17 thoughts on “Prescription for a ‘Doc’- Ariya

  1. Thanks Ariya for your thoughts, a prescription for doctors, in prose.All of us must strive to achieve the highest ideals as prescribed..Some will fall short, like the infamous Dr Larry Nasser.!
    This era of the doctor/patient relationship is slowly coming to an end.The new era that is rapidly dawning and is well under way is the evolution of “an informed patient”, directing their health with the help of the doctor.This is based on the premise that no one has a greater interest in your health than you! Is this not true when we as doctors seek medical advice for ourselves. ?.We seek the best available because of our knowledge about our own health status.Countries are opening up their medical records to patients, Sweden aims to give all it’s citizens electronic access to their medical records by 2020.There will be a shift in emphasis from doctors to patients to informed patient and doctor..This addresses the fundamental problem with our current system, where patients lack knowledge and control. Access to data will result in a empowered patient, who will in turn ask the doctor, ‘Why not do this ?” or Don’t you think that it is this ?.The doctors of the future will have their work cut out. Eddie.

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    • Thank you Eddie, for your assessment and the forecast of future health care

      Attitudes of both professionals and of patients are changing & will not spare

      Improvements of Information technology aid to challange as well as to share

      Patients are more knowledgeable of illnesses, their rights & pathways of care

      Ariya

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  2. Ariya,
    Very lovely set of verses, A Prescription to The Doctor — From A Patient .
    I hope The Doctor fills out The Prescription …. and Listens to The Patient .
    eaglemd

    .

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  3. Message from Rani

    Thanks Ariya for posting the Patient soul searching, well written Narrative poem.

    I agree withAriya and Eddie. Health Professionals should be encouraged to involve patients in treatment decisions.Patients are the best experts ,to recognise their unique knowledge of their own health, and their preference for treatment.,health status, and outcome.

    The method of involvement of patient in treatment decisions by doctors will definitely improve health outcome and enable doctors to be more accountable to public.

    But the draw backs are ” not enough time”for doctors to build up a partnership with the patient in order to work out treatment options, to suit the patient.

    At times this may be challenging as the patients preference may differ from the evidence based ,or doctors guidelines.

    Some time if the patient finds the doctor more knowledgeable and powerful the patient may be reluctant to voice their preference. ( unfortunately it happens quite often in Srilanka, and many a times I have accompanied patients / friends in a relation capacity not as a doctor,to help them overcome this barrier)

    I believe at present the doctors may not have the appropriate communication skills to elicit patient preferences, and involve them in treatment options/decisions.

    May require further training to GPS to involve patients in decisions making?.

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    • My dear Deepthie,

      Another change see in the west is merging of roles at the edges

      More nurse consultants, Prescribing phamcists & physiotherapists

      Share some of the roles previously held by the medical professionals

      The computers and robotic surgeons revolutionised some treatments

      Ariya

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  4. Thanks Ariya for sending this statements regarding patient care. Attitudes and behavior changes must take place in schools during adolescent age and at medical schools

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    • Very Interesting discussion indeed on Attitudes and behavior changes between doctors and patients .

      In Canada , this is part of the current Med school curriculum- students are sent to very rural areas , indigenous communities, certain ethnic immigrant communities to observe, study and learn different Cultural Practices, and how to care for patients and above all LISTEN to the patient .

      .The young MD graduating today in Canada are much better at dealing with patients as they have been taught ‘ How to Listen ‘ to the patient as THEY are your Teachers .

      This creates an environment, where the Patient is totally involved in the Decision Making of his / her health issues/ treatment, and the Doctor is no longer the God of Medicine .

      I found that in SL – the patient is very afraid even to ask a question from the doctor- and was quite intimidated by the superior attitude of the doctor ,which I found very distressing .

      I had the good fortune to be one of the ONLY East Indian Female Locum MD is my area when I was doing locums –
      Almost 100 % of the East/ West / East Asian, Indian Doctors in the area hired me as their Locum which I did for nearly 17 yrs , and id the summer months , when Locums are busy- I would go to work in dressed in a sari- which made my East Indian, West Indian, and other East Asian patients very comfortable, as they knew ‘ we were on the same wave length “.
      After 17 yrs of this – I just got burnt out and quit, 17 yrs ago !

      I remember on our very first month at Med school-Prof C. C De Silva- gave us a lecture at LRH- and he said something , that has been my Mantra – ” Listen to the mother, even if she is only seventeen years old . She is THE Mother of the Child . then, listen to the Grandmother ” ! as most often times it is the grandmother that will accompany the young mother and infant .
      In the West- we call this phenomenon, ‘Bonding ‘!– when it was THE most basic emotional bond between mother and child for 10, 100 years !

      On the subject of Nurse Pract — I had the good fortune to have a very good NP who would take the time of day to LISTEN to the patient , and I would see her more than I would see my own GP for various minor issues.Unfortunately, she has since relocated to another area .

      Doctors MUST change their thinking attitudes that ‘ Time is Money , and Money is Time ”
      This is THE evil that plagues The Practice of Medicine – where ever you go .

      My Two Cents Worth- eagleMD.

