Should I be questioned? A surgeon’s dilemma
I can remember facing my first viva when I was a medical student in 1998 – I was sweating, trembling and did not realize the time passing. I was trembling due to the fear of questions and fear of the examiner. It’s ironical that the questions that were asked at my first viva “What is wrong with the patient”, I still keep hearing after 10 years of becoming a surgeon and professor.
Now I hear the same question from my patients. But I am on a different wicket. I have the authority like the examiner who questioned me and I answer with authority. I realized that I answer the same question with different degrees of authority depending on the person who questions me. Should we be questioned as doctors?
When I was a medical student I remember my village relatives asking me questions about their health during my New Year visits. It gave me a sense of importance and the seed of ego, which I did not realize at that time. Later becoming an intern and a trainee surgeon, that sense of importance kept boosting my ego. Power kept on increasing as I climbed the ladder. Looking back now, I realize that my answers to the same question changed with time and the person who asked the question.
The power that a doctor gets is different to a politician. If I don’t like a politician I can turn my back on him/her and vote for someone else or simply be silent. I have seen how authoritative I can be even to the most powerful people when they are sick. When someone is sick he becomes a patient – “one who suffers”. When you suffer, you are helpless, irrespective of your social class, wealth or power.
Once I received a phone call from an unknown patient while on holiday with my family. He started asking various questions about his sick relative. After answering a couple of questions, I thought ‘why is this guy troubling me when I am on holiday’ and cut the line rudely. My son noticed this and asked me ‘would you react the same way if it was an important person?’ I was really embarrassed.
During my first few years with this newly gained power I started developing an ego and losing my insight. Once I was treating a farmer in the intensive care unit, doing all I could for him medically. But his condition was not improving. His anxious brother began asking too many nagging questions that I answered only with one or two words. The desperate family wanted another opinion and I lost my control and reacted with anger.
I had a similar patient who was connected to the government. My reaction to the same type of questions with this patient was different. Looking back it makes me really embarrassed. When a patient comes to me how low is it to have double standards. If this self-importance and egoistic behaviour continues it internalizes and I can’t imagine where it would take me by the time I am close to retirement.
Later I realized that it’s important to answer the questions. The depth of the actual answer can vary depending on the patient’s background. Most of our patients do not actually seek depth but simple words of reassurance and to be shown that they are being looked after. Sometimes even when the outcome is death, people do not complain if they have been well informed. Allowing questions also helped me to think twice before taking a decision. Sometimes due to the fear of questions I started taking a voluntary second opinion just to make sure I was on the correct track.
There is a downside to allowing questions. You start getting more and more questions. Sometimes these questions are actually annoying even to the calmest doctor. The same question being asked by three family members one after another is not uncommon. But the real downside is that you become popular among patients as a ‘nice’ doctor. This brings more patients because it’s hard to find a doctor who spends some time with the patient. I have experienced this. When I started getting more patients, I was travelling from one hospital to another, wasting time on the road.
This led to another deadly catch – ‘money’.
Money becomes an addiction when there is no upper limit to it. More money means less time spent on answering questions. I started thinking of the next patient before I finished one. This was the problem that I had in the middle of my practice. I was again lucky to realize this, thanks to the guidance I had.
Now I am trying to find a balance between the two. After 10 years of practising as a surgeon, for me it’s ego and money that lies between the questions and answers. I can write about me. But how much it can be generalized is up to the reader to decide.
(The writer is Professor in Surgery, Faculty of Medicine, Ragama)