Dealing with the trust deficit
The word that best describes a doctor’s life is- “unpredictable”.
Every day is a new day that brings on its own challenges. In our battle with disease and death, we win some, and we lose some. There are days when we come home elated, and then there are days when we feel totally defeated. As doctors, we understand the true meaning of humility because however skilled and experienced we may be, the “unpredictability” eventually finds our way to us.
When things go wrong, as they some-times do, doctors find themselves at crossroads, fighting multiple battles at the same time.
First and foremost, we have to deal with the clinical battlefield. Mentally, we need to make the transition from routine to emergency mode and start hunting at breakneck speed for the causes that are leading to the current condition of the patient. It is usually a race against time, and we need to act fast. Every wasted minute decreases the chances of the patient’s survival. Despite all the technological advances and facilities available to us, at times surgical/medical decision making can be extremely complicated. Some-times there are no straight-forward answers and the complexities of human body refuse to fit into any of the pre-designed algorithms. In practice, textbook scenarios are rare. More often than not, best practices tend to fall short and there can be more than one right answer to a problem leading to huge diagnostic dilemmas.
When dealing with a critical patient it is not just about the clinical process. All the stake-holders have to move in tandem with complete understanding of the situation. The patient’s family is the most important stake-holder in this. In days bygone, doctors were placed on a pedestal by the patient’s family irrespective of the clinical outcome. A doctor’s word would be the last word, no questions asked. However, today when things go wrong, doctors have to also battle the erosion of trust and faith from the doctor-patient relationship. It takes no time to transition from being the saviour to becoming the perpetrator. Questions are raised at every step and every move is viewed with suspicion. Conversations start getting an aggressive connotation. All kinds of latent biases regarding age, seniority, experience and gender start surfacing. Noise levels about getting second, third and fourth opinions increase within no time. Random case studies are compared and subtle & sometimes not so subtle threats about violence, litigation and maligning the reputation in media are all thrown into the fray. There can be financial implications in the form of non-payment of bills etc too. The immediate family, extended family, friends and their friends all seem to have one common enemy- the doctor.
The foundation of every relationship including the doctor-patient relationship is trust. However, lack of faith and trust can be very demotivating and humiliating for any doctor. It leads to dejection and can make us feel extremely vulnerable as a human being. It can make a big dent in our confidence level as a clinician. Today, conversations about having a second career option are gradually gaining momentum in the medical circles. Many doctors wish to move out of the realms of clinical medicine and take up less risky and less stressful professions. Sadly, increasing number of doctor parents do not want the next generation to get into medicine for these very reasons.
Whether we are a beginner or at the height of our career, such situations will continue to arise. Only the stakes are different at every stage. Unfortunately, in the medical schools, no one teaches what to do when a patient does not trust us or how to deal with an aggressive family member. Even today there is not much focus on communication with patients and neither on stress management for doctors.
So, is there a solution for this conundrum? Honestly, there can be no right or wrong answers. Every situation is different and has to be managed accordingly. However, I have listed a few points below which can be of help if you find yourself in a similar situation:
- I think first and foremost we need to become comfortable with the ambiguities of a medical career. We have to accept that sometimes despite our best efforts things may go wrong. In this battle, sometimes we may lose to disease as it may turn out to be the more formidable opponent. Do not lose confidence as this has nothing to do with your capabilities. Ultimately, in medicine, we have to work on becoming more resilient.
- Secondly, we have to accept the new realities of our generation. This is the age of information overload where people feel that they can decipher medical complexities at the click of a button. As doctors we need to practice with increased tolerance and detachment. We are no longer living in a world where our word was the last word. Today we have to devote time to answer queries of patients and their families however, trivial they may seem. We have to deal with the Googlization of medicine.
- Thirdly, if things do go wrong with any patient under your care, please spend some time to reflect on the entire clinical journey of that patient. Run it through your mind multiple times and if you feel that you have done your best, there is no need to worry about anything. Be meticulous about documentation. Do not rely on others for paper work. If things get worse, only the written word stands in the court of law. Maintain good records.
- Fourthly, work on stress management. Such situations can be extremely stressful. No one else can understand the kind of stress that a doctor may be going through. At times the weight of this burden may become too heavy to carry alone. It can take a toll on your mental and physical health. Don’t keep it to yourself. Talk to friends, colleagues, spouse or even a counsellor. Sometimes just talking about it and letting it out can make one feel better.
- Fifth, it is very important to seek help. If you find yourselves in a situation like this, immediately reach out to a mentor/colleague/contemporary for help. If the patient asks for a second opinion, be forthcoming about it. Have a transparent conversation with the other consultant about the clinical scenario and the plan of treatment. One on one discussions are helpful to diffuse the tension.
- Sixth, do not feel hurt about your efforts not being recognized. Remove yourself out from that situation. It is important to understand that it is not about “I, me or us”. Do your job to the best of your ability and move forward.
- Seventh, take things in a stride. Nothing lasts forever. Make friends and work hard on building good relationships. Seek help. Reach out. At the end of the day, in difficult times, it is only our relationships that help us to sail through.
Last but not the least, do not make the mistake of generalising. This world is full of all kinds of people. Even today, the number of people who trust doctors and have faith in them are much higher than those who don’t. At the end of the day, despite all challenges, there is no other profession that is as rewarding and gratifying as medicine. We win a lot more than we lose and are blessed with the unique ability to heal people and relieve them of pain. The best way to deal with trust deficit is to continue to have faith in our abilities and good intent for our patients.
1 thought on “Dealing with the trust deficit”
Fantastic write up on present medical scenario and clinical practice in this era. I am sure your suggestions will immensely benefit our medical fraternity.