No Turn-Backs Please

An important point that patients might like to remember is, “Don’t turn back and ask a question while leaving.”

Here is how things can go badly wrong – a real-life incident narrated by a colleague as a letter to a patient!

You came to me for a consultation. We went through all your problems in detail. You had a list of questions and I answered them. I patiently explained the situation to you and then discussed in detail the treatment plan. When we seemed to be done, I asked you whether you had anything else you wanted to ask. You paused, thought and said no. I closed the file, handed you your papers, picked up the next file and signaled for the next patient to be sent in.

 Just as you were walking out the door, you turned back and asked, “Is it OK to have some wine?” I looked at you. I struggled with this sudden interruption, my mind already pre-occupied with the next patient. I looked at you blankly, a little irritated and said “Sure, whatever!”

 You went home and started the metronidazole tablets for amebiasis. The next evening, you sat down with a friend and had two glasses of a new Merlot. Suddenly, you felt flushed and thought your face was swelling up. Your wife called me, frantic. From the description, it appeared that you might be in the midst of a reaction caused by a mix of metronidazole and alcohol. While I went through the possibilities quickly, I also checked my notes and asked, “Did he drink any alcohol?” Your wife said, “No, not really, he just had two glasses of wine” and then paused and said, “Doc, but you said it was OK”.”

 I could not remember having said so, but did remember that I had told you not to mix alcohol and metronidazole during the consultation. A memory came back…you had turned back and asked me a question that I don’t quite remember. Since the reaction was not too severe, I asked your wife to give you an anti-histaminic while she brought you in. It is only when I start talking to you that I realized you don’t really equate wine with “alcohol”.

A colleague of mine has two doors to his consulting, one for entry and one for exit. The “out” door cannot be opened from outside. He has done this explicitly to prevent the “turn back”. Turn backs not only lead to wrong instructions and misunderstandings, they also create problems with the doctor-patient relationship.

I am happy to give you all the time needed to sort things out during the consultation. But once we are done and I have moved on to the next patient and line of thought, the interruption caused by the “turn back” can make me seem irritable and rude and leave you with the feeling that I didn’t respect our relationship, despite having given you all the time necessary.

As care becomes more patient-centric and doctors learn to spend more time with their patients, patients and their relatives too need to get a little more involved. They need to prepare for the consultation, read up from credible sources and prepare a list of questions, in advance. If they don’t have that list written down and with them, it is very likely that they will forget to ask something important, and remember just when they are leaving and at the door. The answer to that question may not necessarily be the most appropriate one at that point in time.

So, please remember! Avoid “turn-backs” and be well prepared during the medical consultation to avoid confusion at a later date. 

26 Comments

  • Ravi Ramakantan wrote:

    Bhavin, I do not agree with you at all on any of this on the ‘turning back” part.. You are making it all too official and scientific and business like.
    Medicine, disease and fear are different. I hope you, or worse still, your dear ones never have to experience it.

  • Rohit Gosalia wrote:

    I feel Bhavin is correct. Every patient must go prepared to doctor with all questions. I fail to understand comment by a reader and he is so muchagainst it. We all want our doctor to be good professional along with good human being too. Then we have to be responsible and sensible too.

  • Vaibhav Dedhia wrote:

    Very apt. Often the same question is asked in different ways. Indians are obsessed with their diet. Even when we broadly give an idea on what is acceptable and what is not, most of the time is consumed in – what should be in my diet? Oneof patients asked me whether she could have almonds or not? After a sbort while her son quipped in – doc which ones 2500/-per kg 1200/- per kg or 500-600/-per kg. I didn’t know what to say, whether I should be irritated or just ignore and move on. Guess some things will not change here!

  • H. L. Chulani wrote:

    Bhavin, you are being naive! Patients call or SMS doctors minutes or hours after the “turn-back” and ask questions, which according to them, ‘in their anxiety’ they or their friend or relative omitted to ask! Part of practice- you cannot choose patients!

  • Dr. Awesh wrote:

    Sir this is just one side of the coin but to be fair we need to consider both sides of it. Yes it’s very true that we doctors need to concentrate on our next patient and the interruption is very disturbing. But we need to consider the patients confusion too, many a times I myself find my self turning back when given a set of instructions, especially when I was in the process of getting my passport. I kept going back and forth because I found the given instructions very confusing. Good that those guys were not rude to me and nicely repeated the instructions when I went back to them. There is always going to be a turning back because it’s a normal to get confused or have doubts after we leave. We are the good guys, we shouldn’t be rude to them or give them a haphazard answer.

