Changing for the better - what is needed?

There are times when I am in my family medicine clinic, that I am at awe at how Dr. Tan does his work. Dr. Tan is my family clinic mentor, and his experience is evident in the way he handles his patients; may it be for examination, explanations or advise. I have attended his clinic four times now, and it is here that I appreciate the true importance of family medicine, and how the difference of ground work medicine is compared to the tertiary setting. Thus, I absorbed Dr. Tan’s every last word, hoping to assimilate his practical advice and teachings into my learning.

            I had a previous patient encounter with Dr. Tan, but it was not until recently that I began to ruminate on it. Basically, a mature lady had come in for her regular health check-up, and has a known history for hypertension and diabetes. Her hypertension is well controlled, however her diabetes is not. Her current BMI is >23, and she looks physically overweight. I was wondering how Dr. Tan was going to help advise her regarding her health.

Madam X asks, “Dr. Tan, are my results alright?”

Dr. Tan replies, “Yes and no. Your high blood pressure numbers you logged are good, however your blood sugars are a little high.”

After this exchange (a usual one between a patient and Dr. Tan), he added, “You know. You are quite fat. Are you exercising?” He then gently tapped Madam X’s belly to emphasize the detail.

Discussion was then done regarding food styles to cook, and exercise time and regularity.

I brushed it off as something that doctors do – well not any doctors, but senior doctors who have been running their own practise for some time. You know, those older eccentric doctors who are set in their ways. Being called ‘fat’ by a doctor is not bad. Rude maybe, but mostly harmless, I thought.

There were also other incidences like this. None were malicious, and all were done to drive home the emphasis that the patient needed to change something within their own lives to get better. Dr. Tan has generally been courteous, and is not impolite to his patients. Thus, all of these pointed to the ‘normality’ of calling a patient ‘fat’ to make them lose weight.

However, our recent LIC session brought about a rethink of what Dr. Tan had been doing. Dr. Shiva spoke about the importance of shifting to a patient centered care module (or PCC), where therapy is patient centric. There is the adage of ‘wool blanketing’ the patient, an example such as always being politically correct (patient with autism vs autistic), and just a general consensus of awareness for every patient aspect. This is in hopes that we become doctors who are patient centric (thus fulfilling PCC) where we treat the patient holistically and not ‘just medically’.

It was from what was discussed during that LIC session that brought about this change. Being patient centric does not mean doings things like ‘empathy’ and just lending a listening ear. No, it entails working with the patient, for the patient. Thus I learnt that PCC has many components to it, and that the soft parts are not the only ones that are essential.

Before, I had asked Dr. Tan regarding his methodology. He replied by asking me if I knew the best way to invoke change in a patient.

I replied, “Something significant has to occur, like an acute disease.”

He nodded in agreement.

We discussed Kotter’s steps for changes, and how if being called ‘fat’ was not enough of a catalyst for a patient to try to lose weight, then there is nothing much we can do as physicians. The patient has a vital role to play too. Dr. Tan is practising PCC, and showed me that there are various forms of which it can take. 

 

This is a  Public reflection which is publicly available for anyone to read.

Created on 22 October 2017 by Albert Teo