Sunday, October 13, 2013
Professional Back Biting
Professional Back Biting
The other day one of my patients gave me a shock, a massive shock, with of all things a few dozen complimentary words praising me. If you are as surprised as i was, let me explain from the beginning. This was a 45 year old diabetic patient who had suffered from a variety of ailments for the past few months without suspecting that it was all linked together due to a single cause- her uncontrolled blood sugar levels. Early into listening to her recite a litany of complaints I suspected her of diabetes and told her get her blood sugar checked and meanwhile started her off on drugs for her current problems.
When she finally came in with her test reports confirming diabetes i had counseled her on having her blood sugar levels within accepted range at all times and then had referred her back to her family physician for further care. And promptly forgot all about her. Consider my surprise when she turned up again in my room after a few months. She had cajoled the nurses to let her in out of turn, walked straight in, sat down in front of me and said in an inappropriately loud voice "DOCTOR, I am so happy. I told my family members, I told people all over my street and I told everyone that I am now completely cured, that you have cured me of my diabetes".
I flinched from the shock of the unexpected blow and glanced around to see who all had overheard this emphatic denunciation. Relieved that none of my colleagues could have possibly heard it, I decided to prevent her from continuing in this same vein of unbridled enthusiasm and pushing myself up straighter from my customary slouch in the chair and told her in a firm voice "Madam, I did no such thing, as I told you before you cannot cure diabetes, you can merely control it". "But, but" she stammered "I checked my sugar level and it’s all gone".
With a sigh borne out of exhaustion at repeating the same thing for the 50th time that day, I slouched back again in my chair and went over the same grounds again "Madam, diabetes is a lifelong disease, you have to keep taking drugs all your life to keep your sugar levels under control. If not they will rise again". She nodded her head and seemed to have at last got the message. I concluded my lecture by telling her "So what has happened with you is that your blood sugar is normal only because of the medicines and will be normal as long as you continue taking them daily. Leave alone me, no one can cure diabetes, so if someone says he can please don’t believe it" and with that parting piece of advice I sent her on her way.
Now to explain why i was shocked at her emphatic appreciation on my skills in curing diabetes was because I remembered the times I have been part of a crowd of doctors who laughed over these absurd advertisements on curing diabetes published by quacks (fake doctors) in vernacular newspapers. The way these fake doctors cured diabetes is to convince a normal person (healthy/disease free person) that they have diabetes, take a blood sample for testing, switch it with a diabetic patients and show the gullible patient the false result.
Once the patient believes that they have the disease, these quacks go onto prescribe medicines made of secret ingredients which they will guarantee to cure diabetes and after a proper interval challenge the patient to go to any lab and get a sugar test done. Naturally their blood sugar level would be normal and when the patient sees the normal result they immediately believe that the secret medicine has cured their diabetes- which they never had in the first place. So a simple sleight of hand trick like magicians do is behind all these fake diabetes cures. Which is why I didn’t want to be labeled as one of them people who can "cure" diabetes.
Whenever we doctors get together and relax - like in the changing rooms of operation theatres between patients- we do tend to gossip a bit just like others do. And sometimes the gossip is about the way innocent patients get cheated by other doctors. Most of this gossip would be just unsubstantiated urban myths - like the one about how people who go to fertility clinics advertising 100% guaranteed child- often go home with someone else's kids because the sperm used has been switched with a healthy donors sperm- a very persistent myth you keep hearing often. But mostly it’s about the different ways unscrupulous doctors rip off patients- some of them wholly original inventions. But all that talk is in the dressing room only- rarely do doctors wash dirty linen in public- like all other professions the medical field too maintains a distaste for exposing other doctors wrongdoings to outsiders. But things are changing. Doctors have started talking to their patients about other doctors- especially their previous attending doctors. And unsurprisingly whatever they tell patients about their previous doctors is mostly uncomplimentary and all about fault finding – or so says a new study.
The Journal of General Internal Medicine (May 2013 ed) has an article which analyzed the number of times doctors talk to patients about other doctors- the results were 29% of positive comments, 4% as neutral and 67% as negative comments critical about other doctors. As surprising as this fact is, I guess its happens more often than we think or acknowledge. Some doctor’s exhibit this instinctive need to breast beat their prowess when compared to their patient’s previous doctors. While others merely offer on or two cutting comments on the line of treatment or choice of drugs previously given by other doctors. None of which is wrong ethically but still a frowned upon practice under the dictum- thou shalt not speak ill of a fellow physician. But doctors are not the Sicilian mafia- there is no code of omerta and hence such doctors who constantly criticize other doctors rarely feel the need to temper their criticisms unless one or more of their patients goes back to confront their previous doctor and says flat out "my new physician says like this, like that, that what you did for me was wrong and you must be stupid" at which stage a battle royal ignites followed by a feud for generations.
Anyway, unlike the previous example of American doctors criticizing other doctors publicly, most doctors in India are wiser (or more discreet) and rarely (never) tell their patients outright that such and such a doctor is bad. It’s all mostly winks and nudges when a patient asks about another doctor. It ranges from “well, I have not heard anything of him till now – which really means- anything good till now” to “why don’t you try someone else, I heard his success rate is not good- which really means half is patients die so why take the risk” all of which is trying to pass the message as subtly as possible that “although I would love to share the horror stories I have heard of the doctor you are asking about, I can’t come right out and say it because my professional ethics forbids me”. Some patients are wise enough to understand the subtle hints and knowing winks. Others are not. So the next time you ask your family physician about another doctor- please watch out for those tell tale signs and subtle winks.
The point of this post is - like all professional relationships the doctor patient relationship is based on trust and it works only if there is absolute trust both ways – second guessing leads to a lot of avoidable tragedies. Hence unnecessarily back biting colleagues and bad mouthing other doctor’s to our patients leads to an overall collapse of trust in all doctors, in the medical profession itself, which would be a tragedy for both patients and doctors. Likewise doctors have a duty to prevent their patients from getting bad treatment by incompetent doctors. But there are ways to do this properly- constructive criticism rather than negative criticism is the way forward. It helps if doctors keep gossiping about colleagues to a minimum- but I guess that we are all human and apt to slip up now and then. So the only way to do this ethically – is for doctors to directly call the other doctor and query him/her if they feel that their patient has received sub-standard care rather than badmouth to the patient. Both as a doctor and as a patient I would appreciate this gesture as it would lead to a solution rather than just blame. So what do you think? I would love to hear your views on this sensitive topic.
And to conclude- I can advice, counsel, prescribe for diabetes- but I cannot cure it and neither can anyone else at this point of time, ok?