The Comfort Factor

Why a patient feels comfortable with one doctor and not with another depends on whether the attitudes and expectations of the two match well.

In the conventional “Paternalistic attitude that doctors have sported over the centuries, it is he who decided what was best for the patient and ordered only one line of treatment that the patient  followed  unquestioningly and faithfully. Assuming a father-like role, he assessed his patient’s need, tolerance and affordabilility and “told” him what to do. Many patients still prefer this simple apprach and ask “Doctor, please tell me what I should do”.

This “paternalistic” attitude prevailed when treatments were few or none, and the doctor-patient relationship was hinged on blind faith. In present times, when treatment options are exploding and patient’s expectations escalating to dizzy heights, this appraoch is heading towards obsolescence.

In the current age of “Cafeteria Appraoch” doctors are required to place all the treatment options on the table, each with its risks and benefits, and facilitate the patient to choose from the “menu”. A typical example is to discuss with a patient of heart disease the risks and benefits of 3 treatment strategies; continuing medications alone, undergoing coronary angioplast, or a “bypass” heart surgery. Each has its unique advantages and risks, the perspective often varying from severity of disease, age, and the patient’s ability to endure the invasive procedure. A frank discussion on cost of therapy and expertice of the doctor helps the patient make a well informed choice.

Although a mathematical answer is what many doctors and patients grope for, it is often not easy to come by. How, for instance, does one weigh the small risk of death of 2% for a 60 year old man contemplating heart surgery against a 5-year survival of 85% if it goes well, when his daughter’s wedding is scheduled 6 months later?  

The onus of a decision whose outcome has gone awry is therefore now shifting from the doctor to the patient himself. As the society gets more litigant , requiring doctors to become defensive, many are finding it more comfortable, albeit time-consuming, to quote appropriate facts and figures, and leave patients to decide their own fates. However, as surgeries and procedures fetch in the moolah, doctors do inject their biases. Watch the laparoscopic surgeon deftly mention the “slight” but tangible risk of cancer developing in your gall bladder should the silent stones not be removed, or the cardiolist tell the anecdote of one of his patients who refused angioplasty last month and collpased on the golf course a week later.

Highlighting the features of a new product is easy but customer feed back, that could critically tilt the scale, is not often easily forthcoming. Appealing to the “fatherly” sentiment of the modern doctor with the question “What would you do if you were in my shoes, doctor?” often makes it easier for Indian patients to decide.

As published in HT City ( Hindustan Times) dated 13 March , 2011.