By Lamya Ibrahim:
Last week, the Annals of Internal Medicine featured two blood-curdling incidents of misuse of authority. The entry written by an anonymous author, had asked a classroom of medical students to share an experience from their clinical rotations that they “perhaps still can’t forgive” themselves for. The first mentioned an offensive remark when preparing an anesthetized patient for elective surgery, and the other was a tasteless victory dance after reviving a lady from life-threatening bleeding post-delivery. What emerged was a varying amount of guilt and reminiscence from the medical fraternity and, horror amongst the public. How could doctors violate the trust patients place in them? And what can be done to bridge this increasing gap between practitioners and people?
In India, medical ethics has constantly swirled around hard-hitting topics like abortions and euthanasia, while issues of less urgency lay overlooked. Although life has proceeded at breakneck speed since Independence, the medical curriculum hasn’t changed much since the 50’s. Despite being heavily clinic-based, medical training rarely wanders into soft skills during the formative years.
MBBS graduates deal with the sick and dying, yet are rarely taught how to break bad news, how to console the terminally ill or, inform someone their loved one is no more. As primary care physicians, they are envisioned as the go-to caretakers for a huge range of problems, yet they have no formal training in dealing with sensitive issues. Sexual issues remain a taboo due to which unwed mothers, members of the LGBTQ community and young people with Sexually Transmitted Diseases are much less likely to seek help openly. Lack of proper sex education in India puts part of the onus of meting out advice on protection, contraception and medical termination of pregnancy on doctors, but how many feel at ease enough to discuss these frankly?
The absence of such ‘soft skills’ is further explained by the existence of guidelines that remain within textbooks but don’t get implemented. While forensic medicine touches upon sexual abuse and sexual ‘perversions’, community medicine highlights topics of communication, counseling and health education and, most manuals on clinical medicine start with a chapter on assisting patients in expressing their concerns freely, students remain oblivious about keeping an empathetic approach because the knowledge is limited to the textbooks.
The current health scenario warrants an urgent remodeling of this attitude. Against a backdrop of shortage of funds and facilities, overcrowding, and a distorted representation in the media, the doctor-patient relationship is at jeopardy and needs to be addressed right at the undergraduate level. Recommendations ranging from regular feedback from senior doctors and patients to role-playing activities in the classroom should be followed, or better yet, standardized by the Medical Council of India as part of the syllabus. Communication skills can be applied throughout clinical education, as opposed to isolated workshops, cultivating habits in verbal communication, body language, and involving patients in their healthcare. Including students actively in different scenarios would allow them to reflect upon various aspects of a case, as would happen in real life.
Though it may take plenty of effort and time to make this vision a reality, we can hope it will result in more compassionate doctors, more applicable education and ultimately, contented patients.