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By Dr. Helene A. Sairany:
“Doctors are just so mean and arrogant,” I keep hearing. I somehow have to agree with this assertion considering that every physician-patient experience I have encountered has been nothing but a disaster. I understand that not everyone is a cupcake or rainbow. I also understand that doctors work under loads of pressure but I feel doctors fail to grasp a good understanding of their role. The ultimate role of a doctor is to heal and healing demands loads of patience and empathy.
I once over-heard my friend, who is also a medical doctor, utter that medical students should face the various stages of every disease before continuing to become doctors. I knew what he meant. He meant nothing but empathy! To practice empathy, you have to build an understanding of what the patient is going through. I remember as a pharmacy student, I was required to live the life of a diabetic, hypertensive and hyperlipidemic patient, where I had to inject myself 3 times daily with insulin shots, I had to stick my finger to get sugar readings, and I had to take multiple anti-diabetes, anti-hypertensive and anti-hyperlipidemia tablets. Every day I had to record my compliance and to my surprise my percent compliance by end of the month was 30%. After going through this exercise, I was able to build an understanding toward a patients’ non-adherence. Just now I understand what it means to live with multiple chronic conditions, to inject yourself so many times and to take multiple pills. Had I not gone through this exercise, I would not have had built this understanding
Empathy is what doctors are missing in Kurdistan. Empathy is the capacity to recognize and, to some extent, share feelings that are being experienced by the patient. A doctor has to have a certain amount of empathy before they are able to feel compassion. You might, like myself, wonder if empathy is an innate practice or can it be learned? Of course it can be learned. We have to make this learning available to our students.
One of the by-products of a lack of empathy is failure to utilize patient-specific language when it comes to patient interaction. The practice of patient-specific language is also is a learned process that has to be incorporated in the medical curriculums. I recall that, though I was providing my instructor with the right answer, points were still taken off because it was not in a language that patients could understand. Doctors typically do not have large amounts of time to educate patients, and impersonal, voluminous patient handouts are largely ineffective. Patient compliance is a significant problem and it is strongly correlated with the patients’ understanding of their condition and prescribed treatment.
Our doctors, like many other doctors elsewhere, fail to practice what they preach to their patients. Almost every other doctor smokes here in Kurdistan. Being part of the faculty at the medical campus myself, it only bothers me to see residents and medical students smoke indoors. It bothers me further when I fail to see a law prohibits the act of smoking indoors. I for once took the initiative to approach a group of residents in the college cafeteria who were smoking. I kindly asked that smoking indoors is not good for my health since I have an allergic reaction to it. I was not only treated with disrespect but also handled bitterly when I was only trying to be professional in my approach. Their reaction makes me question residents’ true intention toward their profession. Why do you want to become a medical doctor when you fail to strive for a patient’s comfort? Aren’t you wanting to heal a patient?
Arrogance among doctors is an attribute that is impossible to miss. Confronting doctors with a medical error of theirs is blasphemy! I am the kind of soul that loves voluntary and motivational work. I once decided to help a colleague with his PhD data collection by passing out surveys to medical doctors and acting residents. Filling a survey is completely voluntary. The point of this survey was to grasp the magnitude of our doctors’ understanding of methicillin-resistant Staphylococcus aureus, which is a type of Staphylococcus aureus that is resistant to the antibacterial activity of methicillin and other related antibiotics of the penicillin class. I am yet to understand as to why some senior residents took filling the survey so personal, as if we were testing their knowledge. We all know surveys are completely anonymous. We had some doctors look at the survey intent on correcting its content while others stated that, if the survey was on some cardiology-related topic, the story would have been far different. I thought to myself, how about just completing the survey?
I wish every doctor was as sincere in his/her duty in public hospital hours as they are in their private clinic hours. When we aren’t feeling well, which of course is the reason we are paying these individuals a visit, then facing harshness and cruelty may leave us feeling intimidated, angry, frustrated, or a host of other negative emotions, none of which is helpful for improving our health. Confidence and self-assurance are good traits for doctors to have. We want to know that our doctors are confident about their work and are positive about their abilities to help us. But wise patients understand that there is no room for arrogance or narcissism from an egotistical medical professional. Their lack of respect for our needs, and their difficult personalities will prevent the patient-doctor relationship from developing, which will lead to a negative outcome.
