Patient Care: A Forgotten Art – Ten-Point Solution for Better Patient Care

“Care more particularly for the individual patient than for the special features of the disease.” –Osler[1] Treating the disease is an important aspect of a bigger goal of healing the patient, which we all should be capable of doing. William Osler, considered by many to be the greatest of clinicians ever born, once famously said “The practice of medicine is an art based on science.”[2] By this, what he meant was that understanding deranged physiology no doubt fundamental to medicine, but paying attention to the patient’s needs, hopes, and desire to understand the meanings behind their illnesses was equally important and needed to be addressed. Sadly, the teachings of Osler, that it is the well-being of patient, which is paramount, and not accurate diagnosis and effective treatment alone seem to have been forgotten by now over the past many decades.[3] To bring back the focus on the forgotten art of patient care, we offer these simple 10 solutions appropriate to our context, which have been largely inspired by Osler’s aphorisms. STUDY THE PATIENT AS AN INDIVIDUAL let your patients know that they are more than work for you, treat them as equal, and if possible, be friends. be on time, spend time with your patient, and use the unique clinician–patient relationship to motivate your patient. the patient must have the freedom, autonomy, and self-determination in decision-making or at least expressing opinions about the different treatment options, including sharing of information, and about accepting instructions of the doctor. it empowers patients and also improves services and the health outcomes.[4] Let your patients know that they are more than work for you, treat them as equal, and if possible, be friends. Be on time, spend time with your patient, and use the unique clinician–patient relationship to motivate your patient. The patient must have the freedom, autonomy, and self-determination in decision-making or at least expressing opinions about the different treatment options, including sharing of information, and about accepting instructions of the doctor. It empowers patients and also improves services and the health outcomes.[4] “Learn to study patients, not cases or individuals, not diseases.”[5] LISTEN TO THE PATIENT “Listen to your patient; he is telling you the diagnosis.” –William Osler[6] Listen to patient’s woes; don’t just record or hear, but actually listen; the patient might guide you to the best management plan too. There are published literature, where just listening to the patients by honoring their understanding and wishes have led to not only better diagnosis but also better patient outcomes.[7] CLEAR THE DOUBTS OF THE PATIENTS Share knowledge with the patient and reassure frequently. Many patients have doubts which they often are afraid to ask the doctors. Address those in the language they understand without using much of medical jargons. One of the easiest ways to allay anxiety is to address their queries and doubts. EMPATHIZE Laugh and cry with your patient; once they know you care, they become well too. Peabody in his landmark article, written a century ago, highlighted the value of establishing personal relationship between the physician and the patient; the failure of which might account for much of the ineffectiveness in the care of the patients.[8] He famously wrote, “Young graduates have been taught a great deal about the mechanism of disease, but very little about the practice of medicine--or, to put it more bluntly, they are too “scientific” and do not know how to take care of patients.”[8] HONE YOUR SKILLS Work on the knowledge and skills you have acquired; actively and passionately work on them to do better every passing day. The science part of patient care is the core foundation of patient care, without which patient care is meaningless. Remember, caring, communication (listening and explaining), and competence are the 3 C’s of clinical confidence. Today, e-learning through multiple ways and many physical workshops being conducted in various specialties are a good avenue for honing one’s knowledge and skills.[9] PAY ATTENTION TO DETAILS AND TAKE ENTIRE RESPONSIBILITY OF YOUR PATIENTS Although there are many stakeholders in patient care, as the primary doctor, you are the one that the patient is looking up to and rely on. Make an effort to understand the uniqueness of your patient and know everything about your patient as much as practical.[8] Every disease manifests differently in different individuals. Thus, studying the patient as a whole also gives us an opportunity to gain experience and learn beyond literature, and develop more insight about the disease. Clinical care means the care that is essential to maintain the health and safety needs of a patient, but is not limited to, assistance with medication administration, medical needs, nutrition, and supervision for safety as well as activities of daily living. This also provides an opportunity for us to win over our patients, by clarifying on any guilt the patient feels for the disease. BE KIND AND CHOOSE YOUR WORDS WISELY Think before you speak. Patients tend to remember everything from their meetings with doctors. Never lose your cool with patients, however busy you are in your daily practice. The hurtful comments or the comments made with indifference will be remembered lifelong, in spite of all your time and efforts. Always be kind, and your kindness will attract more and more patients to you. “People will forget what you did, but they will never forget how you made them feel.” –Maya Angelou.[10] BE AVAILABLE Be approachable enough, so that they can ask anything and anytime from you as far as practically possible. One should take pride that our patient has faith in us and trusts us, for the patient seeks you in trouble, in whatever hour. As such, there is no use of the massive knowledge and skills, unless you are there, when you are most needed. IMPROVE YOUR COMMUNICATION SKILLS Improve your attitude toward patients by treating them with respect like cheerfully greeting them, a simple smile, using patient’s name while interacting, making eye contact, saying “please” and “thank you” more often, and not showing any restlessness on your face while interacting with your patient. Remember, you may not get a second chance to make a first impression. FOLLOW-UP ON YOUR PATIENTS Follow up with your patients since admission till discharge and also after discharge. This not only helps in managing patients better but it is also a great gesture to express your genuine concern. It helps in checking progress of a patient, addressing any confusion between the doctor and the patient, and in adjusting management plan. Patients need to be approached person to person, away from all the constraints of medical jargon, technology, laboratory tests, and statistics. Develop a long-term relation with every patient for better patient outcome as well as meaningful patient satisfaction. To conclude, in one of the most cited and revered articles of all times, Peabody wrote: “Time, sympathy and understanding must be lavishly dispensed, but the reward is to be found in that personal bond which forms the greatest satisfaction of the practice of medicine. One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.”[8] Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.