- Greet your patients by their name: As the patient enters your chamber, always greet the patient by his first or last name. It has a magical effect on gaining their trust. The patients remember their doctors but the doctor remembering the patient is a very big deal. This is especially true for those practicing in busy referral institutes in metropolitan cities. Whenever I addressed them by their name, I saw them getting visibly relaxed. Even If they had been waiting long hours for their turn, frowns on their face simply melted away as I called them by their name.
- Mind how you address your patients: Old people are extremely sensitive to how they are addressed. They may not like to be addressed “Mother”, “uncle” or “aunty”. I learnt it the hard way when I addressed a middle-aged lady Mata Ji (mother) and she brusquely told me that she was younger than me.
- Learn communication skills: You may greet the patients as they come in, but always ask the patient and the accompanying person to sit before proceeding with the examination. I learnt it the hardest possible way when I was all of 27 years of age, and as is so often the case at that age, I was rather arrogant and carried a swollen head brimming with newly minted knowledge. A 10-year-old child had been referred to us and was accompanied by his father. One look at the fundus of the child, and I proclaimed rather loudly, 'your child has blood cancer'. Next, I heard a loud thud. While I examined the child, the father had been standing and as I broke the news, he fainted and fell on the ground. Bleeding profusely from his head, I had to rush him to the emergency to save his life instead of his son.
- Always give follow-up appointments: Always give an appointment when you would like to see the patient again. If a patient misses an appointment remind them by writing a letter/email/message. A letter from the doctor has a huge impact on building patient-doctor trust, a critical element for building a successful practice. Patients invariably appreciated this gesture and told me in so many words. When I practiced in the institute, I must have written thousands of such letters with the result, more than 90% of my patients showed up for follow-up, many of them for decades. Such patients were my biggest resource for continuous learning for over 40 years.
- Know about facilities if you don’t have one: Even if your hospital does not have a facility, you must know where it might be available in your region, country or anywhere else in the world. I learnt this lesson again the hardest possible way. In the early '70s, vitreous surgery was not yet available in India. An old man, a retired army officer, came to see me in the outpatient department. He suffered from diabetes and had been a patient of my then chief for several years. He had been blind from vitreous hemorrhage in both eyes. In our institute, he had been told that even God himself cannot make him see again. Using extremely abusive language and profanities for my superior, he told me that he met the God in Canada who performed pars plana vitreous surgery on one of his eyes and got his restored. He did not want to see my consultant but merely came to tell me that we ought to be better informed. He was once again going to Canada to get his other eye operated on.
- Never make economic decisions for your patients: Don't go by their outward appearance or socio-economic class. You never know how much value they put on their vision. Again, I learnt this lesson the hardest possible way. In the early 1980s, one of the sanitation workers from our hospital brought his mother, who lived in a distant town, for her cataract surgery. The only intraocular lenses (IOL) available those days were the expensive imported ones from the USA. A new company had just started manufacturing the IOLs near Delhi that were priced very low compared to the imported ones. I advised the son to procure the locally made IOL unaware of the safety record of the IOL. While the surgery was uneventful, the patient developed recurrent hypopyon that responded well to the topical corticosteroids but recurred as soon as the steroid drops were stopped. The patient had to make enumerable visits over the next year. Finally, the son's patience ran out and he asked me to explain what was going on. When I told him that it was an IOL-related complication and that I had advised a cheaper locally made IOL in good faith over an expensive imported IOL, he questioned my authority to make an economic decision without informing him of the choices. A lesson learnt that I shall never forget till I live.
- Ensure confidentiality of conversation with your patient: Nearly 30 years ago, one of my uncles had come calling in my clinic. I asked him to sit in the same room and continued examining a woman patient. The elderly gentleman as is usual in our society, cupped his hand around his right ear to listen in to the conversation. Spotting this gesture she flared up and asked him to get out of the room and not overhear the confidential talk with her doctor. Intimidated by her outburst, I dare not reveal that the gentleman was a close relation.
- Be mindful of the patients watching you: Unknown to the doctors, while they wait for their turn, patients keep an eye on every movement of the doctor and the other staff. Some 30 years ago a senior judicial officer was referred to me for managing postoperative infection in his eye following cataract surgery. Unmindful, that he was keenly watching me, I asked him to wait till I washed my hands once I had finished cleaning my slit lamp and the table with an alcohol swab. I followed this routine for years after examining every patient that came to see me. As I invited him to sit across my slit-lamp, I was taken aback by his sudden loss of temper. "Now I know why I developed the infection after my surgery. I have never seen my surgeon either clean his machine or wash his hands!” This was such an embarrassing situation, I could not utter a single word in defense of the surgeon.
- Always inform the patient how long it will take for any procedure: I almost lost my job not following this simple bit of common sense. A member of parliament, obese and a diabetic for a long, came to see me for his eye checkup. After I did the preliminary anterior segment examination, I made him sit comfortably in a side room and put dilator drops in his eyes. When I went to fetch him for his retinal examination, he was furious, red in the face, he shouted the choicest expletives at me for making him wait for 20 minutes! “How dare you make a member of parliament wait so long? Don’t you know my father founded this institute! I am going to write a complaint to the union health minister to dismiss you forthwith.” No matter how I tried explaining, he kept threatening me and walked out in a huff without getting his retina examined. I feared losing my job but got my comeuppance on learning a few months later that he had passed away due to diabetes-related complications.
- Be honest with your patients: All of us who ever operate do have once in a while unintended complications during surgery. Many of us try to cover up and do not inform the patient of the mishap and what all we can do to mitigate that complication. More than 40 years ago, in the pre-vitrectomy era, while I was assisting a junior resident during cataract surgery, the nucleus dropped. There was some confusion and a sharp exchange of instructions as he tried to retrieve the fast disappearing lens. The incision was sutured and the patient was kept in the ward. Those days we kept the patient admitted for a least a week. He remained alright for about 5 days and then one morning lost vision from this eye and developed intense inflammation and hypopyon. While we were at a loss to explain what had happened, he said, “I knew right on the operation table that something had gone wrong with my surgery. You should have told me there and then and not kept it a secret from me. Tell me what can be done now?” Except for trying to control inflammation, there was no way we could have removed the nucleus in that era. Eventually, the patient lost his eye and taught me a lesson for my entire life. If you cannot handle a complication, immediately refer the patient to someone who can deal with it. Never lie to the patient, it will come back to haunt you forever!
Ten Lessons I Learnt from My Patients
Published Online: February 7th, 2022 | Read Time: 12 minutes, 30 seconds