Though the better-known saying is “ Physician heal thyself ”but I believe its even more applicable to the patient. Some doctors are also known to be lacklustre about their own health that a saying goes. The doctor says ”do as I say, not as I do.” my hypothesis in this story is patient has to play an active role in his own healing. Generally, it is considered by patients, that when you suffer, its enough to see a doctor and take the prescription. What many don’t realize is, you have to follow the prescription too, exactly.
Why many patients don’t recover simply because they have not followed doctor’s advice. For benefit of patients, I want to list here some of the mistakes patients make, that delay their recovery.
For many patients most important thing is to see a well-reputed doctor, get tested and diagnosed and receive the prescription and of course pay the doctor’s fee. What he has forgotten is, this is not a blessing or court’s decree that would be automatically executed. The doctor’s prescription has to be executed by the patient himself and fine print not missed.
Many times doctor has prescribed 2-3 or even more medicines, which may need to be taken twice or thrice a day. Some patients immediately retort, who will take so many medicines. Naturally, the medicines have to be taken by the patient only. To these patients I always say; if you can get better by taking medicines only than you are lucky. There are so many patients out there who have to undergo multiple surgical procedures and still don’t get better, few actually deteriorate. On top of this, there is a sizeable number of patients to whom modern medicine can offer little.
As a doctor, it is my misfortune that I have to come across patients to whom we can offer little. Sometimes we do not succeed in even alleviating the pain. So if there is a patient who can get better on medicines, that’s a great option much to rejoice about and not pull a face and complain to the doctor.
Another issue with some patients, especially orthopedic ones is their reluctance to do Physiotherapy. When they realise that Physiotherapy has been advised, some patients react as if great injustice has been done to them. Many will want somebody to come to their home at a convenient time and do it without bothering them. To be fair there are exercise enthusiasts who rejoice on hearing about Physiotherapy and say. Doctor please advise me Physiotherapy only I don’t like to take medicines. This is a peculiar issue with many Indian patients, they don’t want to take allopathic medicines which they consider English or not Indian and full of side effects. Some of our patients have a strange predilection. They prefer the local system of medicine called Ayurveda as it is considered natural. Indians believe Ayurvedic medicines are natural and safe as they are made from herbs. While it is believed Allopathic medicines are made of chemicals, hence cause side effects. I feel hassled if a patient comes to me, let me do a full examination, let me write the prescription and when I start to explain the dosage, the patient would suddenly say, but doctor I cant tolerate Allopathic medicines, my stomach is very sensitive. I have to say to such patients, you saw my qualification on board. I am very obviously an Allopathic doctor and under the law, I can prescribe only allopathic medicines. These patients in their heart are like Ayurveda as it is of Indian origin, but still, admire Allopathy as it is a modern system of medicine. The fact, however, is Allopathic medicines are perfectly safe, provided they are prescribed by a qualified doctor and taken as advised. The problem in India is, allopathic medicines are often prescribed by Ayurveda Homoeopathic doctors (who obviously are not qualified to prescribe them). This is because of lax govt. regulations. Indian Medical Association has been protesting for long, that Government must stop unqualified people from practising modern system (Allopathy) of medicine.
Another fact is a doctor will prescribe the medicine for a limited time and right dosage (being aware of side effects etc.) but the patient might take it for a longer duration as he can only perceive beneficial effects.