  • P. Venkatraman wrote:

    The point that Bhavin is trying to make is well taken. The point is that patients must take charge of their own health, nutrition and medical aspects first. I am not implying self medication. I am saying that if a patient does not care to be aware of things then there is very little that the doctor can do beyond a point.

    Even worse is the tendency to blame the doctor for the lack of due care on part of the patient.

    I have known cardiac patients who have done 2D echo and do not know what their LVEF is. I have know Hypertensive patients who do not know what tablets they are taking.

  • V.Subramanian wrote:

    While it is good to get a Doctor’s perspective,it may not always be possible to prepare a comprehensive list of questions,given the midset and physical condition of the patient.Often the patient comes home and tells the spouse or relatives that he forgot to ask a particular question to the doctor. Turning back and asking a question need not necessarily be an irritant.It depends on the patience of the doctor and the number of patients sitting outside. From the patient’s perspective turning back is better than forgetting to ask altogether.
    Very few people do write down the questions before visiting a doctor.It also depends on the nature and intensity of the ailment and the alertness of the accompanying person.

  • Durga Godbole wrote:

    I think it should be a good balance of both: the patient being a little more alert and the doctor being a little more patient. But then as one of the commentators has rightly said, sometimes patients and their accompanying members are not in the state of mind to come up with a list of questions. Also, it does not hurt for the doctor to devote 1-2 extra minutes of his attention to the patient’s last minute query. However, the ideal situation would be to frame a set of questions, which I usually do, while visiting my gynaec or my daughter’s paediatrician.

  • jamna varadhachary wrote:

    I agree. List your questions and hand it to him. The doctor’s answers can be the basis of your compliance. Useful for both the doctor and the patient

  • Sujata Morab wrote:

    A solution is to take somebody with you. A parent, a spouse or a child depending on your age. So that nothing is left to chance. And doctors should exercise patience with their patients and not get irritated by a simple question.

  • arjun marphatia wrote:

    Glad this has been highlighted. It is very true and the best solution is as suggested by Jamna that one should have a list of questions ready for the doctor. A suggestion even the most trivial of questions should be on the list as mentioned in the article about wine and alcohol!

  • This reminds me of a sign I saw in England in the 1970’s….
    DOCTOR IS BUSY, HAVE YOUR SYMPTOMS READY.

  • Ajay Bhonsle wrote:

    I never expected this kind of a reaction from ANY Doctor. It sounds very uppity with the Doctor putting himself or herself in the ‘holier than thou’ category. I think a patient is well within his rights to clear ALL doubts during or even AFTER the consultation (whether by ‘turning back’- [which I consider another snooty term] or even on the phone). Otherwise what is the difference between doctors and tax consultants who are known to put a timer and charge by the hour or fraction thereof for their advise?

  • H.L. Chulani wrote:

    Bhavin, you are being naive. Patients sometimes call (SMS) minutes after their ‘turn-back’ asking questions because they forgot due to their ‘anxiety’! That is the way of practice- you cannot choose patients just as you cannot choose parents!

  • Abhiroop Banerjee wrote:

    There are several dozen patients being treated by a doctor at the same time. Every case is different and requires careful attention. If I expect my doctor to address all my concerns with due care and thought, I should help her do it by being a responsible, considerate, respectful patient, mindful of the fact that my doctor is a human being and not a machine. In fact, machines would have required me to be a programmer!

    During rather long drawn out treatment for my thyroid problem when I was 17, I remember doing something like this. Upset that I forgot to discuss one point or the other during every consultation, I decided to write things down. So, the evening before the appointment, I would sit down and make three lists on a foolscap sheet, 1. improvements/changes since last visit
    2. things which have not changed
    3. new problems
    Which I would present to my doctor along with, obviously, past prescriptions, test reports etc. Not only did this ensure I did not forget anything, it also reduced consultation time, made for a happier doctor and crucially, helped me track my own treatment in a much more organized manner. Win win, I’d say.

