By Jay Desai
Here is a question for patients – how would you feel if your doctor tells you that your diagnosis is unclear, and that a work-up or even a discussion of your case with colleagues would be the next step? How would you feel if he or she does not write a prescription immediately after examining you, but instead refers to a book or a reliable online resource to make sure that the drug and the dose are correct?
For most patients, the traditional image of a good doctor is someone who asks a few questions, does a quick examination, arrives at a diagnosis and makes a recommendation. The society encourages the persona of the omniscient doctor.
However, in the 21st century, the practice of medicine has changed significantly. Original research and evidence-based literature gets published every day. New drugs are approved for use every week. Practice parameters and guidelines change every month. New treatable diseases are defined every year. There is an explosion of medical knowledge in recent years. A good doctor knows a majority of what he or she is doing. A very good doctor in addition is humble and will refer to the new knowledge every now and then, will accept his or her limita-tions, and will consult colleagues for difficult cases.
With proliferation of pharmaceutical industry and with advances in medical science, doctors now have a wide variety of therapeutic options at their disposal. A majority of medical interventions have potential risks. The key is to evaluate potential risks and benefits of each possible treatment option and to offer it only if the risk benefit ratio is favorable and that too after proper counseling of the patient. More medicine does not mean better medicine.
Medical errors are one of the commonest causes of injury and death around the world. It is a matter of great concern, as it violates the principal precept of medical ethics of primum non nocere or ‘first do no harm’. In this day and age, being a good doctor is not only about being brilliant but also about being cautious. Of course, this does not mean that the instinctively good and experienced doctor can be replaced by a mediocre compulsive one, but the essential attributes to practicing good medicine have evolved.
It is critical for a doctor to recognize the limitations of the science of medicine. Even more critical is a change in the perception of the society as to what attributes are necessary to be a good healthcare provider. Finally, patients have to be ready to accept unintended medical errors. After all, doctors are only human.
[The author is a practicing Neurologist]