Doctors are gods. That is the sentiment that I have been overwhelmed with since I got here. Whenever an important doctor walks into a room, all the MLOPs and administrative personnel stand up out of respect. Patients look up to and defer to doctors to the point of not even being involved in their own care. At first I was surprised that none of the patients were seriously reading consent forms or participating in conversations about their own health. In a sample demographic survey I gave out, one of the questions (shown below) asked what kind of written information the patient would like to receive. I added option “g” in because I knew that some people must think that way, but neither I, not my bosses expected anyone to choose it. We assumed that they would check all the above boxes, because having as much information as possible never hurts. But when I got the five Tamil-translated surveys back, four of them checked “g”, and the fifth one seemed to misunderstand the question. It surprised and actually scared me to think that none of the patients wanted to understand their disease or treatment; they just wanted to blindly follow the doctors. But then I thought of my experience regarding my own health.

Demographics Survey Question

I consider myself to be a relatively informed person, and I do read up about any condition or diagnosis that I receive; however, I cannot recall a time when I have seriously questioned the validity of a doctor’s suggestion or diagnosis. Even though I am on a pre-veterinary track in college and am interested in medicine, I still unconsciously believe, “Who am I to question the opinion of someone who went to medical school”. Unlike the patients I surveyed at Aravind, I do want to understand my diagnosis and treatment, but I still do not converse with my doctors about it. And I can even see where that affects my own compliance and adherence to medication. If someone like me, who is aiming to become a medical professional in five years, cannot converse about my health and treatment with my doctors, then how can I expect that of patients in Aravind, who may be less educated, and whose doctors more often than not do not even speak the same language?

Shared-decision-making is a popular new concept in medicine. “Medical noncompliance has been identified as a major public health problem that imposes a considerable financial burden upon modern health care systems” (Donovan JL), and shared-decision-making helps to increase adherence. Both the doctor and the patient are considered to be experts on the patient’s health, and they are meant to collaborate in order make decisions that the doctor approves of and the patient will follow. By doing this, the patient is empowered and is more informed as to the importance of his/her role in the treatment process. And since the patients consider their own “beliefs, personal circumstances, and available information”, they are able to better determine whether they will be able to adhere to the treatment plan.

So far all of my interventions for patient information had been concentrated on bridging information gaps using multiple mediums, from smartphone apps to information on discharge forms. But now I believe that it is not only important to bridge gaps in information, but to also get patients interested in obtaining that information and discussing it in counseling. For now I have made an information sheet that is given by the doctors at the time of diagnosis for the patients to read before counseling. Once it is approved I will try to get the counseling sisters to discuss the sheets with the patients in order to get a dialogue going so that a patient can feel free ask questions and hopefully become involved in his/her own care.

Citation

Jenny L. Donovan (1995). Patient Decision Making: The Missing Ingredient in Compliance  Research. International Journal of Technology Assessment in Health Care, 11, pp 443-455.