Nepali docs found ‘severely lacking’ in people skills

- Weena Pun, Kathmandu
Nepali docs found ‘severely lacking’ in people skills

Jun 21, 2014-

Three weeks ago, 23-year-old Neelomony Lama went to see a dermatologist at his private clinic in Hattisar for a rash on her back.

The doctor told her that the rash was an allergic reaction to dust and prescribed her antibiotics. Curious to learn more about her condition, Lama started asking him about the disease, the medicine and whether it had any side effects. To her utter surprise, the doctor was annoyed by her questions and rudely told her that he did not care whether she took the medicine or not.

After a while, the doctor prescribed her another set of antibiotics. When asked about the difference between the two different antibiotics, the doctor told her that since she had objected to the first brand of antibiotics, it had been replaced by the second.

Lama left the clinic without picking up the prescriptions.

This is not the first time Lama has faced doctors with poor communication skills. Although ethically bound to provide every bit of information a patient needs to know about her medical condition including prognosis, regimen, financial costs and treatment alternatives, most doctors gloss over this requirement. At stake here, however, is not just a patient’s wellbeing, but that of her doctor as well.

Jagdish Prasad Agrawal, head of Internal Medicine Department at Teaching Hospital, says the fault lies in the first MBBS curriculum developed in 1978. The curriculum did not design a separate syllabus on doctor-patient communication,

but left it as part of classes on how to take a patient’s medical history. “The medical students never learned to build a rapport with their patients. There was no one demonstrating the students the skills of a communication savvy doctor,” says Agrawal.

Agrawal researched communication skills of MBBS and MD/MS graduates in 2002 and 2013, respectively. He found out that while the fresh MBBS graduates performed below average, they were still better than MD/MS graduates. “The older the doctors the grumpier they were,” says Agrawal. The reasons behind poor communication skills of health professionals are not yet studied, but most doctors blame high volume of patients and lack of time. Some patients also complain that a doctor’s behaviour depends on how the patient looks and behaves. If a patient seems highly educated, like someone who can speak in English or who can go home and google her condition and medication, doctors tend to be generous with information. Others think that only doctors who are family friends act friendly and offer answers before questions.

Ajay Rajbhandari, assistant professor at Patan Academy of Health Sciences, says that doctors have no right to hold back medical information from their patients. “Too many patients and too little time is a weak excuse,” he says. “A patient’s first impression of her doctor is the doctor’s interpersonal skills. Irrespective of the technical skills, the doctor will be judged bad if he or she is poor at communicating with her patients.”

The public perception of doctors is not just at stake, however. Failure to convey the seriousness of a disease to a patient or her relatives has led to increasing number of cases of vandalism and violence against health care workers in the country.

Nepal Medical Association recorded 61 cases of violence against health professionals between January 2007 and January 2012. In an article published in the Association’s journal, Sudhamshu KC, a hepatologist at Bir Hospital, wrote that the “failure of patient’s kin to understand the disease and the disease process” was one of the reasons behind these violent incidents.

In the article KC does not delve deeper into this cause, seeking answers to what might have caused the patients and their relatives to not understand the disease and its prognosis: Did the kin of the patients understand the doctors or did the doctors never bother to convey the gravity of the situation?

Agrawal thinks it is the second. “Twenty-five percent of the threats and violence doctors face are because of their poor communication skills. A patient’s relatives are bound to get angry if they find themselves in dark as their loved ones lay dying,” he says.

Things, however, are changing, assure medical professors. After realising the importance of interpersonal skills in health professionals, Tribhuwan University designed a separate curriculum on doctor-patient communication for first- and second-year MBBS students in 2008. These medical students are yet to start their practice.

“We are hopeful that these graduates will remain committed to sharing medical information with their patients, and will develop themselves into role models for future doctors,” says Agrawal.  

 

Published: 22-06-2014 09:28

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