reprints of articles published in magazines

Saturday, 21 April 2007

The Other Side of the Doctor Patient Relationship

The doctor –patient relationship is one of the most sacred and truly rewarding of all alliances. Millions of people all over the world enjoy good health all thanks to the positive therapeutic alliance that they have with their doctors. Yet this beautiful relationship can sometimes go sour. Thanks to the ubiquitous unpredictable vagaries of Human Nature.

What I’m about to tell you now, might shock you out of your wits. So gather your strength together and listen to these stories…of course, professional ethics demand that I conceal the true names of the protagonists. So I shall tell you no names, just the tales.

Tale One: She had been suffering from piles or Haemorrhoids as it is called in the medical jargon. Unable to bear the pain yet unable to meet expenses at a private clinic, she went to the out patient department of the government hospital. She was history-taken, examined and referred off to the Surgical department. Luckily for her, the surgical department had a lady surgeon-in-training. The patient was examined by the surgeon in the making, who opined that a surgery would cure the problem. The patient got admitted, underwent the routine blood tests, ECG and X Ray. A panel of anaesthetists examined her and found her ‘Fit for Surgery’. She was given an appointment for surgery on the Theatre Day.

In the theatre, the patient was disrobed, disinfected and draped with sterile clothes. Then she was made to lie down on the operating table, with only a loose drape over her body. She was told to turn to one side, curve her back into a neat C and Zschick! A needle inserted into her spine benumbed her from hip downwards. She could not feel anything below her waist. The patient was then turned face up. The lady surgeon propped the patient into a convenient position and bent over to remove her haemorrhoids. While the surgeon was intently cutting and suturing the unwanted tissue, the patient started to squirm. The doctor straightened up to see why the patient who could not possibly feel any pain, squirmed so much. The patient raised her hand and mumbled something behind the oxygen mask on her face. The anaesthetist mumbled something about insufficient anaesthesia and gave a quick injection into her intravenous line. The surgeon went back to work.

The postoperative period was uneventful: no fevers, no bleeding, no infection. The surgeon was happy with her handiwork and a day later went to change the wound dressing for the patient when the patient asked the surgeon: “I raised my hand during the surgery, why didn’t you notice?” The surgeon was perplexed.

“So why did you raise your hand, tell me now?” She enquired politely.

With her eyes brimming over the patient whispered, “The man standing beside me…he was fondling me. I had a drip on one hand…could not stop him…I hoped to draw your attention. But…” the patient burst into tears, unable to narrate the horrible incident any further.

The surgeon was horrified.

Tale Two: She was complaining of vague problems like poor sleep, absent mindedness, sudden urge to walk out of the house and just go away somewhere, recurring bad thoughts and lack of interest in life. For each of these complaints she had met several doctors but nothing seemed to work…she remained ill for long. Exasperated her husband brought her for a psychiatric evaluation. The patient told the shrink all about her physical problems and was duly given medication.

But none of the medicines worked and the patient was still suffering from “got to get out of the house” syndrome. The psychiatrist decided it was time to delve further, set a long appointment and began to probe deep into the recess of the patient’s mind. After a lot of hesitation and many bits of distracting information, the patient finally began to trust the therapist and opened up: “My cousin, he used to misbehave with me. I was unable to protect myself. Finally I found the nerve to stop him. But even after all that stopped I felt tainted. I started having headaches. I was taken to this doctor….”

The patient closed her eyes and laboured hard to breathe, “This doctor, he misbehaved with me too! I was terrified. What is it with me, that makes men behave bad with me…” so saying the lady started to weep. “How could he do that! He was a doctor for god’s sake. He should not be misbehaving with his own patient!”

True. A doctor ought not misbehave with his/her patient. Because a doctor is like a parent…like a father or a mother. Just as it is formidably incestuous for a parent to get sexually involved with his/her own child, it is wrong for a doctor to use his/her patient for sexual gratification. It is a kind of professional incest. It is unethical and is a punishable offence.

But before you jump to conclusions and raise slogans against them Bad Bad Doctors, let me quickly tell you the Tale Number Three: She was a nervous bride-to-be. Her fiancé was constantly cajoling her and talking dirty over the phone. She was shocked that men could be so gross and refused to get married. That made her parents bring her for a premarital sex education session.

In the mean time, she developed pain on her right side of stomach. She was referred to a surgeon. He suspected Cholelithiasis, which is Medicalese for Stone in the Gall Bladder. The surgeon wanted an ultrasound scan of her abdomen. The radiologist was summoned.

Now this radiologist was a thorough professional. He kept a lady nurse by the patient’s side and proceeded with the scanning. The girl’s clothes were parted to reveal her abdomen and the lubricating gel was applied to her skin to make the scanner move smoothly. The radiologist dutifully peered at the granular image of the girl’s abdomen on the monitor and moved the scanner down to check her pelvic organs, all the time reporting his findings to the nurse.

Suddenly the patient jumped up on the examination table and screamed, “Save me, this doctor is disrobing me!” The next moment the entire hospital staff was assembled inside the scan room. The radiologist was completely bewildered. So was the attending nurse…the doctor had had not even touched the girl, not even looked at her, all he did was roll the scanner and check out her organs on the screen. But the patient accused the doctor of pulling away her pavadai. The doctor was aghast. How could he scan with the pavadai on? The patient had been adequately covered with sterile cloth to protect her modesty, moving the pavadai would not have endangered her chastity. Yet the patient raised hell and the psychiatrist who first referred the patient was immediately summoned.

