a film star, an industrialist without appointment or out of turn. We feel we can always cash on the obligations. Remember "A doctor, if takes an obligation worth of thousand, pays back a million". These extra free services are very difficult to stop later on in life.
- Tendency to amorous relationships with patients - A study done in the US (in 1987) showed that as much as 45 percent - 65 percent doctors have had relations with their patients. In our quest to ape the west, this is one area we should steer clear off. More so in a developing country like ours, keeping FREE patients to a minimum is top priority.
Use these tips in practice, if you are not already doing so.
