Genuine concern for the patient

Genuine concern for the patient

Vijay Gopichandran


If you ask me what is the single most important characteristic that defines a good doctor, it is the genuine concern and interest that the doctor has for his/her patient. In this blog, I will describe why I think that the ‘genuine interest’ in the patient is the most important trait for a doctor, more than even technical skills and knowledge.


I had a patient last month in my clinic who was suffering from very bad oral ulcers. These ulcers were painful and were preventing her from eating even the blandest food. She came to me in tears, asking for help so that she can start eating again. With the help of a dermatologist friend, we diagnosed that the lady had oral lichen planus. The definitive treatment for this condition is to give oral steroid cream. I prescribed this cream to the lady, but unfortunately, the cream was not available in any pharmacy in the nearby town. She went to the nearest district headquarters which is 40 km from her village and tried to buy the cream. But she was unsuccessful. She called me desperately on my mobile in tears and cried that she could not find the medicines. I had to buy the medicine from the city and gave it to her when I went to her village the next week. There is another elderly man who has a prostate enlargement leading to difficulty in passing urine. I also buy his prostate medicines from the city when I go there. Like this, there are many people whose medicines I personally purchase and take with me when I visit the village. It is not a big deal, but sometimes, the efforts that this takes can be huge. I need to remember the medicines, make a list, make time out to visit the pharmacy, purchase these medicines and carry them with me without forgetting. This can at times be stressful. The only way I can sustain this practice is out of genuine concern for the patients who would otherwise suffer without these medicines. Buying them medicines from the city and taking it for them with me is a very tiny gesture, not even worth the sheet of paper on which this is written. But, the driving force behind it is ‘genuine interest’ in the welfare of the patient. This is precious.


Once, a lady from the nearby village brought her daughter to the clinic to see me. The child was expelled from her school because she was “behaving inappropriately”. On listening to the details, the mother reported that her daughter was having exaggerated bowel movements all day long. She would keep disturbing the class by always asking for permission to go to the toilet. Sometimes she would just pass motions in the classroom itself creating a lot of disturbance of the class. The mother had taken the child to several doctors and they had all treated her with many medicines including antibiotics for a bowel infection. But the child continued to have the problem. The child also had very low self-esteem because for the past 4 months she was constantly teased and mocked by her classmates. The mother brought her to me as the last resort, as all other treatments had failed, and she did not know where to go or what to do. It was a very sad story and I was listening to her intently. The child gave a history that every time she took something to eat or drink, even a sip of water, she would immediately have a large bowel movement. The bowel movements were large and painless. She never passed any blood, pus or mucus in her stools. When I saw her old records, I noticed that she had been treated with medicines for amoebiasis, antibiotics for bowel infection, and some medicines to sedate the bowels. Her mother reported that she would feel the relief if she took the medicines, but the moment she stopped the medicines the problem came back. I am not a pediatrician. I have no special training in diseases of children or diseases of the bowel. I didn’t know what to do, but the distress of the child, the insult, the humiliation in her eyes and the distress of the mother troubled me a lot. I called my teacher, a pediatrician in the institution where I studied to seek her advice but couldn’t reach her. I tried some of my pediatrics friends, none of whose advice seemed convincing to me, all of that had already been tried for this child. I started the child on an antibiotic and oral rehydration solution, reassured the mother than I will somehow try and find an answer for her daughter’s problem and left the clinic that day. My head was full of this child’s story. I couldn’t sleep that night. The forlorn look on the child’s eyes haunted me. I started reading about the child’s symptoms. I couldn’t find anything noteworthy. I would visit the clinic only the next Sunday and throughout the week my head was filled with thoughts about the child. I was starting to get frustrated as I was not making any progress in understanding this child’s illness. On Friday that week, I went to a family event. There I bumped into a senior doctor, who is a distant relative of mine. She is a retired pediatrician. Just as a time pass conversation, I spoke to her about this child. She immediately recognized the condition and told me it sounded like giardiasis. She had seen many children when she was practicing actively. Giardiasis is characterized by an exaggerated gastrocolic reflex. This means when the stomach gets filled up with anything, even water, the large bowel starts moving. This leads to the passing of motions. The senior pediatrician told me that the best way to treat the condition is to give a long course of medicines to kill the giardia organism and replenish the bowel with a lot of friendly bacteria, which is present in abundance in curds. Nowadays treating children with diarrhea with lactobacillus is standard practice. But I am talking about 10 years ago when this was not routine. I trusted this senior pediatrician as she sounded very much convincing. I suddenly felt relieved that I have something to tell the child and her mother now. I went back to the clinic on Sunday and suggested the treatment to them. The effect was dramatic. The child’s condition was completely cured. Today the child is in college, studying BA History. I feel very happy to see what a well put together young girl she has grown up into. The best thing I remember about this girl and her treatment was that I lost sleep and was deeply distressed by not finding a solution for her problem and the persistent search for an answer ultimately led to me to the correct treatment. This is what I call “genuine concern”. The desperation to find an answer for the patient’s problem, that even in a family function I thought of talking to a relative about her is the kind of “genuine concern” I am talking about.


I think “genuine concern” is the single most important trait because I believe it covers and subsumes all other dimensions of medical professionalism. Genuine concern makes the doctor obtain knowledge, requisite skills, and competence to address the problems of his/her patients. I am extremely happy to write about a brilliant clinician whom I know very well. He is a senior family physician from a little town near Trichy. He is trained in general medicine, however, he made it a point to undergo training in ultrasound scanning, upper gastrointestinal endoscopy, basic surgical dressing of diabetic foot ulcers and other such procedures in order to serve his patients more effectively. He obtained knowledge, skills, and competence to do what is in the best interest of his patients. He was driven by the single most important trait “genuine concern”. Genuine concern for the patient will make the doctor act in only the most ethical manner. The physician who is genuinely concerned for the welfare of the patient will communicate effectively and will empathize and emote appropriately. All of these, which are components of medical professionalism are covered by a single trait.





However, constantly being genuinely concerned about the patient’s welfare can be tiring and stressful. I can't explain the kind of distress that I suffered when I had left a child who had suffered a scorpion sting and developed inflammation of the heart, in the intensive care unit at the end of my shift to go to my room. I was unable to rest properly in the room, constantly playing out in my mind various scenarios of what could go wrong in the ICU. After a fitful night of restless sleep, I rushed back to the ICU the next morning to see the child stable and resting. It is not healthy to be constantly engaged with the patient and losing peace of mind over patients. I learned that I should trust the collective competence of the team, I should learn to work with teams that I can trust. Genuine concern for patients does not only mean that I should always stay connected with the patient. Sometimes it means I should trust my team to take over from me and continue the good work.


And the best thing is that “genuine concern for the welfare of the patient” is a potentially learnable and teachable trait. It is not something as abstract as emotional intelligence or something as technical as a procedural skill. It is an attitude and can be easily cultivated. If every doctor makes sure that they ask the one question, “Is this in my patient’s best interest” and puts the patients' interest above everything else, then the practice of medicine would be far more professional. Therefore, I believe that all the ethics and professionalism courses in medicine should only cultivate the attitude of genuine concern for the patient's welfare among medical students and doctors.