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  5. Thanks Ariya for this wonderful Prescription of Ethics for doctors to live by. As Rani has pointed out , Piching and I also have accompanied patients to see specialists in Sri Lanka. Having introduced our selves as Docs the usual two minute history and examination was extended to perhaps three to four minutes. The history and examination was cursory .

    What you posted Ariya is not only applicable to Physicians but some of the statements are true and appropriate rules to live by on a daily basis.

    I have access to all my medical records on a secure web site through my medical insurance provider. I can set up appointments for visits, request prescriptions request tests to be done through my PCP ( primary care physician ) on this web site. Therefore Eddie , what you had mentioned about Sweden having a system giving complete access to medical records by patients in2020 is true today here in the US.

    Nisantha

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    • Thanks Nisantha for your contribution.Unfortunately USA does not have equal access to health for everyone.What about those on Medicaid?I am sure your insurance provider is doing a good job.The whole industry! Is evolving.The first change that is happening is that letters to PCP’s from secondary and tertiary services are being written in layman’s language to the patient with a copy to the PCP.You can see the evolution of the patient as the focus.Medical knowledge is easily and instantly accessible with the advent of mobile phones, provided that the knowledge they seek is reliable.This information together with their personal data on mobile phones is a very powerful tool for self directed requests for the best treatment.In any system there will be outliers who will not use all the information available to them.To this when AI is added, self directed health care will reach new realms.Already apps are available for mobile phones which alert the owner when dexterity and confusion are compromised ,indicating the first signs of a cognitive disorder.The new spectrum of tests evolving now uses sweat as the investigative medium and with the right apps the mobile phone will direct the owner to seek further advice from a professional when the sweat on your hands says that a problem is brewing. Interesting times ahead.Eddie.

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    • Thanks My dear Mates for appreciating the ‘Prescription’

      Pleased to share with my mates, few ideas similar to above I put forwarded

      During Tony Blair’s primiership, were included in the cabinet office web site

      So that entire nation could see and adopt as ‘ Examples of good practice’

      Priviledged to be the lead mentor for good practices of govt. services in Yorkshire

      That included all departments served by government, not just the health sector

      Being the first clinician to hold for a decade, the prestigious mark public service charter

      A fete not matched anyone before we did satisfy all 63 criteria of excellent practice

      Received a personal acknowledgement with a gold plated charter medal, from the primier

      Ariya

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  6. Eddie even medicaid patients have access to quality care. I know of a patient who has an ulnar nerve entrapment at the elbow. This particular patient was seen by one of the best hand surgeons at John Hopkins hospital. She is scheduled for surgery mid March.

    The surgery involves release of the ulnar nerve entrapment and also tendon transfers to make her fifth and ring finger to move better. I know of this particular patient because she sought my advice whether to have the surgery. This was because of her age ( 90 years ). I found out that the surgery will be done under regional anesthesia and I V sedation. I suggested for to have the surgery. She relatively healthy 90 year old. If she does not have the surgery she will have a left hand ? arm , which will be a useless appendage.

    I have anesthetized many medicaid patients who have had very exotic surgical procedures done by top surgeons . The quality of care was the same as for a patient with insurance.

    Nisantha

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    • My dear Nisantha,

      Reading through your notes saw John Hopkins been mentioned

      Though my knowledge on hospitals in the U S of A is very limited

      Thought of sharing a favour they did to Matale hospital on my request

      New VOG, returned from UK surgical equipments in Matale were limited

      Laporoscopy not establised though I had done many in England

      My special interest was infertility and this was a handicap very bad

      Fortunately I saw a note in a Sri lankan daily, hospital John Hopkins

      Replacing after three year usage almost all their surgical equipments

      Being a bold and unflappable guy I wrote a letter to the hispital administrator

      Explained my plight, skills learnt unable to put to good use facilities being poor

      Whether they could find a way for me to receive ‘old’ laporoscopy equipments

      I was surprised to receive equippments & establised an infertility invstigation unit

      Ariya

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      • Yes Ariya It was very nice indeed for them to send you the equipment to run your clinic.

        I have collected laparoscopy instruments and other medical instruments and sent it to Sri Lanka. I sent it through the Priests at the Washington Buddhist vihara. The equipment was sent to the Karapitiya Medical school hospital. There was an article that appeared in the papers of the priests handing over the equipment . My name was mentioned in the article . The Hospital medical director sent me a nice letter thanking me for the gift.

        Nisantha

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  7. Thank you Ariya and Nisantha for the good work of getting ‘ Used ‘ surgical equipment from USA .

    I do recall, not too long ago Dr Dudley Halpe ( Ped Cardiologist ) and others in Phoenix , Arizona, fund raising ( I helped this fund raising cause in Toronto- ) to send Ultra Sound Equipment to the DMH Neonatal Unit, and helped set up the Pediatric Cardiac Unit , with Ped Card surgeon from Arizona, training the Docs in SL — All on a Voluntary basis .

    The Mississauga Buddhist Temple had two members ( both in Nibbana now ) were major donors in Canada .

    These equipment were new , as we had collected enough funds for this cause .
    I think, Sam too was involved in this project .

    eaglemd

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