Another situation, peculiar to India is, patients often solicit advise from pharmacists, who with their limited knowledge, but can't resist the temptation to act doctor. I have seen patients die of safe drugs because they were taken without proper supervision. Sometimes patients themselves advise other patients on what medicines to take. I strongly believe all Allopathic medicines are safe provided taken in proper dosage and under supervision. For example, a commonly used NSAID (non-steroidal anti-inflammatory) drug “Diclofenac” is widely used and safe in proper dose for a limited time. I once saw a 70-year-old woman with Hypertension and Osteoarthritis knee who was advised diclofenac by her grandson (who happened to be a Physiotherapist). Because this lady was relieved of pain, she kept taking it for a few years. Fact is Hypertension can damage kidneys and diclofenac is also toxic to kidneys. Eventually this lady died of kidney failure. Now this is neither the fault of Hypertension nor diclofenac. It is simply taking medicine without proper medical advice. But the family members blamed Diclofenac and its side effects for her death. Now what kind of justice is this. As a matter of fact, Allopathy is the most scientific system of medicine, based on continuous research and evidence. Actually, other systems benefit from Allopathic research. As X-Rays, Ultrasound and other labs. Investigations are all finding of Allopathy but also used by practitioners of another pathy. Everybody has heard of stamp collectors, coin collectors etc. but do you know strangely there is a category of patients who can be termed as “disease collector”. Maybe not as a hobby but due to lack of awareness. How? Human body just like all other living objects is not permanent but prone to gradual deterioration. For example, throughout life, a person’s body keeps gradually deteriorating besides suffering from one or the other disease. Of course, there are disease-free intervals of variable length. There are different diseases for different age groups. In a normal situation, if a person falls sick, one would expect him to take treatment for it. Even if no Treatment is available, at least take expert advise. As a doctor I agree, I may not be able to treat certain conditions but I can provide some relief at least, (If I cannot provide 100% relief or cure, I can provide temporary relief may be only 10-20%) and will be able to prevent complications.
I have felt sometimes patients have unreasonable demands/expectations from a doctor. Like a 55 yr old patient would come with pain in knee joints and say, ”doctor please cure me permanently. I don’t want short-term relief.” Now, what can any doctor do? What is permanent? No book of science mentions anything as permanent. Even metals have a half-life. Only spiritual books mention that all is transitory, only God is permanent. In India life expectancy now is about 65 yrs. Which means on average we expect an Indian to live up to an age of 65 yrs. So, somebody please tell me when life expectancy is limited how the cure can be permanent.
The fact is that today any system of medicine can cure some disease, limit some others and provide some amount of relief in rest. Even in those cases where we can only provide relief, we can prevent complications. Doctors admit we do not know everything, but we know quite a lot. And without any doubt the Medical knowledge is increasing rapidly. So rapidly as a matter of fact, that even some doctors cant remain updated. I want to say with a little pride that the amount of research taking place in allopathy far exceeds that taking place in Ayurveda, homoeopathy. Reason being that Allopathy has adapted itself very well to modern science. And all the inventions of Science have been integrated into modern medicine (also called Allopathy). A good example is the department of scanning and imaging. The kind of images we can take today were unimaginable a decade ago. But coming back to collecting diseases,I will explain with example. There are two common health conditions; Diabetes and Hypertension. Both are chronic in nature and difficult to cure. But a good Physician can control them very well and prevent or minimise complications that usually follow these conditions. Many patients, just lose heart and don’t think it's worthwhile to spend money and time on doctor’s fee and investigations. With the result Diabetes and/hypertension worse and attendant complications follow. So, after 10 years you have a patient with uncontrolled diabetes/ hypertension with damaged kidneys and heart and eyes. So a patient who had only one condition has managed to collect 4 and has also developed a sense of hopelessness because of gradual worsening of his medical condition. Some patients will visit doctor once wit diabetes/ Hypertension and keep taking the same medicine for yrs. and yrs. They will have a false sense of security, I have consulted a doctor and I regularly take medicines. I find this very painful, because, this treatment is neither difficult nor expansive. But still because doctor is not regularly consulted a difficult situation has become complicated.
Let's see another example. A patient has gall-stones. He has advised surgery. He doesn't opt for surgery because, in his perception, he can manage and considers surgery unnecessary. Now this patient after 15 yrs. can develop cancer in the gallbladder which spreads into liver easily. By now he is quite weak, depressed and is again advised surgery (now much more extensive than the one he was advised 15 yrs ago. Another surgical condition very often neglected by patients is Piles, due to constant bleeding over years patient can develop anaemia and malnutrition, and of course along with negativity. If you go to any hospital and see terminally ill patients. Invariably they are suffering from 5-6 diseases. Each one of them individually manageable, but all taken together difficult to handle. In such cases whom to blame; the doctor or the system of medicine or god or the patient himself. The reader should come to a fair judgement.
One of the very senior, experienced and qualified Orthopaedic Surgeons; with whom it has been my pleasure and good luck to work with, Pro.MuradLanghi of Tripoli, Libya was requested by me to review this article. His comment, “Man, Medicine and Technology contribute to our good health but God is our Healer.”