Many of you who read this blog or visit our clinic know that from time to time I like to conduct surveys to see if we are doing right by patients.
I recently conducted a ‘patient information’ survey, assessing certain parameters of the relationship between doctors and patients.
It was a 10 question based survey and I had a total of 187 responses! I am grateful to all those who took the time to answer the questions.
The questions were based around what patients expect of their doctors. There were certain questions that probably had more than one answer that patients wanted to choose, but only one answer was allowed for the following reasons –
1. The survey was conducted using a free version of SurveyMonkey, that allows only one choice.
2. I wanted to know what the MOST IMPORTANT thing was with regards to certain aspects of doctor-patient relationships.
For those who found a couple of questions frustrating, I unreservedly apologize!
Anyway, the survey results were quite an eye-opener. I have analysed the results for you, and will be presenting the findings here. Please do have a look and let me know what your thoughts are.
1. What age group do you fall in?
The age groups were quite variable, with most falling in the young to middle age group.
2. Do you think doctors spend enough times with their patients in the outpatient department?
This was the first question that was asked. I was expecting a resounding NO, and was pleasantly surprised to see what the results showed.
It appears that 56% of patients felt that doctors spent enough time with their patients, while 44% did not.
In an article published in The Indian Express, Indian doctors spend only about 2 minutes per patient. While this may be the case in some places, I found that statistic hard to believe.
There may be many reasons why doctors do not spend enough time with their patients –
- They just want to quickly finish seeing their patients
- Increase their income by seeing more patients
- Too many patients waiting in the outpatient department
While these are just speculations, they certainly are possibilities.
India has 0.62 doctors per 1000 population, which is a lot lesser than the USA and UK where there are around 2 to 3 per 1000. This makes a big difference.
Take into account rural areas, and you are looking at an even lower number per 1000.
We desperately need more doctors in our country.
3. What is the minimum amount of time that you feel a doctor should spend with their patients?
This was interesting.
I showed you above in news articles that generally doctors spend very little time with their patients.
But what do patients expect?
I was not too surprised by this result.
As is seen, 45% of respondents felt 15 minutes is the minimum time that doctors need to spend with their patients.
37% felt 10 minutes would be sufficient, and 11% felt 20 minutes was needed. Very few felt that 5 minutes was sufficient.
Now, this is a variable figure. Let me explain how.
When doctors see patients for the first time for a new problem, I personally feel 15 minutes is the right time it would take to do a thorough examination.
But if someone comes for a report, it might just take 5 minutes.
Time given by doctors to patients has to be personalised. If they are ill and need help, more time has to be spent.
Follow up consultations held early after the first meeting may not need that much time either.
That being said, what news reports suggest and what patients expect appear to be two extremes. It is important for doctors to reach some middle ground and give the patients the time they so deserve.
4. What is the most important thing that you look for in your doctor? Choose any one.
This was one of the frustrating questions.
It is obvious that patients look for various things when they approach a doctor.
But what I wanted to know was what was the MOST IMPORTANT aspect of a doctor for patients.
These days I see doctors have numerous qualifications next to their name. In fact, the most I have seen is around 18!
Interestingly, not a single one of the respondents were looking at qualifications as a number one priority when choosing a doctor.
The most important factor that they were looking at was ‘ability to diagnose’.
Obviously, this would be important – it is the primary reason that patients visit doctors.
The next two factors included expertise in the field and being truthful and straight about the medical condition the patient is suffering from.
The duty of the doctor is toward the patient. Sometimes, there are misunderstandings between doctors and family members when it comes to sharing information.
Good medical practice recommends explaining the clinical condition (or procedure details if a surgery or any other procedure is being carried out) to the patient first and then to the relatives. Consent must be obtained from the patient for any treatment that needs to be given.
This, of course, would change should the patient be in a situation where they cannot give consent (confused patients, patients in a coma).
If a doctor feels that they are unable to diagnose a patient, pride should not get in the way. It is important that the patient is referred to an appropriate doctor with expertise in the field.
5. What is the most important thing you see in hospitals when you or a family member is admitted there?
Another frustrating question.
There were two aspects of this that came neck and neck.
Patients felt that having all facilities under one roof was the most important thing. Closely following this was the fact that their doctor was there in that hospital to take care of them.
I thought that cost would be an important aspect, and though I personally feel it is (and I am sure the respondents felt that as well), it does not seem to be the most important thing.
Cleanliness mattered, but not so much in this study.
6. Do you think that patients should be provided with all information about every medicine that they are taking – effects, side effects, drug interactions etc when given a prescription?
As expected, people wished to have all the effects and side effects of a tablet being prescribed to be explained.
Sadly, this does not happen often in clinical practice.
Side effects are rare. When a doctor prescribes a medicine, they take into account the risk: benefit ratio. They look at whether a patient would benefit more from a treatment, as opposed to experience their side effects.
