Fasts and Starvation's

It is a time of fasting for the Muslim communities all over the world. Large numbers of patients who come to us, are from this community, and every day the discussions with patients and families in the ward has been, how can we get them out of the hospital as soon as possible since the fast is on, the festival is coming up. Staying on in the hospital is not something they want to during such a time like this.

Someone recently send me a message – why are you not blogging – I did not realize that it has been a week since I wrote – I told that person – It is a season of fast, I am fasting from activities I enjoy, but I did also communicate that this was not an intentional fast from blogging but a forced upon fast due to confusion from too many issues I am hearing each day, but not sure what are behind these issues…Needed time for the confused brain to ramble…

Though the fast I talked about in the communities around is physical, what we are observing in our practice of health care, are some unhealthy starvation's, which make practice very frustrating. I am talking not about fasts but starvation.

One is the starvation of the art of telling stories – when patients come to us, I hardly hear any more stories. We see this only in health care. If you meet these people, in their communities, and at their homes, stories come out. But in the context of health care – there is a dearth of stories.

We were taught in our training – 80 % of the diagnosis should be completed at the end of the story which the patient tells you. I hardly hear stories these days. Patients will tell you – here are the reports, here is what is being done, please tell me what the problem is. Trying to ask about the story from the beginning of the illness is very frustrating. One does not find much response. I started getting upset with the patients of not sharing all the details. But soon realized the problem is not with them but with us in the Medical profession.

There is a starvation of the art of eliciting stories among the current day practioners. Even among some of the well-meaning doctors one would observe that, reports are which captures the initial attention than stories and history. There is also a “low trust” of the Medical profession at large, and the patients do not want to let them know all the facts. Many come to test and see if this person can be trusted or not.

There is another contributing factor - lack of skill of hearing, forget listening! Many of us doctors have not been taught to hear! There is also the perspective of the clinician that I know it all and expectation of the patient that you should know it all.

So the urgent need of the day is to recapture the ability to hear, and the ability to make people share their stories. But hearing is not enough, we need learn to listen. And have the capacity to listen to what is said and what is unsaid.

We had three young children who were brought to us over last week with severe illnesses. First a 12 year old girl with massive bleeding from her stomach. As we were getting ready to admit, organize blood replacement, Ultra Sound, Endoscopy etc. the mother, father and a relative got together and categorically communicated, that no way will they give blood. Anything else we want they can do, but do not ask any of them to give blood. We heard them, tried to reason, threaten, plead but with no use! They were adamant. They were not too well off, but money was nowhere in the discussions. We were hearing what they were saying, but we were wondering, what they were trying to tell us, what is the World view or knowledge that is making them to behave this way. Girl child and less value, blood as life giving and not to be given away, money should buy anything they want, not their responsibility to be part of the caring process…Or something else?

The second, a child with tetanus, 10 year old girl again! 4 hours by road from our hospital, father, mother and another relative brought the child. They were explained in clear terms that it would take about 15 days, and cost should not be an issue, any needed concession can be provided. They seemed to quite clear that they wanted full treatment, and willing to go through the needed period of time. But next day, the father met the doctor and shared that “his heart is telling him, to take the child home”. No arguing or threatening worked, he was clear that he should listen to his own heart. What was in the heart which we did not hear the previous day? Loss of 15 days of income by being away taking care his daughter, girl child issues again, the world view related issues etc.?

The third was a 7 year old boy brought in last night with acute pain abdomen, and found to have an intussusception and potentially needing immediate surgery. Quite a bit of time was spent by the surgeon explaining the how and why and costs involved etc. They were not poor unlike the other two, but seemed be quite concerned about the costs involved, (which was a third of what the costs outside will be). They were exploring whether insurance would cover them, can we provide cash free services etc. Finally they decided against surgery. What were they trying to tell us? Expectations that they should get services the way they think it should be, their own perceptions…I am not sure.

From the starvation of stories, one needs to move on if we need to practice good medicine. We need to build our ability to hear stories and elicit stories. And also build the ability to listen to what is being heard. But each story has words which are not uttered or shared, some things which we need to listen beyond listening and understand.

I claim that I follow a God who says “Even before you think, I know your thoughts”! When someone talks, can I hear what they talk, and go to the next level of listening to what they are trying to communicate and learn how to graduate to discerning the unsaid issues, which are driving these stories?  Much to learn….if I am expected to follow the master who always heard what was not said!