The essence of the ‘art’ of medicine

The article by Neha Madhiwalla and Nobhojit Roy (1) is a timely analysis of the growing attacks on doctors and hospitals, mainly in Mumbai. The authors identify the lack of communications skills in trainee doctors, especially in sharing bad news, as one of the main factors. This clearly points to the need for communication skills to be included in the medical training given to students.

It is common practice in western medical and dental schools to teach students how to handle difficult situations with patients and their families. An example is the Schulich Medical and Dental School’s clinical skills programme in Ontario, Canada (2). The programme uses “standardised patients” to train and evaluates the students on how they handle various simulated situations.

The Medical Council of India recently announced plans to revise the MBBS curriculum and include communication skills as part of first-year training (3). The proposed changes have been sent to state governments for comment. As planned, medical education units in colleges, often defunct, should be given the responsibility of organising training in skills for communicating with patients and relatives. This would also help in dealing with patient perceptions, a need highlighted by Sunil Pandya in a 2001 editorial (4).

A lot of medical training and the way we learn to interact with patients come from observing peers and seniors. During my training, the most popular clinical faculty members and the ones with the longest queues at the out-patient department were not necessarily the ones who were the best technically, but the ones who were congenial and interacted with patients in a respectful manner. That for me was the essence of the “art” of medicine.

Many other factors have led to the rising violence in medical settings, as highlighted in the article, including a lack of infrastructure and frequently malfunctioning equipment, as was evident in the recent problems with the morgue cooling plant in Sassoon Hospital in Pune (5). This is an example of a situation that can lead to anger and provoke violence among waiting and grief-stricken relatives.

It would have been interesting to study whether there is any difference in the responses gathered at teaching hospitals as compared to peripheral hospitals. More space could also have been given in the article to the perceptions of patients. The article should provoke critical thinking among all of us, but especially among hospital administrators and medical college deans.