Redefining Doctor-Patient Communication
A study on doctor-patient communication by Wilmer Eye Institute, Baltimore, Maryland (2009) shows that physicians spent an average of 8 eight minutes in the room with the patient, including an average of 5.8 minutes talking with the patient. Doctor-patient dialogue was universally physician centered with physicians speaking 70% of the words and asking closed-ended questions that restricted the patient's contribution to "yes/no" or brief responses. A minority of physicians ever asked patients if they had any questions.
Despite being crucial to ensure active and meaningful participation from patients for effective treatment, doctor-patient communication receives very less importance in the medical service delivery system. It is necessary that the doctor explains the nature of the disease, treatment options and cost of the treatment during check-ups. The same research also suggested that there are increasing data hinting that patients encouraged and engaged during the medical encounter to ask questions and to participate in their care do much better biologically, in quality of life, and have higher level of satisfaction.
However, the corporatization and commercialization of medical practices have negatively customized the relation between doctor and patient merely into service giver-service receiver modality. As a result, mechanized pattern of health service delivery, instances of patient discontinuing follow ups, constantly changing hospitals and doctors due to dissatisfaction, is on the rise.
This is exactly what is happening in Nepal's context too. Patients who sometimes wait almost 2-3 hours for their turn end up getting less than 5 minutes with doctors. What's worse is that most of this time is used to prescribe tests and medicines. Not receiving an adequate explanation of what is being prescribed as the next course of action often leaves patients with the impression that the doctor is unnecessarily prescribing a variety of tests and expensive medicines. This should be changed.
And what can be more frustrating when two hours have elapsed since a sick patient has arrived for his or her appointment, only to have a Medical Representative cut in line? Increasingly, patients not only encounter unfriendly administrators and health professionals in practice, inadequate basic facilities like waiting areas and toilets, long queues at the pathology labs and pharmacies, but also MRs from different pharmaceutical companies vying for the doctor’s time during working hours.
Such experiences have only exacerbated patients' and eroded their trust in the existing medical system. Arguably, this is seen in the growing shift towards ayurvedic and alternative forms of medicine and healing. It could be mainly put down to the more personal and simplistic approach of the ayurveda practitioners in their handling of their patients. However, on part of allopathy which is getting complex day by day and its drivers constantly failing to offer proper explanation of its attributes is gradually losing faith among people.
The social positioning places doctors on the top-tier and their very profession mean they are the experts of medical care. Hence, patients might not always feel comfortable expressing their concerns or counter-question their doctors. However, such concerns can manifest negatively, for instance when an unconvinced patient discontinues the proposed treatment plan without informing the doctor, putting his or her health at risk. It is very common practice for patients to interpret the prescribed treatment to fit their own sense of what is right for them.
A research conducted by KMC Hospital in 2006 stated that 14.28% cases of medical negligence in Nepal are caused due to “Failure of Advice and Communication” and 22.22 % cases are caused due to “Errors in Diagnosis". Likewise, it also suggested that giving own mode of treatment without listening to patient’s medical history eventually makes the examining doctor and hospital management liable for medical negligence.
Considering the disproportionate doctor: patient ratio, at least provision of allocating one session where a doctor and a patient have the opportunity to express and hear each other that further enables the process for constructing realistic and detailed treatment plan should be ensured from hospitals side. A patient-centered communication teaching, if effectively incorporated in the curriculum, will produce doctors who are skilled in understanding the patient’s perspective and delivering suitable treatment plan that boosts patient’s will to recover by empowering patients to express concerns and preferences openly.
The current commercialized mechanism of service delivery has reduced the role of doctors as experts who see their patients' merely as medical cases and as means of profit. This is detrimental to healthcare provision considering that patients are completely reliant on doctors to receive the necessary medical treatment. Redrawing the doctor-patient communication method is the need of the hour to improve healthcare provision in Nepal.
We take pride in Sagarmatha and also Bhagwan Buddha. We should introspect as to what has been “our” contribution in the making of both. The tallest mountain landmark is the outcome of tectonic push against the bigger landmass creating the upward drift that created the Himalaya. Prince Siddhartha, on the other hand, was born 2556 years ago or 23 centuries before Nepal got unified under Prithivi Narayan Shah. Siddhartha is believed to have attained enlightenment at the age of 35 or around six years after leaving Kapilvastu.
All this pointed that the election will be held with public support despite efforts by those against it. But all that changed after three people were killed in Rajbiraj after the police opened fire on Madhesi Front cadres who were ‘hurling petrol bombs’ toward the venue where UML Chairman KP Oli had just finished his short address.
Men at work
Currently the larger part of our urban area resembles a war zone with bulldozers and mechanical diggers running amok. What is left behind the unfinished work typically consists of mangled water pipes, jumbled up and torn telephone and electric wires, mounds of dug earth and gravel heaps, unfilled ditches and incomplete manholes.
A great aviator in the Nepali skies
Deepak was not only a competent pilot but also someone who had the inner strength to always remain cool, calm, and collected. That nature helped him make a total of three emergency landings in his career as a pilot when he suddenly had to deal with technical malfunctions while flying an aircraft.
Traffic Police in Kathmandu
As busy and hassling as the traffic system in Kathmandu is, the Traffic Police here have to handle an equally strenuous job. Over 1,400 traffic officers in and around the Kathmandu Valley battle against the pestering traffic and air pollution each day.
Menstrual taboo outdated
I have seen my sisters and friends isolated and treated in discriminatory manner during their first menstruation cycle. They were not allowed to look at the sun, to touch water source, flower, fruits, any male family member, nor even hear their voice. The activist may claim the situation has changed and I do agree but still during every month my loved ones turns into untouchables beings.