By Shalinee Bhardwaj
If you think that medical treatment is only about pills, pricks and surgeries then think again. Over the last decade, global healthcare has taken on an entirely new perspective where the ‘human angle’ or the ‘humane touch’ holds an equal or even more significance when it comes to treating the patients.
Elaborate studies and documentation on these lines further indicate that this is one area in medical sciences that demands serious attention, both on paper and in practice.
We explored it further with Dr Ravinder Mamtani, Professor of Public Health and Associate Dean, Global and Public Health at Weill Cornell Medical College in Qatar, who divulged crucial facts and figures about some of the modalities in patient care, whose insinuation perhaps, had been at the back of our minds; though much underestimated.
Dr Mamtani is a medical doctor trained in India and the UK, who subsequently, moved to the US for receiving additional training in preventive and integrative medicine. For 23 years he had been involved in teaching programs, research and clinical work at the New York Medical College where he gained extensive experience in managing chronic problems and the use of integrative and preventive medicine approaches in treating his patients.
With a generous number of research papers to his credit and such vast experience, Community caught up with him for what turned out to be an engaging new take on the healthcare system per se.
“Today’s healthcare system across the globe is looking at the emergence of a ‘new consumer’ in the patient who is smarter, educated and is attentive to self care. Equipped with Google and Internet surfing, he is looking at various options and choices that he wants to discuss with his doctor. I remember a patient who brought a huge pile of print outs from the Internet, asking questions and discussing his problems at great length. So, now the patient is not a passive person who would be satisfied with a prescription!” says Dr Mamtani.
“Simultaneously, there is the emergence of a new healthcare professional, a medical doctor who is not just a technician in diagnosing and treating but also an administrator running a business; he has to be a great communicator to deal with insurance companies and most importantly, expected to enhance human healing,” he adds, underscoring how “patient centred care has become pivotal and most important.
“Research has proven that when patients are involved in their treatment as an equal participant, the outcomes are superior. Informed consent of the patient at each step in his diagnosis is vital,” he says.
Dr Mamtani stresses upon the human component of a healthcare system that, he believes, is under strain. “According to a study, a majority of doctors interrupt the patients within 20-30 seconds of narrating their medical complaint while it has been found that it doesn’t take more than two minutes for a patient to recount their complete story. By doing this, we are not building a great therapeutic bond!”
And why is this so important?
“The adage — it’s all in the mind — is not without reason and it is now backed by research. Building a trustworthy relationship and compassion can maximise healing response. A study was done on 200 patients with common symptoms but no prior diagnosis. One group was provided positive consultation while the other group received —“I am not certain what is the matter with you”— attitude. Results showed recovery rate to be at 64% in the first group as compared to 39% in the latter, after two weeks!
“It has also been shown that patients who perceive their health to be from good to excellent had lower mortality or better life than those who perceive their health as being poor.”
“How can we not pay attention to this” asks Dr Mamtani, “when warm, positive and friendly physicians get better result with their patients than those who keep themselves professional and aloof. And as I always say, there is no ‘one size fits all’ approach to treating patients. The new approach is holistic and humanistic whereby it is important to treat a person with a problem rather than treating a problem in the person.”
Not only has the healthcare system seen a significant change in how to look at a patient, a number of challenges are driving its renovation as well with premature mortality due to non communicable diseases (NCDs) being one of them.
Dr Mamtani spells out risk factors that although well known still manage to contribute noteworthy deaths in the society, “Health statistics worldwide have shown that a vast majority of people die from NCDs, chronic diseases such as cancer, hypertension, diabetes, and obesity—87% in the USA and 70% in Qatar but inching up. Life expectancy is higher in US or Qatar but people are still dying early; the reason is that they simply do not know that they have the disease! And their diagnosis is often delayed. The challenge is to bring these patients into the purview of healthcare system by providing an early diagnosis/intervention.”
“The other challenge is to improve the quality of life for patients who suffer from chronic illnesses such as arthritis, chronic muscular skeletal pain, depression, anxiety, chronic fatigue etc. With an ageing population there is an increased incidence of associated chronic diseases. Also, as the profile of young people in the modern stressful, competitive society is changing, their mental health is a major concern. There are projections backed by research which indicate that mental health problems will overtake others in the future. It is then nothing short of being obvious that an entirely different approach to managing these concerns is necessitated”, informs Dr Mamtani.
While a warm doctor-patient relationship or the importance of ‘human touch’ and ‘a positive perception’ in treating patients as described earlier by Dr Mamtani appears to hold weight, at this point one could draw from his vast experience in education, research and clinical work to put forth the alternative strategies being looked at in medicine and figure out if this could be the missing link.
Lifestyle medicine and Integrative medicine could be the twin approaches that will bridge the gap in future treatment planning.
He says, “Lifestyle changes that may not be substantial can translate into considerable health benefits. Again, it has been well documented that a loss of only 8 pounds of weight coupled with physical activity reduces incidence of diabetes by 58%!”
“Here we see marginal changes that can even be undertaken from cosmetic standpoint, resulting in tremendous medical benefits. But despite knowledge of such data, the number of practitioners implementing such practises is very low, worldwide.”
“Integrative medicine combines conventional medicine with the evidence based non-conventional therapies that people have been using all over the world. It may be mind-body approaches, yoga from India, acupuncture of China or herbal medicine which has been an integral part of almost every culture in the world.
“In fact, in lower income nations, a vast majority of people rely on such treatments only! How can we ignore these modalities?” Dr Mamtani asks.
“Why not indulge in a discussion with your patient? Many patients practise it at the same time but do not tell their doctor! Herbal supplements or remedies actually contain pharmacologically active chemicals and can interfere with the medications prescribed to them! They may not be entirely safe”, he adds.
“The relation between mind and body is well established. Acupuncture that was earlier thought of as a weird technique of pricking needles in the body is now known to have a neurological basis. The needles stimulate the release of chemicals that aid in healing especially in chronic pains. Mind body techniques like yoga or meditation elicit a relaxing response helping patients with anxiety syndromes.”
Thus it concludes that with the patient and disease profile undergoing a sea change, healthcare system needs an overhaul as well and it appears to be underway. Dr Mamtani suggests “evidence based, integrative, preventive and patient-centred healthcare, which relies on modalities that can complement each other with a view to optimise on highest standard of care we provide to our patients.”
And with as much research backing it, is there room for any doubt?
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