Doctor Diaries- How do I handle the bias?

cognitive-bias-modifcation

There are people whom we like and then there are those we do not. Knowing somebody up close and personal sometimes magnifies their faults and personality quirks. Now, when we handle such issues in our personal life, there is not much of a problem. There are thousands of quotes on the social media which advice us to stay away from negative influences, so that we can be sunny and positive always. Just stay away and your problems vanish. Clap, clap!

But when you are a doctor, and a psychiatrist at that, a lot of people coming to you are not only distressed but also not “nice”, to put it mildly. Within the first few visits, we know their personalities, their decision making skills and their life choices very closely. As a matter of rule, we need to be at our non judgmental best in our counseling. Allow the person to make his/her own life decisions. At best, we can steer them towards a choice, but that too, very unobtrusively.

Unfortunately, this seems utopian on paper, not reality. How can one remain unaffected when he/she hears of a man boasting of knowing how to keep his unruly wife in place by resorting to violent means? How do you react when a lady comes depressed because she is worried about her daughter in law being snubbed by her own daughters? Such a concerned woman, you think. The concern emerges from the fact that the girl’s father has paid a fat dowry and is asking uncomfortable questions about the same! How do you console a father when he cries, that we should convince his daughter to go back to her alcoholic husband’s home, because they have already depleted their life savings on the marriage? How do you convince an utterly melancholic woman (melancholic because, her parents had no male progeny, and hence died uncared for and now the daughter in law has produced two healthy bonny girl babies), who obviously will leave her uncared for too?

These are situations which arise frequently. On a particular level, I understand that these are people who have a different value system and a way of thinking alien to mine. They may have a genuinely good side to them and maybe just discussing their miseries. Atleast they are honestly bad! But these are also times which make me want to quit my “non judgmental” high horse and tick them off like a very strict school marm.

I keep squirming in my seat trying to calm the feminist in me. Most times, I am successful. Occasionally, my unobtrusive push becomes slightly more forceful. And rarely, I do scold. I do fervently hope, that  this happens to anyone who handles human emotions as a part of their profession.

We do not understand the decisions that others make and their reasons for it. Over the years and with some maturity comes the discovery that we cannot change the world so easily. Change is for most part slow, a lot of hard work and painstaking. Once the abusive husband, after 6 months of counseling, finally stops abusing his wife physically (though a wee bit of verbal abuse remains), I should consider it my victory!

Unfortunately, this victory is not all sweet! There is an itch to do something more, push a little more and dream a little. And go back to listening all over again. Maybe, this is more like the bevu bella (an offering of neem and sugar eaten during ugadi, the traditional new year), which symbolically signifies that you should swallow the good and the bad with equanimity. Probably, I should start everyday with a small bite of the same:)

Does this happen to you?

 

 

Doctor Diaries.

There are certain life experiences which come to us, courtesy our professions. Some of them make good dinner table conversations, some put a smile on our face years after they occur and some make us feel a deep pain inside. As doctors,  we see many incidents which have the power to move us beyond what we thought was possible. And such incidents make us richer, wiser and sometimes more cautious. I have always wanted to share a few of my experiences as a doctor first, a psychiatrist next, about how we see the good, the bad, the ugly and the hilarious as a part of our everyday life in the hospital. Hence ,the doctor diaries.

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Of when my idealism died.

Off late, medical professionals  have been viewed more with suspicion and wariness than respect and love. We often hear stories about how doctor so and so ripped off a poor patient, or performed an unnecessary surgery or followed some unethical practice.

As much as I know of most people in our profession, they seem hard working to such an extent that they have no time to even defend themselves in times of crisis. In a day and age, where most media bytes  go to a person who voices the highest decibel levels, we seem to have missed the bus by a mile. A lot of us are excellent clinicians, but poor communicators. Mostly, not our fault. We were never taught that our practice, would one day, turn out to be a war zone with land mines, which we had to gingerly tread through. Do not get me wrong. It is not everyday that we go to work like scared rabbits. We enjoy what we do, and how we do it. But on occasion, fear does seep into our bones. This was one such time.

