The Consultation Room

Prof. Dr. CMK. Reddy

General & Vascular Surgeon, Halsted Surgical Clinic, Chennai, Tamilnadu, India

Chapter 16: Punctuality

‘Those who come late are not busy, but lazy’

-Mahatma Gandhi

Respecting the value of time of everyone, we should try to be as punctual as possible. An anxious patient tends to be more and more emotionally disturbed, if he has to wait for hours, to see the Doctor. If the Doctor is held up in an emergency, the reception should brief the waiting patients about it and indicate the approximate time Doctor is expected to be in the office.

It’s nice for the Doctor to express, when the patient is called in, a word of regret for the delay, mentioning the reason. If you are a surgeon, best way to maintain punctuality in office is to schedule surgeries not during consulting hours, say early mornings.

Other advantage in early morning surgeries is some unexpected and more important assignment during day time, may dislocate or disappoint patient scheduled for surgery or their attendants, upsetting their plans for the day. Patients definitely appreciate our ‘time sense’ and commitment to stick to the schedules.

“Conventional medicine says take Aspirin. In the incense of tort reform, defensive medicine says MRI and Cat Scan.”

Chapter 17: Pleasantries

“Smile on your face is an inexpensive way of improving your looks”.

Doctor should receive the patient into his chamber, with an attitude depending upon their earlier relationship. After the usual pleasantries, it’s better to start with some nonmedical subject (other than the patient’s illness), may be related to the attendant.

For example, if patient’s daughter is accompanying him, you may ask her what she’s studying. Suppose she says ‘I’m doing MSc Physics’, you might say ‘Oh ! Physics was my favorite subject, I used to get centum. In fact, I wanted to become an engineer, but somehow, I became a Doctor’. Such conversation puts them at ease, tends to identify with the Doctor, before actually going to the subject.

It’s also nice, if any major event in the patient’s family, such as graduation, marriage, child birth, major accident/illness or death, is brought to your notice, to make some enquiries and offer your feelings about it.

Chapter 18: Interrogation

Of course this gives you the most important information, to arrive at the probable diagnosis or at least short list the differential diagnosis. Attentively listening to what all the patient wants to say, would give you some valuable clues whether it’s organic or functional and also very vital to gain their confidence.

If you feel he is drifting away from the main subject, you may put a leading question, to bring him back on the right track. A study revealed that now a Doctor spends 30-40% less time with his patients, compared to 40-50 years ago, which is responsible for eroding into the all important ‘Doctor-patient relationship’. Losing emphasis on clinical diagnosis is a very important reason for escalating the cost of medicare.

Best way to gain confidence of the patient: maintain good eye-eye contact, keep the external interruptions (on your mobile or the intercom) to minimum, review all relevant records patiently and ask pertinent questions in eliciting history.

It’s better to ask all the attendants including the nurse, to leave the room, to ensure strict privacy, before asking personal questions, such as sexual history (marietal or extramarietal) or erectile dysfunction etc. or any other confidential matter, he may want to disclose. We should remember, they may even hesitate to talk about their smoking, alcohol or other unhealthy habits in the presence of elders, out of respect.

As you are doing physical examination, you may ask more questions, initially overlooked or felt necessary in view of certain findings. History related to incidental diseases discovered, such as a thyroid nodule, umbilical/inguinal hernia, hydrocele, sebaceous cyst, lipoma, phimosis, halux valgus etc. which may or may not be related to his primary problem, has to be noted for future reference.

Chapter 19: Interruptions

It’s very annoying to the Doctor as well as the patient, if their conversation is getting repeatedly interrupted by phone calls or assistant’s visit to the Doctor’s chamber. It’s important to create an impression to the patient that his matter is the most important at that point of time and the Doctor is giving his ‘undivided’ attention in that respect.

We should keep such interruptions to minimum, preferably to the short gap ‘in between’ patients. It’s also undesirable to discuss on phone about a patient, critically ill (in ICU) or expired, which may generate negative thoughts in the patient sitting in front of you. Of course, the patient and the attendants should be instructed to switch their mobile phones to silent mode, before entering into Doctor’s room.

Continuous noise of an AC unit may be disturbing, unless it’s a split type or there is central air-conditioning unit. Similarly, we should avoid external disturbances from the adjacent room or the neighboring areas, which will disturb the tranquil ambience and requires louder voice, to make the conversation audible.

“We have two options. I can open you up again or I can report the watch stolen and split the insurance money with you.”

Chapter 20: Language issue

“If you talk in a language which one understands, it goes to his head, but if the same is said in his mother-tongue, it reaches the heart”.

-Nelson Mendela

If you have problem communicating in their language, request any of the attendants to assist you, or get an interpreter, who knows both languages (yours and patient’s). It’s advisable that the consultant makes an attempt to learn those languages, mostly required to improve the efficiency of his professional work.

After my return from USA, I started practicing in Chennai in 1970, when I didn’t know a stroke of Tamil. My elder brother, a graduate of Kilpauk Medical College and a leading general practitioner, whenever he sent a patient to me, he used to send an intelligent’ interpreter along, with instructions about what to (I should) tell the patient, regardless of what I might say, since he felt I couldn’t communicate well!

You have to put all your efforts to ensure there is no communication gap because of language issue and the patient should leave your room with a satisfaction that he conveyed everything he wanted.

In city practice, patients belonging to various languages come to us, it’s important to make a note in his record the language(s) the patient can speak, so that you can converse in a language comfortable to both on future occasions.

“The Doctor just finished his rounds. I better go soothe the patient’s psyches.”

The Consultation Room