Dr. YK Amdekar writes that it is possible to be rational in medical practice if you set a goal to achieve it. It does not take time and with repeated practice, it becomes a habit. It offers satisfaction to a patient, happiness to a doctor and promotes good health in both.
What is rationality?
Rationality refers to judicious and well-reasoned sensible use of resources to offer quality service. Judicious use of resources in medical practice simply means minimal intervention (investigations and drugs) to get maximum benefit (cure if possible, comfort always).
Quality service in medical practice implies holistic care. Holistic care is possible with the use of all modalities endowed upon humans by nature – body, heart, mind and soul.
When translated into medical practice, body is knowledge, heart is compassion, mind is commitment, and soul the conscience. If it is done with devotion, love and loyalty, it becomes divine and it is so sacred that it helps with ultimate healing.
Medicine and rationalism are inseparable
Medicine is the most touching science of all. It involves healing, caring, soothing, reassuring, understanding, and offering hope. Medical practice should be a perfect combination of science and art. Rationality of science involves detailed history, keen observation (it is well known that eyes don’t see what the mind does not know), focused physical examination, objective reasoning and analysis, introspection and learning from your own mistakes. Rationality of art includes empathy, compassion, communication, counselling, and documentation. It is only when judicious use of science and art is combined that rationality is served.
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Universal pitfalls in medical practice
There is not enough time spent on detailed history. Proper information is not sought because of lack of time – it is an excuse. Whatever information is obtained is not analysed and interpreted due to lack of thinking. Once this habit is stuck, thinking itself becomes a disuse atrophy. This leads to unfocused physical examination likely to miss abnormal findings. It sets a vicious cycle of unnecessary tests, empirical therapy often with multiple drugs. It is obviously not conducive to communication, counselling or documentation. This is irrationality at its height. However it may still work and give a false sense of competence to a doctor. Unfortunately, the patient may not know about the poor quality of service but the doctor should introspect.
How to ensure rational medical practice?
Care always: For whatever complaint the patient may come to you, offer advice on preventive health issues such as growth monitoring, developmental screening including vision and hearing, ideal diet, proper hygiene and lifestyle.
Use clinical skills: Try to arrive at provisional diagnosis by analysis of detailed history and focused physical examination. Order investigations only after provisional diagnosis and that too if necessary.
Be a good listener: Every parent of a child or child himself may give you a clue to a diagnosis only if you care to listen to them carefully and allow them to express what they wish to say. Most illiterate persons also know enough to express though one may have to filter out what is not relevant.
Test a test: Before you order a test, think of ways such a test would help you to arrive at a diagnosis. Don’t order a test because you don’t know probable disease and so you don’t know which tests to order. There are no routine tests.
Be a rational prescriber:
If you don’t have any provisional diagnosis, decide whether it is safe to wait for disease to evolve. Empirical therapy is justified only in serious situations and that too after ordering relevant tests. Prescribe minimum number of drugs. Symptomatic therapy is necessary only if symptoms are very discomforting to a patient.
Communicate, counsel, and document: Inform the patient about his illness and therapy in simple words which improves compliance of treatment. Counselling is an art that guides the patient to go through his illness which instils confidence in a patient. Document in brief relevant facts that signifies transparency and accountability. It also helps to be legally safe.
Choose your own way
You have to set your own goals in practice and pursue them. Let your goals be professional credibility, peer acceptance, and social respect. To achieve this goal, be rational in practice and once you adhere to rationality, it becomes a habit that is sustained throughout life. It may take time to begin with but spending time for rationality is worth it. It leads to happiness and promotes your own health.
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