It was a sleepy Sunday afternoon broken by an earth shattering cry, that would have woken the dead. All of us in the surrounding vicinity came out on the roads to see what had happened. What we saw was not a pretty sight. There were two people who had accidentally got electrocuted, lying on the road literally fuming at the mouth. There was this huge crowd gathered around. The stench of burnt flesh was overpowering. I live just across from the hospital that I work in. By the time I made my way through the crowd, I saw that two of our hospital staff had already lifted the victims bodily,and put them into an auto rickshaw.They drove on to a tertiary care center five minutes away for ICU care. The whole episode must have taken around five to seven minutes at most. I was impressed by the immediate action taken by our orderlies and was on my way to praise them, when I was in for a rude shock.

One of the people from the crowd asked us why we had not taken care of the patient. They started accusing us of poor first aid. We appeared confused at first. They must have taken it as a sign of weakness or guilt.

The cause for our confusion, was the fact that, apart from having a time machine to do the needful, we had been as fast as we humanly could. Two of our staff had rushed to find autos on a deserted road to ferry the patients, while two others had helped them into the vehicle and gone to the hospital with them. According to us, we had done all we could and more.Apparently not.

According to the leader of the mob, we needed to check the pulse of the patient before we put him into the auto. The other claimed that we should have done first aid inside our hospital premises before shifting him to an ICU.

We tried reasoning out that time was of utmost importance. That there was no need to check the pulse when the patient looked alive and was breathing. And we shifted him to a tertiary care center only because we did not, as a facility catering to mental illness, have an ICU facility and ventilator support.

Seemingly, all our explanations fell on deaf ears. The crowd kept chanting that we should have checked the pulse. On one level, I knew that they were just out to create a scene. Maybe the shock of seeing a person burn was too much to take. Maybe, they had no idea what to do in case of such a situation.

But on another level, we were scared. Upset that our good intentions were being slandered unnecessarily. Scared that they may abuse us physically.Are really really worried as to why understanding such a simple explanation seemed impossible to them.

Anyway, after a while, for lack of any other logical form of argument apart from the “pulse”, the crowd dispersed. But the hurt remained. That we, (especially our hospital staff who courageously helped the victims without a thought that they may have got electrocuted themselves too) were considered villains even after selflessly doing our best.

It did not matter that half the crowd was totally drunk, and had not moved a muscle to help all through the episode.What did matter, was that a scene was created. And that we looked like the bad people.

In the pat two years, in the small city that I live in, I have seen at least  four hospitals getting ransacked and damaged for some alleged negligence on the part of a doctor, which has later on been disproved. I have participated in rallies held to protect the rights of doctors. The district administration has given us a list of laws and provisions to help us protect ourselves. We now have cctv’s in our hospitals.Despite all of these, the sense of disillusionment remains.

Sort of like, when you have actually done your homework, but forgotten the book at home. The teacher does not believe you, but you want to be believed oh so badly. Standing in front of the class looking like the culprit pains you bad. The pain, that neither your teacher or your friends had the good sense to believe you.Submitting the homework book next day does not really ease your pain. The damage has been done!

And so also in this case.Life  moved on. Work resumed the next day. But every time I pass by the place on the road, I feel a physical pain deep inside me. One for the victim, who was a young man with small children. Two, for my idealism, which died a more cruel death that day.

How bad is it, doc?

doctors There are many cliches associated with being doctors. The near dictum that doctors are next to Gods. That practicing medicine is a noble, respectable, ideal profession. In the nineties, most children in India, I would safely say, grew up with an idea that their life would be made if they became doctors, or engineers. It was the rare parent that would allow his child to choose a profession apart from these two.

According to a recent study by the WHO, despite medical schools mushrooming all over India, we still are short of doctors.  The state of a patient in rural India, who needs some form of emergency medicine is still abysmally bad. So,yes,we do need doctors.

