Thursday, December 10, 2015

Why junior doctors should learn asking "Whys" instead of just "Whats"

It was one fine Monday morning and I was an intern at the Surgery Out-patient clinic in the medical school I graduated from. Back in those days, being a government hospital that it was, the surgery out-patient clinic would get extra-crowded on Mondays. The surgeons there had to attend to a large number of cases in a short period of time.

Briefly, I would like to narrate one incident that happened when I was there. An old woman, should be more than 50 years of age, came with complaints of severe heartburn. She was slow to talk and tended to digress on questioning and she often spoke of how life was unfair to her. A little probing revealed she had consumed "Super Vasmol" and got treated elsewhere but her present symptoms had started soon after and didn't resolve. Seeing me spend much time with a single patient, the junior resident nearby ordered me to write a UGIE (Upper GI Endoscopy) and refer her to Psychiatry along with a prescription of PPIs. I was almost about to, while, without me realizing, I asked her one question which entirely changed the medical management to a large extent. 

I asked her, "Why did you drink it?", probably out of a strange curiosity that had, perhaps fortunately, out of nowhere landed on me that day. Later, I ended up sending her to the ENT department on hearing descriptions of tinnitus and disturbing vertigo that sucked out every little pleasure from her day to day life. 

I seriously don't mean to project myself as the super hero of the surgery OP that day. But I am interested in sharing the little that I learnt in the art of medicine that rarely gets taught in medical schools. If you own this book or have a library which has a copy of Oxford Handbook of Clinical Medicine, please head on and read Chapter 1: Thinking about medicine. It describes how asking "Whys" might change the therapeutic objectives in effectively treating the patient. 

You need to ask yourselves WHY until you get to the bottom what might seemingly pose like the culprit. A patient presenting with iron deficiency anaemia needs iron supplementation. But WHY did he develop a deficiency in the first place? Is it nutritional? or or excessive loss, or something else? Once you find it is nutritional, don't be contended to supplement. WHY nutritional? Is it financial or psychological or something else? And so on... 

Doctors often need to think in lot of different perspectives to effectively diagnose deceptive diseases. Medical students at the Yale University are taken to an art museum and shown art figurines to diagnose. The idea is to train doctors to see things from a different perspective. 

Our healthcare at the primary level must address a lot of basic "Whys" that we often don't bother to think about. Medicines are not magical concoctions. Often prescribing medicines treats the doctor. It makes him/her feel in control. There could a lot to discuss and argue about trying to define what Holistic Medicine should deal with. But as doctors in the making, we could contribute a little in decreasing the inefficiencies of healthcare processes at play. Diving one step deeper could give you insights to make better clinical decisions.