Dr. Helene A. Sairany: Lecturer at the American University of Iraq in Sulaimania. Originally from Kurdistan of Iraq. Grew up in the United States of America.
Copyright © 2012 Kurdistantribune.com
I am sick of the quasi westernised people who are trying to borrow the west medical pseudo values and impose them to kurdistan . It does not work for many reasons. Cultural difference , economic gulf , work force and technical limitation . e.g the parties are more keen to recruit youth to be militiamen than as nurses and healthcare assistant staff. Doctors in Kurdistan are generally doing a fantastic job in difficult and overstretched environment and they are competent.
In the US , if you do not have an insurers , no one would be sympathetic or empathetic with you. A good per cent American doctors are alcoholics and uses drugs in addition to smoking . They are human beings .
It would be good to write something useful pragmatic and realistic . Rhetorics are leading to no where.
I agree with some of the points Ari addressed. In US also there is no empathy when you do not have insurance. In western countries you have a solid healthcare system, the budgets which are dedicated to it is quite acceptable and good, which leads to a good medical education, communication skill and good health care. But it seems you do not like to address the roots of the problems, why it’s this way in Kurdistan?!!!! Besides you made a clear generalization of what you saw, i am saying not everything you experienced is like all doctors in Kurdistan doing like that, arrogance and other interesting words that you used, there might be some but it’s not all. I am not sure if you get any doctors from the western country to practice in the ER in Kurdistan that they will tolerate the situation, they will probably give up. Doctors in Kurdistan see hundreds of patients on daily basis with less facilities and with less salary for a long time, how you can show empathy if you do not have enough time or enough facility, you could see 100 patients in 5 hours, infact Kurdish doctors are adapting to the difficult situation very well, more importantly they have to play the role of psychologist, nurse, dietitian, social service worker most of the time instead of being a doctor first, we have lack of those services i addressed, and those things makes doctors stressful and may not show empathy necessarily, and i hope you do not forget that doctors are humans. Moreover, I seen many doctors in my city on daily basis who treat patients, those who do not have any family or anyone or even money. They pay for their investigations, they bring the things that those patients needs as much as they can, while he or she is in the Hospital. Finally, i would say healthcare system is not perfect in Kurdistan it still lacks major defects, and i hope the healthcare system improves to a better way and i hope the Kurdish doctors always review and improve themselves for providing a better healthcare, and show more empathy as much as they can and Thank you.
That’s a pretty harsh anonymous response to an upfront and thoughtful article. What’s wrong with observing that doctors need to be more empathetic with their patients? It’s an issue not just in Kurdistan but in many other countries too. I remember that in Venezuela local doctors often didn’t like working in the poorest barrios and that’s why Cuban doctors, with a different ethos, were so popular there, at least when they first arrived, as part of an ‘oil for doctors’ deal. But that’s altogether another story … Well done for your interesting article, Dr Helene.
Patient-doctor relationship has nothing to do with USA or Kurdistan. Being a doctor is a noble profession and in reality doctors in the Middle East should be the most empathetic, because they are far more respected and regarded than anywhere else in the world. People almost worship their GOOD doctors there. Now, if I tell you a well-known Pediatrician in one of the Kurdish cities in Iraq basically slaps the little kids when they cry in his office, what would you think? AND parents still take their kids to hiim because they THINK he is good, mostly because he has experience in giving bags of drugs.
The whole culture of Patient-doctor needs to change but you can’t put all the blame on the doctors as well. Lack of patient education can be very frustrating to doctors. Also, the healthcare system in Kurdistan is horrendous with newly graduating doctors not getting paid enough to live the life of a doctor that they deserve after spending a decade just to become doctors. Anyone who thinks the status quo must remain the same is crazy, but also anyone who thinks all the blame falls on physicians is more crazy. Now, how about pharmacists who open pharmacies right and left and put technicians in charge of pharmacies prescribing drugs to patients right and left, how come no one is talking about that?
FInally, lets not forget that there are thousands of undertrained nurse practitioners who exploit patients in poor neighborhoods by opening fraud clinics, giving a dozen medications to every patient, in the process rivaling many doctors in income.
Maybe these are some of the issues that need to be discussed to be fair to doctors.
