On Doctor's Day, remembering that the patient is a teacher par excellence
It was in January 1990 that I had taken my father to an ophthalmologist. My father paid the fees. Politely, but firmly refusing the fees, it was pointed out to him that it was a privilege to treat a colleague's father. The doctor then said, 'In fact, maybe we should pay the patient, for what we learn from them'.
This set me thinking. Looking back, there have been scores of incidents where a patient's behaviour had a major influence in shaping my outlook and response to life. William Osler had once remarked, 'To study medicine without books is to sail an unchartered sea, but to study medicine without patients is not to go to sea at all'. Every time we bask in the glory of a well-received paper, do we realise that this was only because of our patients?
Why we exist
The raison d^etre for our existence is our patients. Encounters with patients expose us to a variety of emotions. The rich, the poor, the humble, the arrogant, the know-it-all, the uninformed – each patient is a different tale. Health conditions may be the same but patient responses are not.
I once had to operate on an economically-challenged patient in a nursing home, as an emergency. Settling the subsidised hospital bill itself was a difficult task for the family. Professional fees had been waived; however, the patient insisted on settling my bill through EMIs. In another instance, on a visit to a university, I was accosted by a patient's attender who insisted that I have coffee with him, pointing out that I had operated on his daughter, years ago. Not wishing to hurt his feelings I complied. I learnt that the patient had died immediately. The attender thought we had done our best throughout the night in a government hospital, fate had decreed otherwise.
Another instance was that of a postman with three adult intellectually disabled children all of whom suffered from seizures. His wife was calm, cool and composed - a personification of equanimity. In 1976, I had assisted in the surgery of a young baby with a spinal deformity. Over the next two years she underwent several corrective surgical procedures. 30 years later, paralysed below the waist, she was using used a motorised wheel chair, catheterizing herself intermittently. There was also the case of a musician with a tumour in the speech area of the brain. He preferred to avoid surgery, so that he could sing for longer. He died a contented man.
Going beyond textbook learning
Medical education stresses factual knowledge from books and journals, lectures, surgeries, workshops, seminars, conferences – the list is endless for a clinician's education and continuing education. If only there was, however, a structured, organised way in which we could recall and learn, what each single patient teaches us, we would be the greatest healers of the world. Thousands of patients pass through our hands – each one of them without exception – may have had something to tell us, beyond our ken. Alas, we seldom look upon the individual patient as a source of knowledge. Are we letting slip, an education, which no university could ever hope to provide - doctorates in the study of humankind? Satisfying our patients is what matters, not necessarily the results. On occasions, patients clutching a straw, have proved to be right, when I, endowed with technical knowledge had thought otherwise. How often has a patient been angry, cynical, cantankerous, churlish, cranky and cross when I tried to depict a realistic scenario that was not necessarily rosy? But as often, has the doctor not been deified, accompanied by scenes of joy, rapture, exaltation, ecstasy and bliss when there is an excellent outcome?
A doctor today can effortlessly and permanently record for posterity, every single thought, every single interaction, every single investigation, of every single patient he will ever see, multiple times anywhere on the planet. Using AI-enabled smartphones, tablets, laptops and cloud storage one can store petabytes of information. Learnings from every individual patient whom you are able to identify with and relate to, will always be meaningful. Decision-making is unconsciously influenced by what happened to one's previous patient. A bad result following aggressive surgery would lead to subsequent conservative management.
Acknowledging patients
Today we have Mother's Day, Father's day, Teacher's day, Doctors' Day and hundreds of such remembrances to pay homage to those who shaped our lives. It is perhaps time that we have a Patient's Day.
(Dr. K. Ganapathy is a distinguished professor at The Tamil Nadu Dr. MGR Medical University and past president of the Neurological Society of India and the Telemedicine Society of India. drkganapathy@gmail.com)
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