Doctors should always respect patients’ wishes, say expert
Waiting at the hospital for a diagnosis can be quite an unsettling experience - the sterile surroundings, the traces of disinfectant lingering in the air and doctor’s seemingly clinical, monotone voice all seem to increase the foreboding. But little do patients realise that delivering bad news from across the table can be as difficult as receiving it.
In an attempt to help doctors improve their bedside manners, the College of Family Medicine Pakistan organised a workshop on Sunday. They were presented a wealth of information on how to deal with difficult cases and improve communication skills.
Dr Rukhsana Yousaf Ansari, a family physician at Indus Hospital, said that around three decades ago, medical ethics allowed doctors to withhold details which would cause extreme distress to the patient. But this has changed drastically over the years. Now, patients must be given all details so that they can make informed decisions. She said that between 50 and 90 per cent of the patients want doctors to be candid.
“Physicians feel uncomfortable and are hesitant in disclosing any news that drastically impacts the patient’s view of the future,” she said. This includes telling people that they have cancer, a sexually transmitted disease or any other lifelong illness. Quoting studies, Dr Ansari added that some physicians feel that patients will blame them for inflicting mental pain and suffering on them.
But doctors are not the only ones who have questions. Families of sick people have concerns about privacy, the healthcare professional’s attitude when breaking bad news and the physician’s competency. When doctors are preparing to break bad news, they should take time to prepare the prognosis and put together treatment options for the patient.
In her presentation, Dr Faridah Amin of Aga Khan University Hospital (AKUH) said that healthcare professionals find it difficult to maintain doctor-patient confidentiality when dealing with their colleagues and patients’ relatives or when preparing an audit or research paper.
For instance, what should doctors do when women diagnosed with breast cancer ask them to hide this information from their husbands and relatives? “The rule of thumb is to always respect the patient’s request,” said Dr Amin.
Dr Samina Hoosein, family physician at AKUH, spoke about palliative care of people with terminal illnesses. It is extremely important in Pakistan, where there are no hospices. “A doctor should give medical, psychological, spiritual and therapeutic care to the patient.” This may involve medication or just simple moral support.
Dr Aziz Khan Tank, the secretary general of College of Family Medicine Pakistan, spoke about training programmes for doctors. The college has been organising workshops every Sunday over the past seven years for family physicians. “A government hospital in Pakistan closes after 2 pm and it’s the family doctors who are available to people close to their localities. They are also the first ones who a patient comes to.”
The training excercises are for students, private practitioners, doctors as well as those planning to give professional exams and the participants are charged a nominal fee of Rs500 per lecture.
Published in The Express Tribune, October 1st, 2012.
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Doctors anywhere around the world you go, a good doctor is really hard to find as all they want is your money by charging high fees. Medicine has become overly commercialised and any negligence is covered up swiftly with paperwork and one cannot find which doctors are good and bad as due to privacy reasons in any country it is very difficult to find out. Also I think palliative care is highly lucrative as well as oncology as you can give them medication and pretent you care as you know they are dying and you can charge your fees as well, that is great making money from the dying.