  • Norman wrote:

    What a wonderful world it would be. If on a flight there was an emergency and the passengers flock towards the stewardess/pursers and ask them how to use the safety gear, and they reply, but we gave you a demo at the start of the flight.
    Same on a ship that is about to sink.
    Come on guys be a little humane. i can smell disaster……
    It reminds me of that famous story about a studious man (have changed it a bit so that no one is hurt)who was crossing the river with a young boy who was rowing the boat. The man asked the boy if he had read this article, studied this or that and the boy replied in the negative. Finally when they were midway. the boy asked the man if he could swim, and the man said no, why?. The boy replied why not get all those books that u have studied to help you, as there is a hole in the canoe, and it will sink at any moment. The boy jumped in the river and saved himself. No need to spell ou what happened to the learned man.
    Dear friends, we should always remember that we are not GOD ALMIGHTY and that we need one another to exist in this world. Just because some quack spent a lot of money to get a degree (not only Drs. pl)he should forget his clients, or think he should make up by treating his clients so shabilly, as to…..shame and pity…

  • mahadeo bhide wrote:

    1. Bhavin, your perspective is entirely doctor centered, Patients ask questions when those questions come to them, sometimes when they are about to leave.They can’t help it.

    2. It is easier to change the habit of one doctor than habits of his 1000 patients. I suggest we dont start thinking of the next patient until the first is totally out.

    3. “I was distracted when advising” wont stand as a defense in a conversations amongst friends talking over tea, forget the court of law.

    But Bhavin you do have the skill of getting the arguments / discussion going!

  • Jayesh Desai wrote:

    I am afraid I have to disagree with you here, it is important that patient understand and therefore if he asks questions to clear his doubt it should be responded to. Even if he comes prepared with questions as suggested by some, new questions and doubt crop up during consultation. We deal with dynamic situation with no two patients or clinical situation alike, what with diversity of hindustan with its numerous languages and different cultures, it will be foolish to copy the methods of US or UK. Add to this total inactivity on the part of Government in educating general population about health and preventive measures. I remember during swine flu outbreak UK’s NHS distributed booklet of do’s and dont’s in EIGHT languages apart from English that included Gujrati and some Afrikan language. We will have to learn to not to get irritated though it is difficult, after 30 years in practice I still do get disturbed by this. But as previous comments say you do get argument going. It’s like “manthan”, at the end of it something invaluable comes out.

  • anand kamath wrote:

    the turn backs will lot depend on the doctor’s specialisation and qualifications etc. a highly specialised doctor may not be able to give much time to the patient and on the contrary a general physician may give a second or even a third hearing to a patient.Really it depends on the time factor as well as gthe specialization.

  • I’m an ophthalmic surgeon and deal with a lot of elderly patients and their anxious relatives with numerous queries. After I have explained everything in details I have a counselor who goes over the same advice again outside my consulting room. If they have missed any simple (non medical) questions, like the hilarious one about various priced almonds mentioned by someone earlier, they are answered by the counselor. If the questions are of a genuine medical nature the patient is kept waiting till I finish my next patient and then their queries are addressed so that I don’t give a hasty response in an irritated state of mind.
    I sympathize with the patients who forget to genuinely forget to ask the important questions in the doctor,s chambers and then have no way of getting their queries solved.

  • Sriganesh wrote:

    I would like to know which Doctor has the time to patiently listen and answer all questions and ensure that the patient(should I say customer?)has got his money’s worth?

    Without realizing some doctors use high flung words and we just cannot make out. Similar to what most CA’s do when it comes to answering questions on Income-tax.

    Keep It Simple so that even a Stupid can understand is the solution for all professionals.

  • @ Sriganesh … It’s very easy to make sweeping statements about doctors like this. I can name a number of doctors who ensure that patients get the best care possible. I can also name a number of patients who will not blink an eye while spending Rs. 120 for popcorn at a multiplex ( actually worth Rs. 5 ) but crib while paying doctors their fees ( which by the way are 1/3 of doctor’s charges anywhere else in the world) and call doctors “chors”. These same people will then go to quacks for “alternative medicine” and cough up 5 times the doctors fees, not get cured and still think of the quack as a saint!

  • Armaity Patel wrote:

    Thanks Bhavin, a point to remember!
    Kind regards.

  • You are right Bhavin. We tend to blame doctors when something goes wrong and patients are also equally to be blamed for taking medicines too casually.

  • Janak Sheth wrote:

    Disagree. Non-experts take time to understand, assimilate and then articulate. It can happen after minutes or even days. A professionals job is to be patient and explain/answer the troubled person.

  • […] course, in one sense it turns around the “No turn-back” issue on its head as well, doesn’t […]

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