There is an old Chinese saying “Give a man a fish and you feed him for one day. Teach him how to fish and you feed him for a lifetime”
From times immemorial, the practice of medicine has been a closely guarded secret. The physician is the “know all” and the patient is the “ignorant recipient” who was expected to blindly follow the orders. The medicinal concoctions were a secret. The prescriptions were in Greek or Latin.
I strongly feel that being a doctor-patient team and enabling patients is a better method of caring, curing and healing.
I deal with asthma. Asthma is a chronic disease which will stay with the patient. It can be controlled but it can’t be cured.
In chronic diseases, if a good outcome is desired, the doctor and the patient have to work as a team. The role of the doctor is more about teaching and less about doctoring. It is about empowering and enabling the patient to manage the disease himself/herself. Power must lie in the hands of the patient !!
Enabling patients does not make the doctor weaker. In fact he becomes stronger.
Can all patients be enabled and empowered ? Do all patients want to empowered ? Can all patients even comprehend the concept of empowerment? The answer is NO. Not all.
Some patients shy away from taking this responsibility. They like the doctor to hold their hand and lead the way. They do not want to be or find themselves incapable of being a part of the decision making process. Some may even think that the doctor is unsure/incompetent to be asking and wanting to know the patient’s preference.
I had a previous patient of mine bring her old mother from a village to come and see me for her medical problem. On my asking her “ Mataji, what is your problem” her response was “that is for you to find out”. And the look said it all: “You said he is a good doctor, but he seems to be an idiot. He’s asking me what the problem is.
Patients who claim they want to be empowered also become shaky when it comes to the crunch. I remember reading a very interesting study from the Mayo Clinics. They asked 100 healthy women in the age group of 50-60 years that if they were to be diagnosed with breast cancer, would they like the treatment modality (surgery, radiotherapy or chemotherapy) be explained to them and then they themselves decide what they want or would they like the doctor to decide what is best for them. As expected, a majority said they would like to decide for themselves. Another 100 recently diagnosed breast cancer patients were also posed the same question. Surprisingly, when the cancer was actually there, a majority of the women wanted the doctor to be the one to take this final call.
So, even though notionally the concept of self empowerment is attractive, when push comes to shove, many patients may still entrust this responsibility with the doctor.
No two patients think alike. So a doctors job is not only to diagnose the patients ailment, but also diagnose how mush to empower the patient. Herein lies the art and joy of medicine!!