Doctor heal thyself!       

Dr.Tandava Krishnan

One day, after a check-up I declared a baby to be out of danger. The baby had recently undergone LASER treatment for a vision threatening condition known as Retinopathy of prematurity(ROP) The parents who had been stoic and composed till then suddenly broke down. It was as if a burden had been lifted of their back. I knew exactly what they were going through. For we had been through a similar experience in the past...
One month before our son was due for delivery, we visited our obstetrician. An abdominal ultrasound scan was suggested by the doctor. When we were ushered into the scanning room, the first question asked by the Sonologist (London trained) was, “Are you a diabetic or a hypertensive?” A negative answer was met with a bizarre retort from the sonologist. “How can that be possible?  Usually you people tend to develop something by this stage of pregnancy!” She managed to sound both incredulous and disappointed in the same tone. With that introduction, she went about the motions of doing a scan. She found something on the scan that caught her attention. She asked us for the previous scans which we immediately supplied. Disappointment was writ large on her face when she realised that the previous scans were done elsewhere. She passed sneering comments on the capability of the doctors who had done the previous scans and summarily dismissed their reports as worthless. “It obviously does not have the details which I wanted. I cannot make any definitive conclusion based on the old scans as neither the scans nor the doctors who have done it are of  the standard I believe in. ” With that she explained to us that the baby had a finding called Cisterna magna with a higher risk of developing neurological impairment. Moreover, the baby seemed to be overweight. She asked us if we had got a “Triple test” done. We had not got the test done as we did not fall into any of the indications for the test. This irked the doctor and she accused us of being callous. I pointed out to her that it was a screening test and was best done for people with high risk category which we did not fall into. She dismissed my answer with disdain. As a doctor my first urge was to hurl the fattest book of biostatistics at her. Nevertheless as a prospective parent, I could feel the ground slipping under my feet. The doctor then went on to list all the things that could possibly go wrong with the baby and gave us a report. Not knowing what to do, we sought a second opinion. The second doctor concurred with the findings of the previous doctor but said that the preliminary scans were normal and hence these findings must only be considered an aberration and not indicative of anything sinister. Despite his busy schedule, he spent time with us patiently answering all our queries and wished us well. While his words were reassuring a doubt had been instilled in our minds, a doubt which just refused to die down. The next 30 days were perhaps the most difficult days of our lives. We wondered if we were being paid back for some bad karma we had accumulated as doctors. Thankfully and to our utmost relief, our son was born healthy.

One thing that this experience has taught me was that it is very easy for a doctor to slip into a mechanical mode and deliver clinical judgements without caring for the effect it has on the patients. And herein lays the conundrum which a doctor faces. Let me explain. In the movie “Munnabhai MBBS”, Bomman Irani in his role as a dean while welcoming new batch of students, talks about how his skills as a surgeon would fail him while treating his daughter as he has an emotional attachment with her. Similarly in a TV serial of the 80’s era titled “Jeevan rekha”, AK  Hangal, playing the role of a professor chides  his students during rounds for making fun of a patient. He accuses them of emotional apathy. There are people who find the terms emotional detachment and emotional apathy similar. The idea that the two terms are alike is akin to saying that only an atheist can be secular. We all know that such a statement is incorrect. A doctor is expected to be emotionally detached from his patients but he /she must not be emotionally apathetic. In our case, we believe that the first doctor showed emotional apathy while the second showed emotional detachment. To be fair, doctors are mere mortals who have no control over clinical findings. But they must be conscious of their body language and the words they choose while conveying their findings to the patients. The decisions made by the doctor must be purely clinical but the message must be conveyed to the patient in a manner which least hurts their feelings. Simply put, a doctor must not trample over the feelings of the patient. In the same manner, there is no need to sugar coat a bad news. A doctor has the responsibility to break the news gently and reassure the patient that he/she stands with them at every step of the management. This can sometimes be a tough call but that is what makes this profession so challenging.
Coming back to the baby I had treated, a paediatrician had directed the parents to our hospital to get their premature baby screened for ROP.  Initial screening suggested that the baby had ROP which needed further checkups. The parents who were from Karnataka were reluctant to stay back in Hyderabad for a longer period as they were already in the city for the past one month when the baby was admitted in an Neonatal intensive care unit (NICU).I spent some time with the parents explaining the nature of problem and the possible course of management which might be needed. Considering their reluctance to stay back in Hyderabad, I got in touch with a reputed doctor in Bengaluru who runs a wonderful ROP screening programme all over Karnataka. He furnished me with details of people who could take care of the baby at Karnataka. I passed these details on to the parents. At this juncture, the parents changed their mind and decided to stay back at Hyderabad till the treatment was completed. Perhaps my act of garnering information about doctors who could take care of the baby back home made them convinced about the gravity of the situation (at least I would like to believe it that way!). The baby underwent LASER treatment in a subsequent follow up and was eventually declared out of danger. I believe that my personal experience with sonologist made me more conscious of the feelings of the parents and thereby gain their trust. The practice of medicine is not pure application of science. Similarly doctors must not behave like hardnosed scientists. We must heal but not merely by medicines or surgery but also by our words and behaviour.
I end this article by reminding all my fellow doctors the famous quote by Sir Robert Hutchison

‘From inability to let well alone
From too much zeal for the new and contempt for what is old
From putting knowledge before wisdom, science before art, and
Cleverness before common sense;
From treating patients as cases;
And from making the cure of the disease more grievous than the
Endurance of the same, Good Lord, deliver us.’






Dr. Krishnan is a Vitreo-retinal consultant at Neoretina, Hyderabad.