But suddenly, it almost feels like doctors are everyone’s favorite punching bag. It is as if we are a group of individuals with dubious reputations, unscrupulous, unethical and those trying to make a buck out of the poor patient’s pocket.

It is therefore probably the right time to remind ourselves that medicine is, basically, just another profession. Yes, compassion is important, as well as a sense of responsibility. But then, those with an aptitude for both should not have difficulty in finding their way into this field, just as someone with good computing skills takes up computer engineering. To deglamorise, doctors study five and a half years for a degree which tells them how tackle certain ills in a scientific manner. We do not claim to be Gods, nor are we the devil reincarnate.

I do agree that there is a lot going wrong with the practice of medicine in India. But these wrongs mainly stem from a flawed, aged, system rather than the individual doctor.

Children as young as seventeen, I believe, rarely have the maturity to realize the seriousness of a profession like medicine. In the west, medical school would be an option to only those with an undergraduate degree under their belt. I personally know of kids who take up medicine because of the glamour associated with it or because of parental pressure. When you choose a profession for the wrong reasons, the outcome seems near obviously bad.

The presence of corruption in a system which deals with life itself. In conversation with one of vice chancellors of a medical school, I get to understand that the seat matrix in any medical school across India is decided by how many palms are greased rather than, how good the patient student ratio in the teaching hospital is. We see around us a number of med schools where professors exist only on office papers, and the teaching hospital needs to be filled with fake patients who are hired during MCI inspections. We PRACTICE MEDICINE. And where the practice of teaching is poor, the confidence of a doctor to handle a patient is obviously poor.

The weird attitude that once we choose to become doctors, we, as individuals, need to give up on material gains. The salaries of doctors in rural service is pathetically low for the amount of risk that they take. To quote Atul Gawande in his book, “Better” ,doctors in rural India are the most innovative and efficient. They need to work with patchy electricity, minus specialist help, have to work against unhealthy  but traditional practices to the convince the family to get the patient treated. Hence, they learn to work with enormous amount of common sense. But, the rewards materialistically or otherwise are poor. They have poor roads, horrible infrastructure, no legal aid, their children have no good schools, due to which they would have to be sent away for their education. All the while, when media glaringly shows them, that their counterparts, with half the years of education, are earning fat sums, driving the newest eye candy, spending time in malls, living in penthouses, working in centrally air conditioned offices and sending their children to international schools. Who in their right mind would choose rural service?

As doctors we ultimately deal with lives. And people. And people with a million different personalities. And these personalities, when they are under stress of illness. But nowhere in medical schools are we taught the importance of good communication, on dealing with grief, on being calm during periods of stress or emergency. It is as if we are expected to magically source this information from some place in the universe and imbibe it. The art of counseling, is not hereditary. It needs to be taught. And as my dean in med school, Prof. Dr.B.M.Hegde would quote, doctors, needed to be trained to “cure rarely, care often and comfort always”. Poor counseling skills, automatically translates to poor patient care.

Law concerning self protection, medical insurance and negligence are alien subjects when we study medicine. We only get to hear these terms when we land, slap bang in the middle of a controversy. We do make mistakes. We are human. But, mostly the health of our egos and our bank balance depend on the good health of our patients. The pleasure we get when we see a critically ill patient walk back home with a smile on his face, is probably what keeps most of my fellow doctors in the profession, despite the grueling hours and non existant social life. Hence, if we were to be taught what to do when we err, we would definitely tread with more caution, rather be caught on tv appearing like a petty criminal.

If we are a society concerned with health, then we have to understand that we have an individual responsibility towards our health. Poor lifestyle habits, not following the doctor’s advice and skipping doses, and then blaming the doctor for poor health despite taking expensive medicines is simply playing the blame game. Not acceptable.

To summarize, we need a multi pronged approach to start a change in most of these areas. Able law makers,thinkers, senior doctors and the public at large who should first understand the flawed but totteringly functional system completely. And then attempt change. Only then, we can hope for the health of the country as well as its doctors.  Till then, still happy to be a doctor and enjoying it despite the hurdles!