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WHY DOCTORS NEED TO PRESCRIBE INFORMATIONAniruddha Malpani
Medical Director, HELP, "Om Chambers" 5th Floor Above China Garden, Kemps corner, Mumbai - 400 036.
Most doctors do not spend much time on educating their patients. This is a shame, because the primary role of a doctor should not be merely treating an illness, but rather to help people to remain healthy, and educating patients is vitally important for this. In fact, in ancient China, doctors were paid only if their patients were in good health. If someone fell ill, the doctor’s payments were stopped, until he treated the illness successfully. This was a very useful model, which should be more widely practised! Remember, the word doctor is derived from the Latin root, "docere" which means ‘to teach’.
Unfortunately, in the daily grind of our busy schedules, most of us simply do not have the time, energy or inclination to encourage questions from patients. Also, most doctors are just not very good at communicating with their patients. This is a skill which is not taught in medical colleges - and some doctors never manage to learn it. Another barrier is the fact that doctors are so used to talking medicalese, that they find it difficult to explain to patients in simple terms which patients can understand. Many doctors, in fact, deliberately speak using medical jargon, so as to discourage questions - and to put the glamorous - and is not financially lucrative either! Moreover, teaching patients can be a difficult skill to acquire - it can be quite boring having to repeat the same stuff again and again. However, do remember, that for each patient, his problem is unique!
Patient education is an important skill, which is well worth learning because it offers so many benefits. For one, the doctor is likely to have happier patients because they have participated in making their decisions, as equal partners, and they have been treated as intelligent adults. Patient education is also important as a practise promoter - patients appreciated that the doctor has taken the time and effort to inform and tech them!
It is also well known that patients forget over half of what the doctor tells them because of the stress of the consultation. Giving them printed materials to read at home will help them to remember. This will help to prevent midnight calls about unimportant issues as well - and ensure peaceful nights for both patient, and doctor, because the patient will not need to trouble the doctor about trifles! Printed educational materials also help to increase patient compliance - and the printed word is very useful in reinforcing the doctor’s advise and instructions!
Also, remember that doctors learn a lot from the intelligent patient. After all, physicians are not veterinarians - and the enquiring and well-informed patient can teach you much more about medicine than any textbook! Educating the patient will help the doctor to learn a lot! A patient’s questions will make a good doctor think about things which otherwise he may take for granted. Remember - the only stupid question is the one which is not asked! Also, reading the patient educational literature can teach doctors to look at things from the patient’s point of view. This helps to increase the doctor’s empathy - a very desirable goal!
Patient education is also likely to help doctors to improve the quality of their medical practise. The well informed patient may help to make you aware of advances which are occurring in otherparts of the world - which may otherwise have been overlooked by a busy doctor.
Some doctors feel threatened by a patient’s questions - and many feel that the patient is challenging them by asking questions. This is not the right perspective at all! Remember - both doctor and patient have a similar goal - to make the patient better - and questions should be encouraged and answered, rather than leaving doubts to fester - a situation which can create unnecessary problems in the future!
Patient education is also likely to reduce the risk of inadvertent complications. After all, doctors are all human, and may make errors - for example, prescribing drugs which may have an unwanted interaction. Intelligent patients are highly motivated to look after themselves - and the informed patient can sometimes point out possible problems with a treatment plan which the doctor may have overlooked (for example, a patient with G6PD deficiency should know which drugs are unsafe for him - and stop the doctor from inadvertently giving them to him!).
Also remember that educating patients will help to prevent health fraud and quackery. This is especially true for chronic illnesses (such as arthritis), and medical problems for which we do not as yet have effective solutions (such as cerebral palsy). If doctors teach their patient about what can be done to help them, as well as the limits of what we can offer them, they are unlikely to be cheated by quacks!
It is also important to document that the doctor has informed the patient of possible complications and risks - and educational handouts offer proof in black and white that this has been done. Patient education is an integral part of "risk management" in medical practise today, and will reduce the risk of doctors being sued if complications do occur.
There are many different methods available for patient education today. The staple is still printed matter, and pamphlets and leaflets form the core of most educational programmes. It is worth spending some time testing them before deciding which ones are suitable for your patients. Remember that patients have different levels of reading skills - and you will need to provide a selection of materials, depending upon your patient population. It is a good idea to leave these in your waiting room, so patients can gainfully use their time while waiting for you (far better than the old film magazines found so commonly in doctor’s offices!). Do encourage your patients to take the leaflets and read them at home at leisure - this is a good way of promoting your practise as well! You can also give them the appropriate leaflet at the end of the consultation..cheated by quacks!
Computer software and CD-ROMs are the high-tech method of teaching patients, and are likely to be very popular with the younger generation.
A common question many doctors ask is : Isn’t all this is a hassle? It’s alright in theory, but who has the time to sit and teach patients? However, just like you prescribe drugs, it is important to prescribe information as well! While in the past it was difficult for patients to get this information, this is now easily available at consumer health libraries, which now exist all over the world - for example, at HELP - the Health Education Library for People. These libraries can be a very valuable starting point for your patient’s search for information. The internet is also well worth exploring as a source of information - though the sheer volume can be intimidating!
Some doctors worry about the impact this information may have on their patients. Won’t it make them worry unnecessarily? Will they be able to understand any of this? Since I can guide them correctly, what is the need for them to hunt for information on their own? However, it is a fact that given the limited time doctors have to spend with each patient, it is important that patients need to learn for themselves! In fact, the role of doctors is even more important, since they need to guidethe patient as to where to find the information - and then to discuss the results of this information search with the patient, so that the patient can apply what he has learned to his individual problem!
Thus, the easiest way for doctors to educate their patients is to write a prescription for information - It’s no longer enough to just prescribe medicines! It is, important that the doctor then discuss the results of this information search with the patient, so that you can help him to determine which information is relevant to his particular problem.
Doctors need to remember that patient education is a very worthwhile investment of their time - after all, the best patient is a well-informed one!
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