The psychiatrist was the only one who knew about the patient’s undue fear of sex. The patient’s over reaction to the radiologist’s clinical move made sense to the shrink. But the surgeon and the radiologist did not want such a ‘damaging’ patient on their hands. “God knows what she’ll accuse us of next, you know how the laws are, men have absolutely no protection,” they said. Which is completely true too. Levelling false charges against doctors is not an uncommon occurrence, it is not that patients are always correct.

Taking about correctness and incorrectness, directly leads us to Tale Number Four: This doctor was a very kind, duty conscious gentleman. All his patients just loved him. More so one of his lady patients. She was married but had no children as her husband had immotile sperms. The lady was very anxious to conceive and for some reason desired to have the doctor’s children. She decided to take the plunge and one fine day poured her heart out to the doctor. The doctor being the thoroughbred professional that he was, politely but firmly declined the request and advised the patient to consult another doctor henceforth.

The lady became all the more anxious and literally threw herself at the doctor, pleading for his forgiveness and the much-desired baby. Now the doctor was in a fix. He did not want to embarrass the lady, but she was becoming a nuisance. Finally he called his nurse and requested her to escort the patient out. For weeks after that he was hesitant to see female patients. Even when he saw them they appeared to him as potential man hunters.

So you see people, the doctor-patient relationship is like any other relationship – complicated! But there are some time-tested ways to keep it uncomplicated, straight forward and strictly business-like.

1. A lady patient should not be examined by a male doctor unless he is chaperoned by another lady. That is a rule in medical practice and righteous doctors always follow that. Doctors frequently request a lady nurse or an ayyah to remain in the examination room, to reassure the female patient that he is only being clinical. If your doctor forgets to bring in a lady attendant for whatever reasons while examining you, politely but pointedly request for one. Or better still, take someone along with you.

2. However familiar you are with your doctor and however sweet your doctor might seem to you, do not let your doctor touch you in the wrong places. But such a blanket advise needs a disclaimer too. Do not become paranoid and distrust your doctor’s every move. For generally doctors are gentlemen, it is only some loose-moralled men who misbehave, whatever profession they are in. Unfortunately some of these LMM become doctors too! One must be on the guard against such men, but one must also guard against unnecessarily suspecting harmless men.

3. Sometimes patients sense that the doctor is not being completely professional, but in their embarrassment just remain quiet. But remaining quiet can sometimes be mistaken for consent. So if you feel uncomfortable say so.

4. On the other hand, even if the patient consents and is willing to have a sexual relationship with his/her doctor, it is unethical for the doctor to indulge in such activity. Sometimes an ex patient may take a liking to the doctor and consider a not-so-professional-relationship with the doctor. But present or past, once a patient the person is off bounds forever for the doctor. For even if the doctor sees the patient only once, the doctor-patient relationship is forever. It is not for nothing that Medicine is called a noble profession, you see!

5. Some patients feel the need to get into the good books of their doctors. The reasons for this could be any thing from a need to be please the authority, a bid to attract the smart doctor or just an effort to reduce the fees. Just as there are reports of lady patients being abused by their doctors, there are reports too of patients trying to seduce their male doctors.

Of course the doctor ought to maintain what is called Professional Impotence and not succumb to the temptation offered by such women. Most male doctors actually feel insulted when a lady patient displays invitingly at them. But then, we do not live in an ideal world; for every thousand ethically clear, morally upright and professionally virtuous doctors, there may be one or two morally bankrupt ones who do not mind mixing pleasure with profession. It then becomes the lady’s responsibility to ensure that she does not even unwittingly give out any invitation signals.

6. If in spite of all these precautions, a doctor does misbehave, then it is the duty of the abusee to report this to the authorities. Unless checked, the abuse may go on and on and ruin the life of many women. Not reporting crimes is one of the big reasons why crime against women is mounting. So kindly report the crime.

The Doctor-Patient relationship is one of the most trusted, sacred and mutually rewarding alliance. And like all relationships it takes two to keep it going good. Let the patient do his/her part well and let’s hope the doctors do their share well too! The doctors are anyway trained in the do’s and don’t’s in their long years of internship. With this article out, let’s hope the potential patient is also now at least partially trained! And so long live the doctor-patient relationship!


Farah said...

"...once a patient the person is off bounds forever for the doctor"...Couldn't that be relaxed just a little? Promiscuity is definitely unacceptable in any field, but what if an ex patient-doctor couple decide to get married? Isnt that honourable as well?

Dr. N. Shalini said...

Medical Councils that monitor physician conduct all over the world, explicitly prohibit such unprofessional conduct. It is unethical for a doctor to consider an amorous relationship with a client -because a doctor is supposed to take a parental stance while treating a patient. Just as a mother or father can never consider having a marital relationship with his/her child even after the child is fully grown up, so too, doctors cannot marry/flirt with/just have a roll with any of their patients.
That is why medicine is such a "noble" profession i guess.