"The doctor will call you back"

“Leave your number, the doctor (al hakim) will call you back”.

How often have patients heard this statement from the physician’s secretary and how often have they waited, called back and gotten the same answer?
Patients wait for the phone call because they need the physicians and because they trust the physician who is a healer, dedicated to help the sick. In Arabic, the word for doctor is hakim. A hakim is a wise person and wisdom encapsulates the characteristics of the ability to judge and discern what is right. Why is it that the majority of the hukama (plural of hakim) do not call back unless the patient is a VIP? Beepers, landline phones, cell phones, all are available. The patient waits. Either the secretary fails to transmit the message or the physician decides to ignore it. In the meantime, the patient’s trust in the doctor and the profession of medicine diminishes.

Is the physician who does not return calls worthy of the title physician (hakim)?Is it the patient’s fault because of calling too often? Or is it simply that doctors are abusing their power?

" اترك رقمك وسيتصل بك الطبيب لاحقاً"
جملة ٌ طالما سمعها المرضى, وانتظروا الاتصال الذي لم يأتِ – إنهم يأملون أن يعاود الطبيب الاتصال بهم لانهم يثقون به, بإخلاصه لمهنته ومقدرته على شفائهم. كلمة " حكيم " التي تطلق على الطبيب تأتي من الحكمة ومن إيمان المجتمع بحكمة الطبيب. فما بال " الحكماء " لا يتصلون بمرضاهم إلا إذا كانوا من الشخصيات المرموقة في المجتمع؟
"إن الطبيب الذي لا تهمه مصلحة مرضاه ولا يتابع أمورهم لا يستحق لقب " الحكيم .

Picture above: They Are Waiting- Sculpture by Nnamdi Okonkwo of Orem

The Hidden Curriclum in Medical School

Physicians treat patients and medicine is a moral enterprise. We all agree to that. Well, I hope we do. In teaching hospitals, doctors teach medical students to become future physicians. Yet, teaching is not all there is to it. From what I can tell, it is basically a “do as I do, not as I say” thing. So, not matter how hard the medical programme tries to teach students to be ethical, to do the right thing, unless the hidden curriculum speaks the same language, it is a losing battle.

Many student of medicine complain that some of their teachers go into the classroom, tell them how important it is to stand up, greet the patient, comfort the patient, treat the patient as a person not a disease and, once on the floors, they see a different scenario, often by the same tutor! They are told to respect autonomy and when in the clinic, they see live scenarios where the right to decide is dismissed. They are taught to be humble and when they shadow physicians, they sense humility has no place in the equation and that their curriculum is a sham.

What do we tell these physicians-to-be? Or better, what should we do, lest we regret?

يوافق الجميع على أن مهنة الطبيب تتمحور حول معالجة المرضى وعلى أن الطب مهنة أخلاقية.

في المستشفيات الجامعيّة، يتعلم تلامذة الطب كيف يعاملون المرضى كما يتعلمّون أسس أخلاقيات الطب التي هي أساس المهنة، ولكن واقع الأمر هو أن أفعال الأساتذة وتصرفاتهم هي التي تترك أثرا على التلاميذ وليس أقوالهم. لذلك، فإن ما هو معروف "بالمنهج الخفي" هو أهم بكثير من المنهج الرسمي المقرر. كم من تلميذ جلس في الصف وتسمّر يستمع إلى المحاضر يتكلم نظريا عن التواضع وعن احترام المريض واحترام حرية قراره بينما يجد هذا التلميذ نفسه أمام ذاك المحاضر الطبيب عينه في أروقة المستشفى وهو يتصرف بعكس ما كان يحاضر. هكذا وبلحظات معدودة يلغى المنهج الرسمي ولا يبقى في ذاكرة التلميذ – طبيب المستقبل – سوى ما رآه من تصرفات الطبيب المتمرس الذي كان له المثال الأعلى.

ماذا نقول لهؤلاء التلامذة أو ماذا نفعل حيالهم كي لا نندم؟

Image above: Hugh Laurie "Everybody lies" - House MD

Getting physicians to listen and talk to patients

Listening and talking to patients is one detail that physicians, residents, interns, nurses and everyone involved in health care should start taking to heart. Surveys all over have revealed patients’ lack of satisfaction with the interpersonal skills of healthcare practitioners. When the patient is a ‘chronic case’, a ‘juvenile diabetes’, a ‘muscular dystrophy in room 205’ instead of a person with a name, with a private history, with a personal narrative,

communication skills are not necessary. When the illness is added to the person instead of taking over the individual, then, communication skills become paramount. So? So perhaps it all boils down to a matter of perception. How do we perceive the patients with ‘juvenile diabetes’ or ‘muscular dystrophy in room 205’?
We were having dinner yesterday night, my friends and, very nice restaurant and very good food. But dinner was ruined by the stories of physicians who tarnished their professions by the lack of their communication or humane skills. Why would a doctor tell a man not to bother spending much money treating his mother because she is old and will inevitably die soon? This was a message delivered during a clinical encounter. His mother is not suffering from any terminal illness (which would not have justified the declaration either).
Then another one added: My doctor does not bother to greet me when I come in; his arrogance is one that leaves a lot to be desired. If I can g to another physician I would. But I am stuck. She hates having to see that physician who exemplifies the characteristics of condescension. Then came the closure: a unanimous agreement that physicians these days do not bother to spend more than a few minutes with the patient whom they treat as an illness to undo. Adieu the good old days!
In my opinion, something is wrong in the system. Medicine is a moral enterprise and the most humane of the sciences. Many physicians still live up to that ideal. If others are not, there must be something that can be done about it. Part of the responsibility lies on the patients themselves. They should know their rights and not allow healthcare workers to treat them as illnesses or numbers. Patients should demand explanations and time. Until this is done, there will always be physicians who will discredit the profession.

Painting above of Egyptian Physician by H.M Herget