The Need of the Hour – Revisiting the Importance of Counselling in Healthcare
Can counseling really make a difference? It was a cold night of my mid medical student life. I voluntarily made up my mind that year that I’ll make a list of all our classmates and write down their blood groups and phone numbers on it just so because the hostel had always been swarming with attendants of the patients of our hospital looking for a blood donor. Anyhow that night I got a call from a person named Mr. Iqbal who was in the hostel and wanted to meet me because he needed a blood donor for his daughter who was admitted in Obstetrics and Gynecology Department and he had to arrange blood for transfusion immediately.
So I went on to meet him. I was surprised to see the poor old man, somewhere in his fifties probably, who looked very rickety himself wearing only a messed up shalwar and qameez coughing. He resided in a nearby city and had no one else to help him. I asked the old man about his daughter’s blood group and to my surprise he did not know.
So I asked him who had sent him here and he responded by saying that he had been asked to come here by a nurse, in order to arrange blood for his daughter. This was quite a frustrating thing for me to hear. Anyways I decided to help him. We went to the hospital and found out that his daughter’s blood group was O+ve.
A sigh of relief for me because it was easy to find. I sat down with Mr. Iqbal and explained to him how this works and how he can arrange himself a blood donor. After I left him at that time of the night, I made sure he would be able to find a donor by himself but I couldn’t help feel sorry for the man because he was another victim of medical negligence.
Why didn’t anybody tell him about the disease? Why didn’t anybody guide him towards looking for a donor? And more importantly why didn’t anybody tell him his daughter’s blood group? I never got to meet him again but one day I received a call from an unknown number. It was him.
I asked about his daughter and came to know she was doing well and he had found her a donor the following day .What he said to me afterwards is hard to forget – “Doctor Sahb, I am very thankful to you for the guidance you gave me that night, before that I didn’t even know where to go and what to do”.
Sir William Osler considered the “Father of Modern Medicine” says in his famous quote, “One of the first duties of the physician is to educate the masses, not to take medicine”. Ignoring proper education and counseling of patients and their attendants has become a major type of malpractice that has been occurring here in our country for many years especially in case of blood transfusions. Why is our maternal mortality rates (MMR) one of the highest in the world (260/100,000 live births)?
One of the reasons behind this is because we, in our medicine practice fail to educate our patients about the seriousness of their condition and the risks involved, especially in the Obstetrical complications involving hemorrhage. Study says “Obstetric hemorrhage is the single most significant cause of maternal mortality worldwide, accounting for 25–30% of all maternal deaths”. For a pregnant lady who can go into hemorrhage anytime in her gestational period, the easiest way to prevent maternal death is by standing ready for any complication that we know of. If her obstetrician counsels her at the start of pregnancy when the chances of such complications is none; if she is told to have at least 10 donors for her standing ready during her pregnancy, wouldn’t that be a safer way for herself and her child.
Not just obstetrics but other surgical practices can be a disaster too without adequate counseling of the patient or the patient’s attendants. It’s so obvious when we as medical students go up to a bed to look up a file of a patient, the patent’s attendant would quickly rush to us and start staring with a type of expression that says, “Please! tell me something”. If an attendant like Mr. Iqbal arranges a pint of blood that goes on to give a transfusion reaction to his patient, is he really the one to be blamed?
An organization in UK known as “Serious Hazards Of Transfusion (SHOT)” is established to keep track of the transfusion based reactions that occur every year. According to them, “Incorrect Blood Components Transfused (IBCT) has been the most frequent transfusion hazard reported to SHOT since 1996. These incidents make up more than 35% of all incidents reported and are all preventable”. Although for IBCT, the doctor or the laboratory staff or the nursing cannot be blamed completely but a simple fact which would help prevent the incidence would be a well educated patient’s attendant who would be careful in donation, collection, screening and then transfusion of blood.
When a patient is sick, his hunger for knowledge about his sickness is at its peak and counseling that patient is one of the easiest ways to promote health education into the community. According to the “health education code of ethics” article no 1: “A Health Educator’s ultimate responsibility is to educate people for the purpose of promoting, maintaining, and improving individual, family, and community health”. So when we are counseling a patient, we are not only treating one’s sickness but we are also promoting health education. We are not just concerned about treating the patients but also about how they will be able to spend their lives afterwards.
Counseling has a greater impact on the patients’ after-being-cured- life as well. It’s very easy to understand that a patient who is treated nicely by a doctor when he is sick would obviously refer to the same doctor again if he happens to fall ill again. The point being that in our country, hospitals are usually avoided because they are unable to provide proper care and health education since we are not spending enough time with our patients. Figuring out the reason behind this can be easy though.
It can either be lack of confidence in our doctors and medical staff or simply the lack of staff resulting in their inability to give adequate amount of time to all their patients or it may be simply the sluggishness of our medical professionals or a mixture of any of these three. Whatever may be the reason, the result of this type of malpractice always ends up in lack of education of the community we live in, further deteriorating public health. We fail to recognize that a patient is most curious and keen to listen to his doctor when he is ill and by not educating them about it we miss the opportunity to promote health education in the easiest way.
Every problem can be solved with a multi-disciplinary approach and if doctors, along with all medical staff are determined to overcome these problems, then it will help prevent disastrous outcomes and promote health education in our communities. We just need to realize that people respect this profession and if we tend to do everything the right way, they will surely appreciate it. Just like Mr. Iqbal did.
1. Maternal hemorrhage by M. Walfish*, A. Neuman and D. Wlody http://bja.oxfordjournals.org/content/103/suppl_1/i47.full
2. Health education code of ethics: http://en.wikipedia.org/wiki/Health_education
4. Serious hazards of Transfusion http://www.shotuk.org/wp-content/uploads/2011/09/2010-Lessons-for-Transfusion-Laboratory-Staff-v10.pdf
About the Author: Mubbashir Ali Baig is a fresh medical school graduate and currently house officer in CCU in ATH, Abbottabad, Pakistan. Incharge of blood donation society in his student life, instructor of Cardiac First Response, Emergency First Response and Immediate Cardiac care and Trauma care courses. He can be reached [email protected]
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