Therapeutic Conversation, Helps in Respecting Patient Right to Health Information and Right to Compassionate Care
Dr. Ganapathi Bhat M. is an eminent personality, presently appointed as a Consultant- Medical Oncology & Stem cell Transplant Physician, Global Hospitals, Parel. Earlier he was with Jaslok Hospital as a Consultant in the Department of Medical Oncology and Stem Cell Transplant.
Dr. Bhat takes pride of conducting the “world’s First Case” of post renal transplant plasmacytoma. Prior to joining Jaslok Hospital, Dr. Bhat was working with one of the most premier centres of Oncology in the Middle East i.e. Kuwait Cancer Control Centre run by ministry of health as a Medical Oncologist in the year 2002. He was also associated with Lilavati Hospital and Research Centre Mumbai where he had established first Day Care Unit of Hemato-Oncology Department.
As 4th of Feb, is celebrated as World Cancer Day, it is important to know the importance of doctor-patient communication for the successful treatment of the patient. Here, Ekta Srivastava, Health Technology, talks to Dr Ganapathi Bhat M, about the Doctor- patient communication relation since the patient’s first visit to the last walk out from the Hospital.
How do you see the cancer landscape of India taking shape?
Care of cancer patients in India in the last decade has improved in terms of early detection, diagnosis and treatment most likely because of awareness, education, availability of healthcare professionals, tertiary care centres and innovative approaches in cancer management. But we are lagging in research, reporting like national cancer registry and national health policies which would improve the scenario.
How is the cancer burden in India different from others?
Having Aproximately 1/6th of the population of the world, we have a more patients in number of cancer. Unlike the majority of developed nations, they are detected in advanced stages resulting in poor survival. Time from symptom presentation to diagnosis and initiation of treatment is also much delayed of >3 months unlike 30-48 days in developed countries. The top five cancers in men and women account for 47.2% of all cancers; these cancers can be prevented, screened for and/or detected early and treated at an early stage.
Do you feel that having a good rapport with the patient might be helpful during and after the operation?
Yes, definitely. It is paramount. Not only rapport but also establishes trust and confidence and involvement in their care especially what we notice with preoperative counselling.
How do you actually accomplish this? How do you try to instil this will in the patient’s active participation? How do you actually convert the patient?
It begins right from the first visit until discharge at every stage or treatment cycle. And this is not only with patient but also with family, guardian and caregiver.
In a situation where you want to talk to your patient but you do not have that much time to establish this relationship, how do you proceed?
I involve a counsellor/onco nurse to help of the patient. Give information about patient support groups, other patients who are willing to share information. Also provide patient education booklets, illustrated guides, surgery /procedure information and also,treatment relatedbooklets.(example- chemotherapy , side effects, and management)
One of the main objectives in communicating with the patient is to establish some sort of human relationship. What is the main purpose of this? Is it primarily to reassure your patient that things will go well?
Purpose is to gain their trust, instil confidence, give assurance and elicit good history. This will help in improving patient co-operation and encourage them to partner in decision making and also to involve patient and their family as a unit to take decisions and improve outcomes.
There are situations where the patient may ask questions about her health which you would rather not answer at a particular time and, if so, what do you do
As a doctor you cannot treat emotions but at the same time you should be empathetic to their concerns. In fact we should address them factually during inpatient care as well as outpatient visits. Share FAQ booklets with them and use recorded counselling (record my advice) which they could replay when they need to listen to some advice again which they may not have registered or have forgotten.
Does the seriousness of the patient’s condition affect your behavior?
No because as a doctor you have to have presence of mind and composed to make right decisions in the patients favour at all times.
With different social groups of patients, do you use different conversational styles?
No. But while conversing, consider the linguistic background, cultural and educational background. This is to ensure that patients understand and comprehend what is discussed especially when their consent is also essential.
I know you frequently have patients where the risk factors of the eminent operation are especially high. How do you cope with the conflict of the need for telling the patient about this high risk factor and, on the other side, the resulting effect of possible discouragement and hopelessness?
I clearly explain the risks involved during and after procedure in terms of mortality and morbidity. Share the facts and help patient weigh benefits and risk of every treatment option. And I not only discuss the risk but also cost and other implications.
I presume that these conversations, these attempts to communicate and to establish a human relationship with your patient, sometimes take a considerable amount of time. How do you handle this? How do you try to disentangle yourself unobtrusively, if the patient talks too much about subject matters that are not germane to the issue? Just how do you get away, if you need to, if the patient wants to continue the talk?
Patient is not a commodity customer, he is seeking your opinion and care and therefore it is important to listen to them. In situations where patient talks about unrelated issues, I politely tell them that the need of the hour is to focus on treatment advise and in the next visit we can discuss other aspects. I ask them to note down all other questions before coming to next visit so that we can discuss them later. Also give them an FAQ booklet which answers all their clinical and other related questions.
I understand that a hospital is a teaching institution as well. And so we might be interested in how you handle the presence of interns and residents in these conversations? Are they present, while you converse with your patients? To what extent are they involved?
Yes they are a part of the important members on the patient management team. Bedside manners and reflective learning of effective communication, breaking bad news, follow up patients’ progress, monitor investigation reports, and is part of their training.
In that context, are students of medicine taught the importance and techniques of communication with the patient? And if so, how are they involved?
They are generally taught during bedside consultation, ward rounds and follow up consultations.
Are your nurses aware of what you are doing, of what you are trying to accomplish? To what extent are they cooperative?
Onco nurses and support staff are an integral part of patient management and care since they are involved in every aspect of patient care in the hospital. Their contribution is highly valuable.
As a final question, I would like to come back to what we touched upon at the beginning of this interview. Can you really notice the medical benefits of what we sociolinguists call therapeutic conversation?
Agree. Therapeutic conversation will help in respecting patient right to health information and right to compassionate care. Many patient walk out in a different person after they have a good, meaningful conversation with their doctor which is also a healing.