Beyond the prescription

©Dr. Aparna Govil Bhasker

I’ve always enjoyed talking to my patients, and as much as I love surgery, I truly cherish my time in the OPD. However, the time available in the OPD is limited, and we need to cover a lot in those precious few minutes with each patient. As healthcare professionals, we often become laser-focused on providing well-meaning advice and delivering a neat looking prescription (a challenge in itself for any doctor! Thank God for the digital softwares!). By the end, we feel we’ve fulfilled our duty.

As our practice grows and the number of patients increases, the time spent with each patient tends to become shorter, or the waiting list grows longer. Both scenarios lead to decreased patient satisfaction. But it’s not just patient satisfaction that takes a hit—our own job satisfaction suffers too. Over time, frustration starts building on both sides, and we all know where that leads to.

In recent months, I’ve felt that tension growing within me. I began to question: if I wasn’t feeling satisfied with the consultations, what were my patients walking away with? As obesity care specialists, were we truly making a meaningful impact when it came to lifestyle changes and behavioural modifications? Despite spending nearly 40 minutes with each patient, it felt like something was missing, like we weren’t reaching the level of progress we aimed for. We were not getting through the way we wanted to.

Fortunately, I’m lucky to have friends who share a similar mindset. When I discussed my concerns with my friend Dr. Tejal Lathia a renowned endocrinologist, she highly recommended the Motivational Interviewing course by Prof. Miller and encouraged me to explore it. Although I’ve been in medicine for nearly 30 years and can confidently say I’m a skilled doctor and surgeon, I must admit I’ve never been formally trained in the art and science of communication.

As a bariatric surgeon and specialist in obesity care, I’ve come to realize that communication is the real game changer. We can perform the most advanced surgeries, but it’s only through consistent and effective communication that we can truly help our patients make lasting lifestyle changes. Without it, both doctor and patient can fall into a cycle of judgment, bias, and blame, which benefits no one.

Yesterday in the clinic, we tried the “person-centered” approach for the first time. “We went beyond seeing the deficits on the patient’s side (3 months post a bariatric operation) such as- staying up late in the night, skipping breakfast, feeling low on energy, avoiding exercise, and neglecting her prescribed supplements.” On a normal day, our usual approach would have been to tell what she was doing wrong, offer well-meaning advice, explain the associated health risks of future complications, give her a prescription and send her off, hoping she’d correct course and be on a better trajectory by her next visit.

However, the person-centered approach encourages curiosity. It teaches us to move beyond assumptions about what we think we already know and what we believe is needed. It invites us to engage in deeper conversations with our patients. “With some gentle prompting, this particular patient revealed that for the past six months, she had been burdened by intense guilt. A close relative’s health had deteriorated after being admitted to a hospital that she had recommended. The financial burden from the medical bills was overwhelming, and the relative’s daughter had to give up her full-time job to care for her mother. This guilt weighed heavily on my patient, robbing her of sleep and triggering a cascade of problems—waking up late, missing meals, low energy, and neglecting self-care. It was also preventing her from feeling or accepting any joy in her own life”

She broke down in tears during our conversation, and we discussed the possibility of seeking help from a counselor. While she wasn’t entirely open to the idea, a seed had been planted. She seemed more receptive to make changes to her lifestyle and came up with some solutions on her own. More importantly, she felt understood, and we, as her healthcare team, felt like we had moved beyond simply judging her for not meeting our expectations.

This experience reminded us that as healthcare professionals working with chronic conditions like obesity, we can’t “fix” patients overnight. We can’t just hand out prescriptions and expect perfect adherence. We aren’t in a position to command or take charge of their lives. Our role is to guide them, safely and hopefully enjoyably, towards a destination we both desire. We must acknowledge that life happens to everyone—our patients are no exception.

For those living with obesity, these challenges are often compounded. In addition to everyday struggles, they also face the stigma and bias that come with societal expectations. Patients who have undergone bariatric surgery often feel the weight of taking what is perceived as a “shortcut,” along with the pressure of not meeting expectations, even after the surgery.

As healthcare providers, it’s crucial to make the most of the limited time we have with our patients. Sometimes, the connections we form matter more than the prescriptions we give. Kindness, empathy, and compassion are universally effective tools, often more powerful than any advice alone.

Incorporating motivational interviewing into our practice has the potential to transform not only the patient’s journey but also our own. By fostering deeper connections and helping patients uncover their own motivations, we empower them to make meaningful and lasting changes. As healthcare professionals, we should be open to learning and refining the art of communication at every stage of our careers. It’s not just about enhancing patient satisfaction—this approach brings greater fulfillment and satisfaction to us as doctors too. A well-communicated, empathetic consultation can be the difference between frustration and fulfillment for both parties, ensuring that the care we provide is as effective as the surgeries we perform.

I’m just beginning this journey, but I hope that by sharing my experiences, I can enrich my own path and perhaps make a small difference along the way.

PS: The image is AI generated.