Maze of Multispecialty

Dr. Misba Sayed

Post Intern, Grant Medical College, Mumbai

Auntie M, my 64-year-old neighbour with a kind smile, a lady who had been dealing with schizophrenia for 40 years, living with a pacemaker, one day woke up with a typical case of food poisoning. “It’s because of the party I had, to celebrate my retirement! I’ll be all good in a few days’ time, you’ll see” she told me. But that didn’t seem to be the case. When her diarrhoea continued for 15 more days with severe generalized weakness and loss of appetite, she was admitted to one of Mumbai’s leading private hospitals. After a series of investigations, an abdominal mass was detected on CT and her family was counselled regarding bowel cancer. They were only trying to come to terms with this diagnosis, when her consciousness level suddenly deteriorated. This is when they also came to know that her antipsychotic medications had been completely stopped by the ICU doctors. This was a shock for them because firstly they weren’t informed of this decision and secondly, they couldn’t understand how the medications that she had needed all her life could simply be stopped now. For them, it seemed like stopping the drugs was the reason she wasn’t able to talk to them anymore.

Proceeding with the investigations, her biopsy report ruled out malignancy and she was started on AKT as a presumptive TB case. AKT gave a ray of hope to her family as she showed significant improvement, with her consciousness levels improving as well. Alas, it did not last long. Her consciousness dropped with loss of sensory and motor functions as well. Now, she had an entire team of specialists dealing with her case- internal medicine, neurologists, cardiologists, psychiatrists! The family by now was completely baffled! They had multiple diagnoses thrown at them over a course of few days, and none of the treatment modalities had shown any improvement so far. Was it the fault of the doctors? Wrong diagnoses, improper treatment?

When dealing with patients and their relatives, we often forget the huge barrier that lies between us and them. This barrier could be social, economic and most importantly educational. Hospitals and the world of medicine is an intimidating, terrifying and dreadful place for the layman. This, added with improper communication from the medical team can prove to be a harrowing experience for the relatives. Auntie M was probably receiving the best possible healthcare that Mumbai had to offer, from leading specialists. Unfortunately, though, her family didn’t feel this way. They got to speak to one doctor in a day, which would be different depending on the changing shifts. They’d often get different narratives from different doctors regarding her condition.  If they had some specific questions regarding her cardiac issues or psychiatric issues, they would have to wait for a day or two for the specialist to be available to counsel them. On one occasion, when they asked the neurologist whether she will be started on antibiotics, he replied “Oh, that’s not my concern, I’m only here for her brain issues”. Although he wasn’t wrong, relatives do not understand this. They don’t understand the long hectic working hours, night shifts, complications and the dicey environment of the ICU. This gets even more chaotic in the emergency setting and with multiple students, interns, residents and nurses working together, handover can often get lost in translation and miscommunication. This could lead to a negligent act.

The obvious solution to this problem would be to increase the number of doctors, but that’s not an immediate solution. So what can be done till then? Resident doctors form the backbone of the hospital, so starting with reducing their workload should be the foremost thing. Proper division of work amongst residents, adequate working hours and break time would ensure efficiency. Digital documentation of handover notes can be an effective solution to prevent any miscommunication. Team meetings at an adequate interval should be carried out to ensure everyone is on the loop regarding every aspect of patient care, which will also ensure that the relatives’ queries are dealt with properly. In the Indian healthcare scenario, communication is often overlooked very easily, owing to the overworked, overburdened healthcare workers. We must realize that communication, amongst the team and with the patient is central to adequate healthcare delivery and not an added accessory. Although difficult to achieve immediately, conscious effort must be made towards improving patient communication.

Keywords- Patient communication, Multispecialty, Multimorbidity

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