Unfortunately, side effects can occur unexpectedly sometimes. It is impossible to predict if someone will have a side effect to a medicine unless they have experienced it before.
This is where explaining side effects become important.
If the patient is informed, they will be able to pick up the important and serious side effects soon.
I personally feel doctors must inform their patients about SERIOUS side effects, rather than all of them. There will be over 20 side effects that are unimportant most of the time. If a patient is on 10 different medicines, it can take forever to explain them all.
Also, the entire 15 minutes or even more than the respondents hoped their doctors will spend with them will be over in a jiffy!
People are welcome to look up common side effects online. Doctors can email them links to reliable websites that will provide them with that information.
7. Do you think patients must be given all the information about their condition even if it might be bad news?
This is closely linked to a discussion I held earlier in this article.
In this survey, 65.8% of our respondents clearly accepted that patients should be given all the information.
However, 29.4% of them felt that the decision regarding this should be taken by the treating doctor.
This is a little bit of a tough situation as emotions come into play here.
I guess it is important for the doctor to guage the situation, particularly the emotional stability of the patient.
For example, if someone comes to a doctor with a lump in their abdomen, there is often a concern of cancer. While the patient knows it, the doctor should ideally not reveal this until all the information about that lump is obtained.
Clinical suspicions can be put across, but no definitive diagnosis is given until all the reports are back.
If someone is told they have cancer and the lump turns out to be benign, there will obviously be a huge sigh of relief. At the same time however, the patient would have been through hell until the reports come back.
Imparting information requires the maintenance of a delicate balance between what should be shared now and what later.
8. Do you as a patient feel that you need to be allowed to choose which treatment you would like to have provided you have all the information necessary for your health condition?
Patient autonomy is extremely important, especially when it comes to their health. Providing all the necessary information to the patient so that they can take an ‘informed decision’ is extremely important.
Medical practice has changed a lot in the last decade. There is now a plethora of information around, which has made a doctors’ job a lot harder than it used to be.
In the process, it has also confused patients.
It is always daunting when it comes to taking decisions regarding one’s own health, even if all the information has been put forth.
That being said, take time to process all the information given to you. Many a time, if things have been explained clearly by your doctor, the decision-making process becomes a lot easier for the patient.
In this survey, I found that majority (almost) of patients wished to take decisions about their health themselves.
This is very reassuring, though I would have liked to see the numbers a little higher.
I suspect some who have said that the doctor has the final say might be thinking of more complex medical problems they have encountered.
Overall, an interesting response, I must say!
9. Do you think doctors force decisions (regarding treatment and tests) they make on their patients sometimes without giving them sufficient time to decide?
I had to ask this question given some experiences patients of mine and their family members have had over the years.
The response is not unexpected I feel.
The results can be approached from two angles.
The first….. the patient was very ill and unfortunately did not grasp the gravity of the situation. In such a scenario, it is essential that the doctor take charge if the decision would change the life of the patient.
We have had patients who have come with extremely high blood pressures, fluid in the lungs and even a weak heart, who opted to stay at home for treatment.
This is despite explaining the nature of the situation to them and telling them that the condition is life-threatening.
Such a scenario warrants a doctor to be stern in the interest of saving a life.
The second…. the patient is not really that ill and can be managed at home, but the doctor insists they undergo complex and expensive tests.
I personally believe that doctors have to explain why a test is being done in detail so that patients are not strangers to what is happening to their health.
Scaring a patient into getting a test when it is not necessary is just not right. Period.
There would clearly be an ulterior motive.
I am in no way surprised to see the response here, and I hope to see it change in the future.
10. When a blood test or medical test is abnormal, what is the FIRST thing that you do?
Many doctors now feel that they have become ‘second opinions’. The first opinion is Google.
However, I was pleasantly surprised to see that only 1/3rd of the study group looked at Google before visiting a doctor.
It does, however, beg the question – why would people even want to Google information? 20 years ago, nobody even bothered!
I guess, to an extent, doctors are to blame. Insufficient time, busy schedules etc mean that they cannot spend enough time explaining conditions to their patients.
Patients feel left in the dark, and naturally, the internet is the next place to visit for information.
Many a time, it is unreliable. Mostly because it is not ‘tailor-made’ to the individual patient, but also because some health information websites are looking to make a quick buck by selling ad-space.
The whole reason for me to start this blog was to address this very issue – patient information that is reliable.
I personally feel that every doctor must spend some time imparting health information to patients in an environment where they are relaxed and comfortable.
A blog is a great idea.
After the information is shared, they should be encouraged to ask questions or discuss anything that is on their minds.
After all, it is their health and their right to know about it.
I hope this survey of mine was useful to you. I certainly found it enlightening!
I thank each and every one of you who answered the questions. I look forward to your comments soon!
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