Democratic Clinical Practice: Part A
Mistakes are inevitable. While it is a good thing to accept mistakes and learn from it, it is an act of foolery not to accept mistakes. You can only find a solution to a problem when you accept that there is a problem. My mother told me this, when I was a child. Back then, I was very naive to understand the depth of what she said. Today when I look back, this is one of the most endeared principles of my life.
Recently I took an assessment to discern where I fall on the spectrum of medical consultation styles with Autocracy or Authoritarian style at one end and the Collaborative or Democracy on the other. To my surprise, my approach was more in resonance with the Authoritarian style. Authoritarian style is a prejudiced style where there is no space left for disagreement; no right is given to the patient rather all the decisions are taken by the physician himself.
Every patient is different, a unique case study in himself and hence we cannot justify the use of one single approach for all of them. The issue is that we are rigid in the way we consult; we do not have that flexibility to adapt and acclimatize according to the person who walks through the clinic door. Perhaps, it is due to the lack of a structured training and a proper system of learning and teaching of the medical consulting skills; but then rebelling against the system is not a solution. The structure and mechanism that has been in existence since so long cannot be changed in a single day or by an individual person. Although, if we work together then we can surely amend it, bit by bit.
We can begin the change at the grass-root levels by initiating a wave of learning and propagation of importance of medical consultation. Being aware of different consulting styles and adapting them based on the context will enable us to conduct effective medical consultations. In addition, this will lay a foundation for a strong doctor patient relationship and the democratic practice in healthcare. Yes, it demands herculean courage to bring in the change and good news is that we all have it in abundance. Let us focus on one-step at a time and gradually integrate the skills into our conversations with patients. For instance, taking the first few seconds to introduce to the patients, using a language that is not authoritative rather welcoming, where possible asking questions like “How are you feeling? Do you have any questions? Tell me more? These things might look simple on the surface but have a very deep meaning.
I would like to conclude by saying that effective communication is the key to the change, a doorway to a better tomorrow. Learning and practicing effective clinical communication skills is what endears the potential to turn the long-lived Autocratic medicine to a Democratic one. Therefore, I encourage you to start the journey of change with yourself.
Start today and take an assessment of your approach to patient care (see appendix).
Let the revolution begin.
Final Year MBBS student
Dr.Yashwant Singh Parmar Government Medical College
Nahan, Himachal Pradesh.
Appendix: You can check yourapproach to patient care by answering the questions. Please answer them honestly.
Your Approach to Patient Care
Key: A=Always; F=Frequently; O=Occasionally; N=Never
For each item, circle the letter that applies.
To what extent do I
A F O N Value having patients participate significantly in their own care?
A F O N Ask patients their views about their likely diagnosis?
A F O N Invite patients to help assess their health-care needs?
A F O N Work with patients in formulating the goals of care?
A F O N Work with patients in developing and carrying out a management plan?
A F O N Involve patients in monitoring their progress?
A F O N Give patients timely, constructive feedback on their progress?
A F O N In general, give patients the message that I want them to be active partners in their care?
Count the total for each letter circles:
If your total for A’s plus F’s I'd at least 5, you are a collaborative physician and should have no difficulty functioning as a collaborative physician/teacher
If your total of O’s plus N’s is more than 4, you face something of a challenge in overcoming your background, on your way to becoming an effective, collaborative physician/teacher.
Reference: Westberg, J., Jason, H. Collaborative clinical Education: The Foundations of Effective Health Care, New York; Springer Publishing, 1993.