Patient as a Teacher Par Excellence

- Prof. K. GANAPATHY

It was in Jan 1990 or so. I had taken my father to an ophthalmologist for a consultation. My father paid the fees. Politely, but firmly refusing to accept the money, the ophthalmologist pointed out that it was a privilege to treat a colleague’s father. He then said, “In fact, maybe we should pay the patient, for what we learn from them.” This got me thinking.

Looking back over 47 years when I was seeing patients, scores of incidents flashed back, where a patient’s behavior had a major influence in shaping my outlook and response to life.

It was Sir William Osler who had once remarked, “To study medicine without books is to sail an uncharted sea, but to study medicine without patients is not to go to sea at all.”

Alas, today not many acknowledge this. Every time we bask in the glory of a paper well received at an international medical conference; do we realize that this was made possible only because of our patients?

The raison d'être for a doctor’s existence – even in the digital health era, should be his/her patients. The day one becomes a clinician, it is expected that one should have only one love and interest – one’s patients.

I remember one of my professors mentioning 50 years ago that a doctor should be truly married to his specialty. This marriage would be lifelong. In this marriage, divorces would be unheard of. A legally wedded spouse would at best be a consort to whom one could turn to, for comfort and solace, when the going gets tough with one’s primary spouse!

Encounters with patients result in being exposed to a myriad variety of emotions. The rich, the poor, the humble, the arrogant, the know-it-all, the uninformed – each patient whatever group he or she belongs to, is a different story. Health conditions may be the same but individual patient responses are not. I have on occasions been moved to tears, experiencing the reactions of the poorest of the poor.

I once had to operate on an economically challenged patient in a nursing home, as an emergency. Settling the subsidized hospital bill itself was a difficult task. The professional fees had been waived. However, the patient insisted on settling my bill in monthly installments and over the next year did so with EMI’s! This was in stark contradistinction to some patients occupying super deluxe suites and walking away!

On a visit to a university, I was accosted by an attendant who insisted that I have a cup of coffee, pointing out that I had operated on his daughter several years ago. Not wishing to hurt his feelings I complied. I presumed that the patient had recovered completely. I was astonished to learn that the patient had died immediately. So far as the attendees were concerned, we had done our best throughout the night in a government hospital. Fate had decreed otherwise. However, he was thankful for our sincere attempts. It is said that however thin a slice is cut, it still has two sides. I have also had patients in the 'uppity class,' who would have met their maker, but for timely intervention, refusing to even recognize the doctor later.

I remember a postman. with three grown up mentally retarded children all having seizures. I would sometimes break down, admiring his wife who was always calm, cool and composed - a personification of equanimity.

Medical education stresses on factual knowledge from books and journals. Lecture halls, operation theaters, workshops, seminars, conferences – the list is endless for a clinician’s education and continuing education.

If only there was a structured organized way in which we could learn and remember what each single patient teaches us, we would be the greatest healers of the world. Alas we seldom look upon the individual patient as the ultimate source of knowledge.

Like many before me, I did not make full use of the chance to experience things for myself. The thousands of patients who have passed through my hands – each one of them without exception – had something to tell me, something which was beyond my ken! Alas, I practiced in the pre–digital health era (more about this later).

Are we not letting slip under our hands, an education, which no university could ever, ever hope to offer? A doctorate in the study of humankind! Playing the game of life is what ultimately matters, not necessarily the results.

On occasions a patient displaying a stubborn persistence of hope has proved to be right, when I lesser mortal endowed only with technical knowledge, had decreed that there shall be no hope! How often has a patient been angry, cynical, cantankerous, churlish, cranky and cross when I had tried to depict a realistic scenario, not necessarily rosy. How often is the doctor deified accompanied by scenes of joy, rapture, exaltation, ecstasy and bliss when there is an excellent outcome?

Digital health (DH) has totally changed, or rather can change the picture. DH enthusiasts can only do this much. Providing the tools alone is not enough. You cannot learn swimming through a postal course. You need to get into the water. You can take a horse up to the water, but you cannot make it drink.

This is the first time, since the dawn of civilization, that a doctor can effortlessly. permanently record for posterity, every single thought, every single interaction, every single investigation, of every single patient he will ever see, multiple times anywhere on the planet (eventually anywhere on the galaxy!).

Even individuals can avail themselves of storage media in terms of petabytes using a combination of AI enabled smartphones, tablets, laptops and cloud storage. It is not impossible that today’s voice to text software will someday become thought reading software.

In the 20th century it was extremely difficult to document in real time and more so to retrieve one’s interactions with a patient. Today, the demographic details and routine information, and for specialists and super specialists even the investigations – images and reports – can be made available in an EMR. If only the doctor is willing to spend 300 to 400 seconds more just listening and interacting with the patient and his/ her family, he would learn so much more. Information thus gleaned can be made part of the EMR.

These learnings from the real world would complement what is learnt from an e-journal. Extra effort put in to ensure regular electronic follow-up of patients and studying individual response to management protocols would be learning at its best – as productive as a formal expensive CME program. Here, the learning is from your individual patient, whom you can identify with and relate to, not from a cohort of unknown individuals.

I am optimistic that in my lifetime there will be tens of thousands of private consultation rooms, poly clinics, nursing homes and of course every single district hospital, medical college, trust and corporate hospital will be digitally enabled.

I am equally optimistic that utilization of digital health will make available quality time to the doctor. The doctor should understand that for a purely selfish reason learning from individual patients will yield a dividend comparable to the most sophisticated AI-enabled gizmos. Of course, combining the two would be even better.

Happy reading to our steadily increasing number of readers. Please feel free to send your bouquets and brickbats to 📧 ganapathy@digitalhealthnews.com