What it is like to step into the shoes of a patient?

The newfangled developments of super specialization in medicine has significantly improved our understanding of the disease process and the resultant treatment outcomes. At the same time, it has also increased the inconvenience of patients who needs the involvement of more than one specialist, treating a myriad of their issues, all at the same time. This can involve dealing with many appointment windows and conflicting opinions and overlaps in the ordered investigations. The difficult task of collating different opinions can overwhelm patients trying to make sense of it.

I narrate the saga of a 10-year-old boy and his family during his protracted illness following a severe roadside accident. I happened to witness his quandary of coordinating contemporaneous treatment by several speciality departments of a multi specialty hospital:

“While I was heading a prestigious tertiary care medical institution and also worked as an urology consultant within the hospital, I was consulted for 10-year-old boy, suffering from multitude of problems following a road accident few days before. I had to play a dual role, one as his Urologist and the other as his advocate, coordinating with multiple specialists and services. Our trauma center did a great job in his initial management to bring him out of crisis. He had sustained multiple complex fractures in all of his limbs. His urinary bladder was badly damaged, with complete loss of skin and tissues above it. We needed coordination between the specialties of orthopedics, urology, plastic surgery, plus services such as anesthesiology and operating room scheduling. We had to arrange for voluntary donors to meet the requirement of blood transfusions during his surgery and to organize the shopping lists of supplies needed by all of the different specialties. Because the boy’s parents had difficulty navigating through the system, they requested me to intervene on his behalf as head of the institution.”

My colleagues responded favorably to my challenge and each specialist had done their best to help this child to recover to near normal. This was possible because I had played the role of an influential coordinator in this special case. The obvious question arises: What is happening to the common patient without such an advocate? During the process of my overseeing his treatment, I learnt invaluable lessons, which ignited the need for immediate reforms in the hospital system I was in charge of. But for the experience of acting as a common patient’s caretaker, I would have never realized the need for better coordination within my own system. We worked hard to make the system more responsive following this case, but were met with only limited success because it was nearly impossible to change existing legacy systems, attitudes and prevalent practices.

I firmly feel that very soon, hospital systems and consultants will have to extend the scope of their work to beyond the confines of the disease or injury being treated and the premises of the hospital, to considering the patient and their family as a whole. It is just as important to ensure the compliance of your prescription as it is to writing it.

The emphasis on “patient centric medicine” is rapidly redirecting current hospital design, functioning, systems and physician’s attitudes to move away from legacy systems to single window policy, wherein instead of patient moving from place to place in a hospital, the hospital system moves around the patient to meet his or her needs. It is integrating opinions and actions at the point of care.

“Empathy is about standing in someone else’s shoes, feeling with his or her heart, seeing with his or her eyes. Not only is empathy hard to outsource and automate, but it makes the world a better place.” Daniel H.Pink

Mahendra Bhandari MD, MBA

drmbhandari.com