Chapter 9. Building blocks of patient care

Dr. Yeshwanth K. Amdekar, DCH, MD (Pediatrics), FIAP

Practice of medicine is an art, not a trade, a calling not a business, a calling in which your heart will be exercised equally with brain- William Osler

What patient needs is more conversation Glenn Close


Care always, cure if possible should be the motto of every doctor. In spite of advances in modern medicine, cure is not possible for many diseases. In the past much before modern science developed, physician could comfort patients only by the quality of care they offered beyond prescribing medicines. Unfortunately, this aspect often is ignored by present-day doctors.

Attributes of Quality Care

Quality is an abstract and not a discrete entity. There are two dimensions of health care provision of care (clinical standards) and experience of care (communication, counselling, empathy, ethics and emotional support). There is no doubt that clinical decisions must be based on science that include analysis of detailed history, focused physical examination, relevant minimum tests and rational therapy. However, there are other patient-centric aspects of quality care that relate to individual patients’ needs, preferences and values, patient education and patient satisfaction. Therapy must be safe (no harm while trying to do good), effective – services provided based on scientific knowledge to all those who could benefit (avoiding underuse) and refraining from providing services to those who are unlikely to benefit (avoiding overuse), timely (reducing undue waits and harmful delays for both care-givers and receivers), equitable (providing same quality as per the need) and efficient (avoiding waste of drugs, equipment, tests, procedures, supplies, ideas and energy). Doctor should give adequate time as per the need and not just the standard time slot for every patient. Some patients may need extra time either for diagnosis or counselling and it is necessary for a doctor to manage time in such a way that quality of care is not sacrificed. Dignified and respectful approach is expected and success of quality care depends on patient empowerment that helps him to manage his own illness effectively.

Holistic care ensures quality care

We humans are endowed upon by nature few faculties that must be put to use in every act of ours to obtain best outcome. These include body, heart, mind and soul. When translated into medical practice, body means knowledge, heart the compassion, mind the commitment and soul the inner conscience. Compassion makes us understand the suffering of a patient which in turn would deliver quality care. Of course, we should not be too much attached to a patient lest we go astray in our clinical decisions. Commitment is necessary to do the best to the extent of our ability and should be the way you would expect other doctors to behave if you were a patient. As medical science is dynamic and fast changing, we need to keep ourselves constantly updated. However, in spite of knowledge-based care delivered with compassion and commitment may not achieve desired results and it is where inner conscience plays a part. As outcome in a patient depends on many variables beyond our control, even at the end of poor outcome, we should be so clear in our conscience that we had left nothing undone. After all we are answerable to our own conscience.

Thin line between great and good doctor

Good and great are both adjectives that superficially seem to be similar but are different. Great is an adjective that may be used for both good and bad behavior such as he is a great crook or a great liar. But good as an adjective refers to only right behavior. There exists a thin line between great and good doctor. Great doctor is one whose performance is above average and so is admired while good doctor fulfills the expected or desired outcome including patient satisfaction and gratefulness and such a doctor commands respect. Average doctor treats symptoms, great doctor treats the disease while good doctor treats a patient and beyond.

Is motivation necessary?

Motivation is a psychological driving force that reinforces an action towards desired goal. Intrinsic motivation is driven by enjoyment of work, pleasure without expecting a reward and should come from within. In such a situation, even work load induces eustress enjoyable stress that does produce a positive impact on health and well-being. Once intrinsic motivation gets started, habit sustains it. As against, extrinsic motivation is driven by reward, money or threat, punishment and in which work load results in stress that has negative impact on life, results in life-style disorders. It is the intrinsic motivation that determines what you do but attitude decides how well you do. It is the attitude that takes you to altitudes. If you give a numerical value to each alphabet 1 for A and 2 for B, then attitude is the word that totals 100. It is important to cultivate right kind of attitude to reach heights.

Personal notes

I set up a joint practice so that quantity of practice could be shared with a motto to maintain good quality and I could give enough time to a patient with proper counselling and documentation. All my partners do the same. We are blessed by parents who appreciate care that we give and it brings us an immense joy. Of course, few patients want a quick fix and we are happy that such patients never come back to us. I have met patients who felt I talked more than prescribing drugs and so, they were not satisfied as they thought they wasted their time. Obviously, they don’t care for care but only value the drug prescription. God bless them to find better doctor!

Take home message

Doctor is expected always to offer holistic care and cure if possible. One must develop intrinsic motivation and right attitude that will help building right blocks of patient care. It will benefit both the patient and a doctor himself.