The below summary of a section from the Charaka Samhita, written 700 BC, the world’s oldest medical textbook, is very important to this day. I find that this ancient lesson directly impacts on the results we get at my natural medicine clinic in Delaware.
People are always and very appropriately concerned that the doctors they choose are very good. And they want the doctor’s staff to be efficient and courteous. Of course, they also want the medicine to be effective.
But not all people go a step further and ask is they themselves have the qualities of being a good patient. No matter how good the doctor or the medicine, if the patient does not understand and carry out their responsibilities, results will never be optimal.
Responsibilities of the Physician, the Nurse, the Patient and the Medicine
The text asserts that the qualities listed below are the most important parts of a medical practice that is able to return people to health.
The text also states that the knowledge of medical science has no end, and the physician must constantly learn and should discuss his findings and questions with other physicians because “when one discusses with another that is possessed of a knowledge of the same science, such discussion leads to increase of knowledge and happiness.”
The Qualities of a Good Physician
• Excellence in medical knowledge and diagnosis
• Extensive practical experience
• Skillfulness & dexterity
• Caring & honest personality
The Qualities of Good Medicine
• Precisely matches the diagnosis
• Adequate quantity
• Multiple forms of administration
• Potency in action
The Qualities of a Good Nurse
• Skillfulness in duties
• Promptness in action
• Fairness & honesty in decisions
• Listening to & caring about the patient
The Qualities of a Good Patient
• Clarity in description of problems
• Respectful obedience to the physician’s plan
• Promptness in appointments & payments
• Patience & perseverance
Working with Western Patients
When I was a student in Nepal at the Piyushabarshi Aushadhalaya Ayurvedic Clinic about 40 years ago, Dr Mana many times pointed out to me the difference he experienced with American and European patients under his treatment.
While all Nepalese patients treated doctors like they were great sages, some but not all Western patients would argue with him, not follow his directions, and otherwise violate the rules above.
For example, he would tell them to come back in one week, and they would come back in one month. He would tell them they needed to make dietary changes and they would say they could not do it. He would tell them to take two different herbal medicines and they would take only one of them.
I was sitting in the clinic as a student when this would happen. Dr. Mana would often tell me that “This person probably will not get well, because they lack medical discipline.”
The non-Nepalese patients that he said best fit his definition of a good patient were the Japanese. They would listen carefully, write down everything he said, follow directions precisely and always return for follow-up treatment.
I remember in particular a Japanese patient who, once the consultation was over, made it a point to straighten up the chairs in the office, and straighten up some objects on the table. Dr Mana was very impressed by these simple acts of respect.
Even though its not often discussed, all doctors will tell you, if you ask them, that patient compliance is a major stumping block in the West.
A local physician friend of mine, Andrew Weinstein, MD, for example, has found that patient adherence to asthma medications is a major problem, and that many preventable deaths occur as a result. He has spent years developing programs to overcome this.
My ophthalmologist partner Dr Abel has told me that poor compliance with eye drops has led to many cases of unnecessary vision loss, and even blindness.
A secondary problem is that it is sometimes very hard to even tell patients they need to keep appointments, take their medicine properly and eat properly etc.
Some of them actually get offended when you question their priorities and think you are trying to control them, “not listening to them”, or don’t understand them, or are “attacking them.”
Of course one of the best is when patients don’t follow your instructions because of something they read on the internet. Of course they can ask about what they read, but often you lose two months of effective treatment when this makes them stop something.
A joke that explains this is that a patient walked out of a clinic in a huff when the doctor told her she had an infected abscess on her face that needed to lanced. She told her friend, “That doctor is horrible. He attacked me and told me that my face was ugly.”
There are even some new patients, and this one I really can’t understand, who go through the trouble to make a full hour intake appointment, then don’t show up, don’t bother to call to cancel and apparently don’t realize that (1) They are blocking out patients on the waiting list, some of whom desperately need help, and (2) wasting a whole hour of the doctor’t time.
At my clinic, fortunately, a huge majority of our patients are extremely nice and polite people. However, once in a while we get people who just cannot make the changes necessary for good health outcomes – not only the rules above, but also the changes to a healthy diet, exercise and hard work that are the foundations for good health.