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( By Dr Aniruddha Malpani )

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Chapter 2 - Bridging the doctor-patient communication gap

When Mrs Bhatia had swollen, painful knees, her physician made the right diagnosis of osteoarthritis.

While prescribing the standard course of anti-inflammatory medicines for her, he did not provide her with a list of the possible side effects. MrsBhatia, on the other hand,also did not tell him that she had a peptic ulcer. The medicines caused her ulcer to start bleeding, leading to an emergency gastroscopy to control this. Frustrated with her doctor for not warning her, Mrs Bhatia complained to her friends and neighbours about her doctor's incompetence. This greatly unsettled her doctor, a caring physician, who felt betrayed that his reputation was being tarnished for no fault of his.

Every doctor wishes to see his patients get better. The strong urge to help and heal others is the primary driving force for choosing medicine as a profession. It is the ultimate service profession, and since it entails a one-on-one relationship, good doctors devote a lot of their time and energy in keeping their patients happy. Apart from making doctors feel good about themselves, patient satisfaction also makes immense business sense. Contented patients are the best source of new patients. Word-of-mouth marketing goes a long way in expanding a doctor's practice. This is why happy patients make for happy doctors!

Unfortunately, not all patients respond well to treatment. Medicines do not always work, and the human body is unpredictable. Most patients understand that the outcome of medical treatment is uncertain and that just because a problem occurs, this does not mean that the doctor was incompetent or negligent. Sadly, not all patients adopt such a mature approach. They are angry and need to vent their frustrations, and a doctor is an easy target! Some get abusive (both in real life and online), and others may even get violent. Rather than sit dispassionately with their doctors, they often end up bad- mouthing them and damaging their hard-earned reputations.

What's worse, this sets up a negative vicious cycle. Doctors who have been abused by angry patients often start becoming resentful. They start practising defensive medicine and distancing themselves from patients to protect themselves. Also, doctors talk amongst one another, gathering from other doctors' experiences that patients can be vengeful (for no fault of the doctor's), and that doctors need to protect themselves from their patients! It is tragic that affairs have come to such a sorry state. A lot has been written about how the doctor-

patient relationship has deteriorated in recent times. While many people are happy to blame doctors for this,unfortunately, no one has highlighted the role that patients play in damaging this relationship. Any relationship is a two-way street, and a doctor who has been sued or abused is no longer going to be the same person he was before the ugly episode.

It is a vicious cycle - unhappy patients create unhappy doctors, which in turn again create unhappy patients, since such doctors do not take good care of their patients and often end up disrespecting them and providing poor quality care. The doctor-patient relationship starts deteriorating and becoming adversarial!

Many studies have shown that patients do not sue a doctor simply because of an undesirable outcome. Most patients do understand that doctors are not Gods, and that medicine is not an exact science. However, if the doctor does not bother to communicate effectively with the patient after such an outcome, this is the equivalent of adding insult to injury.

Patients then get angry and find outlets to express their anger.

The best way to prevent this problem is to ensure that patients have realistic expectations. However, doctors are often too busy to be able to sit down and talk patients through all possible outcomes, and most doctors do not want to scare off their patients by talking about risks and complications!

This is why providing Information Therapy through websites and videos is such a great way of obtaining informed consent. It allows patients to understand what the likely outcomes are, at their own pace, in an unhurried, relaxed manner, so they have the time to think it through and make decisions accordingly. It saves the doctor time too, since he does not have to repeat the entire process himself for each patient. It ensures that all possible outcomes have been properly discussed; after all, sometimes doctors may forget some points too, when they are pressed for time. Finally, from a risk management perspective, clever websites that take informed consent online allow documentation of the fact that all risks and complications were properly explained to the patient, thus protecting the doctor in case of a lawsuit. Effective communication helps build relationships, and goes a long way in building a healthy doctor-patient bond that is mutually beneficial.