I agree with most of it. For doctor empathy, there is nothing to make it impractical. Medical texts all advice that in low resource countries as Kurdistan,kindness and empathy may be the only tool available.
No need to get sick from a well written article. There is nothing wrong with promoting empathy. Most health professional in Kurdistan lack empathy because it is not emphasized as part of the training. Instead of an “ad hominum” response from Ari it is more useful to address the problem. Patients could be your close family and they deserve empathy and respect.
The reply by Ari is the sort of response that prove how arrogant and unconfident some of our doctors can be in Kurdistan. In addition, he is very wrong about the attitude of medical doctors in the UK for example were patients are treated with full respect and without any requirement for personal medical insurance. Incidentally when I was in Duhok a few months ago I needed to go to see a private doctor with another academic colleague. I was completely shocked to see patients not only waiting in the waiting room but actually there were six other patients in the consulting room. my first reaction when entered the room is to apologise and to leave the room but my colleague (who is from this area) told me it is normal please stay. The doctor examined all these patients in front of me which I though it is humiliating to all. I was told later that this is normal here!. The doctors may be regarding their patients as production line. Where is the empathy in this situation?
The problem as i can see it is with the writer… Her poorly written piece of writing comes a cross as a fantasy psychoanalysis of all medical doctors :
Despite being a PhD , she has used the pronounce I almost thirty time . Even a novice will notice that this is a very poor english and possibly indicates hyperinflated Ego.
‘Their lack of respect ‘ doctors have to bow to her majesty as she is PhD and american . And participate in all her surveys including MRSA one.
She has allergy to ‘cigarettes smoke !’ In kurdistan smoking is an androgenic attribute . Smoking is part of our culture whether wrong or write .
‘Their difficult personalities’ where is the evidence … lead to ‘ us feeling intimidated, angry, frustrated, or a host of other negative emotions, none of which is helpful for improving our health.’
She then display clear envy ”I wish every doctor was as sincere in his/her duty in public hospital hours as they are in their private clinic hours” Where is the evidence ?
Bizarre vocabulary : ” arrogance or narcissism from an egotistical medical professional.”
Here is another claim ”Why do you want to become a medical doctor when you fail to strive for a patient’s comfort?” How is working round the hours to keep hospital running in internal medicine surgery emergency paediatrics obstetrics. Pseudo academics or hardworking doctors with limited resources and little support.
Ali,
if there is anyone who is arrogant and lacks English skills, it is YOU. This lady wrote a beautiful piece indicating some realities. Your proud insistence on the smoking culture indicates your ignorance, regardless what degree you have. One more note for you, Ali: this girl is not PhD. She is PharmD. Your ignorance about her degree says a lot about your level of tolerance towards her profession.
It is because of people like you that we still have doctors in Kurdistan smoking in their offices blowing smoke in the faces of their patients while they are examinig them (and you call that part of the culture). Also, it is because of mentalities like yourself that we have health directors yelling at physicians and treating them like servants. Being proud of culture is one thing, but holding on to ignorant culture is beyond any logic. We Kurds have not contributed much to any science or technology lately and still act like we are the best people on earth who should be respected and followed. Grow up.
System needs to change and those doctors who are going to oppose change are the ones currently abusing it.
The article was about medical doctors and not an assay about writing in English!
Can Ari explain this piece from his reply? “Smoking is part of our culture whether wrong or write .” ? does he mean right?
Primum non nocere!
the basic duties of a doctor is to alleviate the sufferings of patients, and while we can heal some diseases, most of the time we can only alleviate some of the patients sufferings, but the most important thing for a doctor is not to do anything that will harm his patients(primum non nocere), that is the ultimate principle of medical profession. I think the writer is trying to address a very important problem in any health system, and that is how much empathy a doctor can show to his patients. In Kurdistan the majority of our patients are illiterate or poorly educated and trying to explain the medical condition to them is not always an easy task, besides the empathy the author talking about is not only a problem of medical profession in Kurdistan, human dignity and human value are generally not appreciated in any public office in Kurdistan. We as doctors also have families and we should treat our patients the way we would like our family members are treated when they attend any health institution in Kurdistan. The example that Sherzad mentioned is not an exeption, so how could a patient`s privacy and dignity be preserved, when so many patients are allowed into the consulting room at one time and also the rude treatments of patients by policemen or reception personal when they try to attend a hospital, when they are treated with utmost disrespect and humiliation.I know what I am talking about, as a trainee doctor I Worked in Baghdad,Babil and as a specialist doctor in Hawler, United kingdom and Switzerland.
