Pakistani doctors – Please communicate more

In my childhood days, in a middle class (then) neighborhood in Karachi, we had two clinics nearby that we would visit whenever we needed some help with common health issues such as small injuries, seasonal diseases, vaccination etc.  Based on their behavior we had named then Dr. Chusti and Dr. Susti. 

Dr. Chusti:  While I would be entering the inspection room, he would ask my name and age.  “What happened” was the next question.  So, I would start explaining my issue while still moving from the door to the examination stool next to him.  By the time my description of the reason for visiting him was finished his prescription was all ready to be handed over to me.  Occasionally he would ask one or two more questions, but it was almost always that within 30 seconds of entering his room, the prescription paper would be ready for me.  So, within 5 minutes, at the most, we would be out at the medical store buying the prescribed medicines.  His behavior was the same for all his patients irrespective of their gender, age, or medical problem they would visit him for.  The consistency and speed of his prescription writing earned him the name “Dr. Chusti” in our household.

No matter how many patients visit him, it was always a quick turnaround.  He was a serious, focused and a no-nonsense person, but was a good doctor (to my understanding at that time)

Interestingly his treatment almost always worked, no next visits generally needed, but now we know why, but that is another topic.

Dr. Susti:   On entering his room he would be the same serious, focused, and no-nonsense person, but would provide me with more time to describe my reasons for visiting him, would generally ask more questions. 

It was only after hearing all about the issue he would transform into a different individual.  He would smile and say a few comforting words/sentences before starting to describe what may have happened and why and would then explain how the same would be treated by him.  He will describe the consequences and side effects of his approaches and will describe why he prefers one over the other.  Sometimes, depending on the issue at hand, this explanation may be short and sometimes it may be long.  At the end of his spiel, he would almost always ask, any question?  His prescription will be written only after all the above “nonsense (at least to me at that time) and his treatment did involve follow up visits where he may change prescriptions. 

Bottomline was visit to his clinic took positively 10-15 minutes each time many folds than a visit to Dr. Chusti’s clinic hence he earned the name Dr. Susti”.  Interestingly, despite taking more time, Dr. Susti had more patients visiting his clinic than Dr. Chusti.

At that time, I never understood why Dr. Susti was preferred by more people, including my parents.  Now I know why Dr. Susti was more popular; he talked more.   

In a recent experience of supporting an elderly relative at a government hospital one thing that became very clear was that more doctors are like Dr. Chusti.  Doctors at the hospital, for reasons better known to them, avoid talking to patients/their attendants at all or when they do it is as little as possible.  Instead of explaining to patients/their attendants what they think the problem is, how do they plan to further investigate the problem, what will be their potential course of action for addressing the problem and what may be the consequences of various alternate approaches, the doctors prefer to keep things to themselves.  And even when inquired by their patient/their attendants, they prefer to keep their responses to as minimal as possible also as if they are doing a great favor rather than doing their duty.

If the above behavior was limited to a couple of doctors, to some select/difficult patients, it may be understandable or related to their personalities, however, this approach appeared to exist across the board, by almost all doctors, which needs to be addressed.

Patients and/or their attendants have a right to know all the above, not only to understand the situation but also to make important decisions about their healthcare and treatment and I know that communication with patients/their attendants about their treatment, particularly for critical situations, is part of the medical curriculum.

Doctors need to explain their course of actions to patients for several important reasons:

1. Informed Decision Making: By explaining their course of actions, doctors provide patients with the necessary information to make informed decisions about their healthcare. Patients have the right to understand their medical condition, available treatment options, potential risks, benefits, and expected outcomes. This helps patients actively participate in their own care and make decisions that align with their values and preferences.

2. Building Trust: Effective communication is vital for building trust between doctors and patients. When doctors take the time to explain their course of actions, it demonstrates respect for the patient’s autonomy and fosters a sense of trust. Patients feel more comfortable when they understand what is happening, why certain tests or treatments are recommended, and how the decisions are made. Trusting the doctor’s expertise is crucial for patients to follow through with the prescribed treatment plan.

3. Collaboration: Medicine is increasingly moving towards a collaborative approach between doctors and patients. By explaining their course of actions, doctors encourage patients to actively participate in their own care. Patients who are well-informed and understand the reasoning behind medical decisions are more likely to adhere to treatment plans, follow instructions, and engage in lifestyle modifications that promote better health outcomes.

4. Managing Expectations: Clear communication about the course of actions helps manage patient expectations. Patients may have unrealistic expectations or misconceptions about their condition or treatment outcomes. Doctors can address these concerns and provide realistic information about what can be achieved with the chosen course of actions. This reduces misunderstandings, frustration, and potential conflicts between doctors and patients.

5. Empowerment and Education: By explaining the course of actions, doctors empower patients with knowledge about their health. This education can extend beyond the immediate situation, helping patients understand preventive measures, lifestyle changes, and long-term management strategies. When patients are well-informed, they are more likely to take an active role in maintaining their health and making decisions that support their overall well-being.

Overall, explaining the course of actions to patients is an essential aspect of patient-centered care, promoting shared decision-making, trust, collaboration, and patient empowerment. It enhances the doctor-patient relationship and contributes to better healthcare outcomes and our doctors should make it an integral part of their day-to-day interactions with patients/their attendants.

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Babar Saeed

bsaeed@yahoo.com June 23, 2023