Saturday, April 11, 2015

Reflections IV- Feedback on Feedbacks!

Feedbacks are important. We have feedback mechanisms in our body which help control the physiological mechanisms  especially the neuro endocrine circuits. In schools and workplaces, Feedbacks help us understand the other person's perspective so that we can improve our performance. But what does a feedback do that is less of a negative feedback and more of a complaint?
 So a patient who is depressed and is having interpersonal problems in marriage gives a feedback that the doctor is not empathic. Her father offers the same feedback because he is trying to make me remember his other daughter who probably saw me a year or two back and since I am at loss of recalling her and trying to focus on the current patient, he feels I donot care. The management wants to dig the issue with me, it helps me understand the extent of depression the family is in, but how does it help me improve.....from a clinical perspective it is actually expected and in therapy we call it transference, but from a practical perspective, next time I am vary of  any such patient. The doctor patient bond gets traumatized a little. Next time, a patient's husband mentions that he had to wait for 30 minutes to see the doctor and then he was sent back to the ward unattended.Well, he of course forgot to mention that the doctor was in session with another patient who had come with an OPD appointment and since the indoor patient was getting restless, doctor had taken time to suggest that either they could wait or go back to the ward because the doctor couldnot make patients who had taken appointment to wait. What does this feedback teach me, that I shouldnot allow any indoor patient to come and see me in OPD even if the patient needs to be addressed in the privacy of the psychiatrist's chamber or simply because it is convenient.Another good blow to doctor patient relationship. While psychiatry addresses issues of transference, it also addresses issues of counter transference, wherein the therapist develops negative feelings for the patient or family. This eventually hampers treatment. And this reactive pattern of interaction extends itself to all medical specialties (I refrain from saying all human interactions because the treatment part is not part of other interactions).
There are inherent dilemma's in human interactions, views/opinions/perspectives differ and if everyone stood at their own vantage point, it's difficult to understand beyond one's own needs. From administration's perspective, they need positive propaganda to get the patient back, from patient's perspective, they need exclusive care and attention, even a doctor needs patient satisfaction and positive feedback for good business but they still end up facing the flake. Nobody talks about doctor's feedback.So while the doctor should maintain OPD timings, noone takes responsibility for him/her waiting  in OPD well beyond the scheduled time because 4:00 pm appointment reached the hospital at 5:00 pm but certain people have the audacity to fight to see the doctor before all those waiting because he took an appointment for 10am but reached at 3:00pm. The doctor is told that he/she charges too much consultation fee, or why can't he/she see patient for free for followup because the patient is anyway better with treatment, or he/she is responsible if the medicine doesnot work or causes side effect and therefore again should see the patient for free, or should spend as much time with patient during consultation as the patient needs rather than the scheduled time slots. The cherry on the cake is  when patient's family assaults doctors in emergency rooms across the country and all that happens is a day's strike before everyone starts blaming doctors for being heartless and earning too much (!)
What is of greater concern?
For one, due to the current trend , doctors are becoming too practical in their profession and while medical practice is loosing its heart, the treatment protocols are becoming too rigid leading to less innovation in clinical set up.
Secondly, as the heart goes, the soul will go too. It's already happening at several places especially with greater corporatization of medical practice and setting of goals and targets that do not revolve around improvement of overall health in community but improvement of patient and procedure count for the hospital.
Thirdly, since patients turn consumers, there are higher and higher chances of litigation which lead to the first and second outcomes anyway.
But currently my personal concern is that it will change my own practice strategy. As a psychiatrist, I try to be empathic, but as a human being, I get angry and frustrated and loose trust in the idea of doing good. If I just do my job, I will never intervene and let the hospital and staff tackle people while I follow a rule book where sessions are strictly timed and no interactions outside of clinic are advised. And all those good people who are sensible as well as sensitive will loose out on good care while the one's who are the cause are anyway beyond help!

Lets just hope it does not come to that....

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