For Ari to react so unprofessionally and attack the author personally is pure ignorance and arrogance, since this is an important topic and has nothing to do with geographical location being in Kurdistan, Europe and USA.As an academic person one should have a lot of tolerance and be ready for a useful debate.
I am starting to wonder if Ari knows the author and has a personal problem with her. maybe someone who is being threatened by her? It is possible.
Dear Ari
Once you criticize the individual instead of the argument you lose your point. That is a logical fallacy:
Please read this:
http://yourlogicalfallacyis.com/ad-hominem
She has to address the other defects of other parts of healthcare as well instead of blaming only doctors, like Pharmacists who does not work properly in the hospitals, and they freely give and sell drugs to people without doctors prescription outside, i wonder how many people have got harmed by that, why does not she talk about this empathy?!!! and pharmacists do not have enough knowledge about clinical medicine and yet they give and sell drugs to people as much as they like to. My point is not making personal things between doctors and pharmacists, but the point is the healthcare problem in Kurdistan is bigger than to be addressed in this way and throw all the blame on doctors without addressing the main issues.
Very well written article overall.This is a very important issue that needs to be tackled at all levels.Empathy towards patients is the duty of every person who works in any healthcare system as some of you have highlihted but we doctors are at the forefront of this duty as the public see as us as the role model for all other medical professions.
There is no doubt that the lack of empathy towards patients is not unique to the healthcare system in kurdistan but it is for sure that there are major deficiencies in Kurdistan which needs to be addressed .
My personal view on this matter is that majority of doctors in Kurdistan work very hard and respect their patients but there are some minority doctors who have shown no empathy and only interested in making money which have given a bad name to doctors in general in the public eye.The other group of doctors are not aware of their lack of empathy simply because it is becoming a culture among their colleague and they see that as being the norm !! which this article is trying to address.I also feel that there is lack of formal training of doctors in how to communicate with patients and their families.The other issue is lack of regulations which is an extremely important to protect both patients and the doctors.
In the UK(NHS)the commonest cause of complaint by patients and their families is lack of communications and not being treated with respect ! the difference is every hospital in the UK have a system to deal with these complaints and apologise for any short comings.
So to tackle this issue we need:
1-Riase awareness and break this culture among some medical profession.
2-Formal training of all healthcare professionals in communications with patients and their families and how to treat them with dignity considering the local culture.
3-Raise awareness and educate the public to treat the healthcare professionals with respect and dignity.
4-To regulate by law the rights of both patients and healthcare professionals.
5-The doctors or any other healthcare professionals who break the rules should be disciplined and if necessary prosecuted.
Thanks
Hello all,
I am sorry in getting back a bit too late to everyone as I was busy writing my next piece for Kurdistan Tribune. A big thank you goes to Kak Ari for raising such an important argument. To those who wondered if I know him in person. I understand I had many who object(ed) my work and efforts in Kurdistan but this does not mean I should stop doing what is needed to make a difference in the region.
Smoking was never part of our beautiful culture! Smoking at a patient’s face is not right (right not write =)). It does not take a novice to know this!
To the person who indicated that I should have included issues pertaining pharmaceutical services in the region, I want to let you know that what you brought up is one of the targeted projects we are are working on with Dr. Rekawt, the current serving minister of health. We do have a serious systematic fault in the region. Please read my article, “To Err is Human, To forgive is Divine BUT ignorance is not a bless,” to learn about what I am talking about.
Best,
Helene
It seems like Mr. “Ari” might have bitterness about other issues that he taking out on Dr. Sairany.
Maybe he wants her in a burqa milking goats at home where he can blow cigarette smoke in her face all day while she is pregnant?
Her article makes perfect sense and is reasonable. Empathy is the highest human virtue and is needed in an independent Kurdistan (hopefully one day) and in the U.S.
Blue Bird,
while I agree on your reply as a concept, I think your example of brining burqa in is lame.