The surgical compassion

Representation pic

I am on a WhatsApp group that found itself seething because one of its members died trying to seek a consultation with a famous doctor. It was probably something that required early attention, but no appointments were available, and the patient insisted they wanted to see only him. They were furious that some doctors had now become stuck up and pompous and were misusing the gift of healing bestowed upon them. "I feel ashamed that such rude and non-compassionate doctors exist in our country," an exasperated member lamented. "It's our fault alone that we have relegated doctors to divinity," someone else ranted.

The discussion reminded of the time a patient of mine, Rakesh, who had a brain tumour, once candidly told me, "Sir, hum bade bade doctor chhod ke aap ke paas aaye [I ditched some prominent doctors to come and be treated by you]." I was transiently perplexed whether to treat it as a compliment or criticism. Should I be elated or offended? It got me thinking as to what makes a doctor bada (a big shot), and more important, what does a patient expect from their doctor. So, I put out the question to the same people and a few others with the intent to help make us better doctors.

"Tender loving care," was the promptest reply. "We want our doctors to give us time, undivided attention, answer all our queries, and allay our fears," was another reasonable request. "We know you are short on time, but we are also worried," interjected someone else. "Patience for his patients," was typed by another in all caps. I thought about it and realised that every patient wants more time with the doctor, except the patient that's waiting to be seen next. "I've been waiting for an hour-and-a-half to see you, doctor, and I can't sit for long," an elderly man once told me. "I deeply apologise, but the lady before you had a typed-out list of 73 questions I needed to answer," I explained. "It's always the ladies," he shook his head.

"Listening with an open mind, empowering patients through education, and allowing them to explore other options and second opinions not only fosters trust and collaboration but can also be a transformative experience," was someone else's two cents, as they themselves called it. But an invaluable two cents, I felt. Empathy and kindness were a given.

"How do I become a bada doctor?" I once asked a friend. "Don't give appointments very early unless it's an emergency," was the blunt advice I received early in my career. "If you're easily available, people will think you're faltoo," I was told. "That's how misguided we are as a society," he added. "Bade doctor ka appointment jaldi nahi milta!" To date, I give appointments at the earliest.

Also on the list were the famous four As that good doctors are meant to have: Accessibility, affability, accountability, and affordability. "I toh want to be able to talk to my doctor on WhatsApp any time I want," someone else demanded. This was a popular interpretation of accessibility in today's highly connected world.

Speaking of affability, I once asked a friend about a visit to a new diabetes doctor she had been recommended. "I didn't like him at all," she said condescendingly. "Why, what was the matter," I asked, intrigued because I had heard such good things about him. "He's too short," said the five-foot, eight-inch lady with zero irony. "You don't have to slow dance with him to bring your sugar down," I said, challenging her absurdity. Even if he's vertically challenged, he's still not going to be "looking up" to her.

Another complaint was that some doctors keep sending you from one specialist to another. "The buck just doesn't stop with the first consultation," I am told. "We want our doctors to partner with us all along in our healing journey," someone added, which I agree is good accountability. "Also, what are these crazy charges? Some doctors charge R5,000 for a five-minute consultation and scribble something on some paper that only the chemist understands," was another viewpoint. "Do they think they are God, or what?"

That brought to mind Alec Baldwin's speech in the 1993 film Malice, where he sneers at the prosecuting attorney during a deposition hearing in the film (where he was accused of removing a seemingly healthy ovary) who asked him if he had a God complex. "If you're looking for God, he was in operating room number two on November 17, and he doesn't like to be second guessed. You ask me if I have a God complex. Let me tell you something: I am God." The movie was ludicrous, of course, but also lots of fun.

I was a little surprised that no one had still spoken about what I thought was the most important A, the fifth A - ability. Doctors study for over a decade in medical school and residency to enhance their expertise and sharpen their skills and, yet, that requirement doesn't come across as a top priority. I think it's because most people agree that doctors are good at what they do. A few people might clear their throat or raise an eyebrow at that statement, but I also know without a doubt that most individuals have had positive interactions with their doctors and proudly recommend them to others. Especially those on disgruntled WhatsApp groups.

To further expand my research on this subject, I asked my tennis buddies the following question: "If you had to pick only one of the two qualities your doctor could have, competence or compassion, which would you prefer?" The response was immediate. "I don't care if my doctor is a sociopath - all I want is that he's knowledgeable, sound, can communicate clearly what needs to be done, and do it," was the reply from a practical mind. "If I'm having a heart attack, I don't want TLC; I want the freaking clot unblocked ASAP!" he rationalised. "Compassion without competence is a friend," another buddy said. "And competence without compassion?" I asked. "That's a transaction," he said, without a thought.

The relationship between doctors and patients is built on a delicate balance of expectations and understanding. For doctors, it is essential to remember that while competence is the cornerstone of medicine, compassion is what turns a good doctor into a great one. As patients, we must realise that doctors are human too, with limited time and countless responsibilities; yet, we are all committed to your well-being. When we understand this, healing becomes a partnership. As Hippocrates, the Father of Medicine, once said, "Cure sometimes, treat often, comfort always." But if he were alive today and had a long day in the clinic, I'm sure he would have resorted to, "We can't cure everyone, but hey, we can at least try not losing our minds in the process!"

PS: Hippocrates was really short too.

The writer is practising neurosurgeon at Wockhardt Hospitals and Honorary Assistant Professor of Neurosurgery at Grant Medical College and Sir JJ Group of Hospitals mazda.turel@mid-day.com