Doctors: The Challenge from IDIOT

Foods for Thought

By Dr R Neerunjun Gopee

On July 1, 2022 Doctors’ Day various functions and celebrations were held in the South Indian state of Karnataka in recognition of their services, especially during the various waves of Covid-19.

Doctors + Challenge from IDIOT. Pic – Dreamstime.com 

While participating in a programme to honour senior doctors and their family members at United Hospital, Jayadeva Hospital Director, Dr C.N. Manjunath noted that due to innovations in technology, the expectations of people and patients on doctors are increasing. Due to ‘IDIOT’ syndrome, it is becoming very difficult to treat educated people, he said.

I had never heard of IDIOT syndrome, and it turns out the acronym stands for ‘Internet Derived Information Obstructing Treatment.’ People blindly trust medical information available online and stop their treatment abruptly without consulting their doctor, or query their doctors based on such information.

In fact, it is not only educated people. Anyone with a smartphone – which means everybody! – has information available 24/7 and as Dr Manjunath pointed out: 

‘People are getting information about their ailments and diseases with the help of technology available on their palms. Amidst the explosion of technology, the expectations of the patients and their attendants have increased. Doctors are overwhelmed when people rush to the hospital with unrealistic expectations of doctors. In this changed context, the need for a specialist doctor to have not only technical and professional skills but also communication skills has increased a lot.’

However, even before the advent of the palm held, information loaded devices, I and I am sure many of my colleagues had faced patients who come armed with what they think are intelligent questions. But it is not their fault, it’s just that people talk a lot about their medical and health matters, and bits and pieces of ‘knowledge’ are picked up by all and sundry. We all know that the hairdresser’s saloon or the open market – la foire – are the favoured locations where the juiciest gossipy exchanges take place. Often, almost invariably in fact, they include details about one’s ailments, health establishments where they are being treated, the behaviour of the health personnel including doctors of course. These snippets ate tucked away in their natural CPUs aka the brain and who knows when they may surface!

I had an inkling of this phenomenon almost thirty years ago when I was treating an elderly lady for a superficial infection of the thigh known as cellulitis in a private clinic. The diagnosis is made by a simple examination and requires no investigations whatsoever, and treatment with antibiotics had already started. Two days later when I went to visit and told her she can go home, I was not a little surprised when she asked me in Bhojpuri: ‘Ultrasound-wa nahin karba?’ – ‘won’t you do an unltrasound?’ She was from a rural area, was not really literate though very cultured, and I was left to wonder where she had picked up the term ‘ultrasound’ which was locally relatively new then. I was reminded of our local adage: ‘pas guette zozo par so plume!’ Transliterated, this means: don’t judge a person by his outward appearance.

However, the context has since moved quite far from this innocuous kind of setting. The trend probably began in America, where doctors are always under the threat of the big sword of Damocles known as litigation, and which has ruined doctor-patient relationship, eroding the trust that ought to be the sacrosanct basis of medical practice.

Several years ago, when I was at the Ministry of Health, we were discussing such matters with colleagues from the University of Geneva who were visiting. One of them told me that when patients due for joint replacement (hip or knee) consult their surgeons, they come with a list of the different prostheses available and point out to the treating surgeon the success rates of each one and there follows lengthy and time-consuming discussions about which one is going to be chosen. Instead, this should be left to the better judgement of the surgeon, because these data have to be analysed and understood scientifically, and the metrics advanced by the patients may not all be relevant.

Whatever be, no doubt this is the evolving situation in which we all find ourselves now, but the ground realities vary from country to country as is to be expected. Unrealistic expectations are a fact of medical life, and the more complicated the problem the greater they are. There are always difficult decisions that doctors are faced with; honest discussion and communication are key to handle such situations.

Just the day before the celebration of Doctors’ Day, I was reading about the murder of a practitioner in the US, with a headline that read: ‘Murder of Physician Raises the Stress Level for All Clinicians,’ reported in Medscape of June 30, 2022. The article carried the picture of the lady doctor, and the incident was described as follows:

‘Physician stress — indeed, the stress level for all medical personnel — has reached new heights.

‘As if it weren’t enough that doctors work in a profession where it’s almost more a question of when they’ll be sued than if they’ll be sued — where Covid, staff shortages and long hours, and patients frustrated over canceled procedures have caused unrelenting fatigue and stress — they now have to worry that an unhappy patient is going to buy a gun, walk into their office, and kill them.

‘That’s exactly what happened in Tulsa, Oklahoma, where a patient complaining of pain after back surgery murdered his doctor and several others who happened to be in the wrong place at the wrong time.’

‘The article listed some other reasons for such an extreme behaviour: ‘It could be a drug-seeking patient complaining of ongoing pain, angry because he can’t get a new prescription. It could be a patient whose unpaid bill was turned over to a collection agency, angry because he’s now getting calls from collectors. It could be someone who blames a physician for the loss of a loved one. It could be someone who would otherwise have filed a lawsuit, who now thinks he has a more effective option for exacting retribution.’

Violence against doctors and other health staff is not uncommon in several countries, and we have had several incidents locally too. Paradoxically, it was worse during the acute phase of the Covid pandemic, when the level of stress was the highest for all parties concerned, as the article extract above shows. Undoubtedly, the IDIOT syndrome vastly complicates matters, and it’s a joint societal responsibility to handle it appropriately and effectively.

Mauritius Times ePaper Friday 5 August 2022