It was 24th of December, I was posted in the USG section of Tata Hospital. The next patient was a 60 year patient named Mr. Joseph. He was operated for a cancer of the oral cavity, which recurred twice in his neck and he re-operated for the same. he had now developed another swelling on the opposite side of the neck. He was here for a USG guided FNAC from the new swelling (which is like taking out a small sample for examination). This looked like another recurrence and the cytologist examined and confirmed the presence of malignant cells. By this time Mr Joseph had figured out that something wasn't right (Being operated multiple times, he was quite well versed with basic medical jargon.) He asked me "Doctor , how is the report? " I explained him that it looks like another recurrence and I called out the next patient. He went outside and came back again asking if he can have a word with me. He asked me by when will the report be available, which is usually 2-3 days. By that time Tata Hospital had adopted an online system and patient could access the reports online. Once they are online, the patient gets an SMS regarding the same. So Mr. Joseph calls me outside and tells me " Beta, can you delay the report and the SMS by a few days?" That was a strange request as most of the patients want their reports to be processed asap. He continued, "I want to enjoy Christmas and New Year with my family in a happy mood. I don't know how many of them are left with me." I had tears in my eyes. I didn't know what to say to him.

            That's when it hit me that we often do not realize what the patient goes through before he comes to us and while he awaits a report from us. As a radiologist we do not have a lot of actual interaction with patients, except for USG and intervention procedures. And that's the reason I like both of these. We used to have a lot of patients who come for yearly/ 6 monthly follow up USG to rule out any recurrence or metastasis. Imagine the anxiety each of these patients has as he boards his train for his follow -up check up, while he discusses his illness with his fellow inquisitive travelers (who always has a story about some distant relative/ friend who died of cancer or had a bad recurrence), while he waits outside the USG room for his appointment (where his fellow patients too often have scary stories), while we are doing the USG and once we are done with it. All this while he and his family are praying that he remains cancer free. Imagine yourself in that situation. It must be tough. And once he is done with it , his question is "Dactar sab, report kaisa hai?" (Doctor sir , how is the report?). I have seen my colleagues and my juniors often saying "Apke doctor ke pas jao, woh bataenge apko (Meet your doctor he will tell you the report) and that too in a rather insensitive tone. In fact even I have done that at times. This is especially true if the report has some positive findings. Communicating bad news to the patient in the appropriate way is an essential skill which a physican must develop. Due to the limited patient interaction we have, this is something that we lack and maybe that's one of the reason why we fail to convey reports to patients . For the patient however the anxiety gets even worse  as the treating physician's OPD is usually 2-3 days later. Imagine what the patient goes through for those two days. " There must be some problem, that's why the doctor didn't tell me right away", that's the first thought that comes to his mind. And he thinks of the worst possible outcomes , only for the doctor to tell him two days later that the report is perfectly normal. It would not have taken more than few seconds to let him know that report is normal. And I have seen the sense of relief when I tell them that the report is fine. That look says it all. Even when there is a positive finding , I feel it's best to tell them in simple terms what are the implications of the same as patients assume the worst possible outcomes when they are uninformed. Imagine this is just one report. There are at least 5-6 reports he has to collect every time. These are times when "Ignorance is bliss" seems so apt (in the case of uneducated patients who do not have much idea about these as compared to the informed Internet savvy educated types)


         At Tata , we get patients from all over India , it being a tertiary care center for oncology. Being the one of the top most government institute for cancer treatment, that's a place where patients get referred to from the remotest part of India. I had a patient who came all the way from Andaman and Nicobar for his follow up. He was treated case of rectal cancer. While doing his USG he told me how he had to travel for approximately 60 hrs from Andaman to Kolkata and from there a train journey for 40 hrs . And then he waited for another hour in the line before he came to me. All of this for a 5 min test (at times even less than that). And what would he feel if, at the end of these troublesome 100 odd hours he is doesn't get an answer. I told him his report was normal and he had this huge smile on his face and he thanked me and said if I ever visit Andaman , I have to come to his place.


       The story is not different at Municipal hospitals. I was in the surgical ward during my second year of residency, going through patients' files, looking for that elusive " good exam case". While going through one such files , the relative told me "Dactar sab , kya hua hai inko, char din se yeh sab davai , test ho rahe hai. Par hua kya hai inko. (Doctor what has happened to him. We are being doing all these tests and taking medicines since four days but exactly what has happened to him). It was a case of duodenal ulcer , which I explained with the limited medical knowledge I had at the that time. The relative and the patient both had a smile on their face (in spite of the pain he was going through) and told me that no one had told them till now what was the exact problem since they were admitted.


       Communicating with patients in the right way is not only important for the patients but that is also important for a radiologist. That way you assure that the patient stays with you. Also being a para-clinical branch we do not get the kind of satisfaction our surgical/ medical colleagues get once they treat the patient. Building a good rapport with the patient, talking to him is one of ensuring that. It's an important habit which we may realize once we start private practice. I remember one of my professors telling us this when we were caught postponing patients " Now you are refusing these patients, behaving rudely with them. Why ? Just because they are coming to your government hospital? Once you will leave this place you will crave to have such a number of patients and you will have to talk to them politely to each of them". Not only that but communicating with the patient will often save you time and help you from missing important findings. For e.g. One of my juniors came to with a patient saying he diagnosed situs inversus totalis (which is basically a condition when there is a left right inversion of organs) and he had some doubts in the rest of the scan. On asking the patient , this 60 year old lady ("maa-ji") pointing to her abdomen says " Beta yeh sab ulta hai . Idhar ka cheez udhar hai and udhar ka idhar. Aur yeh pitta ka thaili bhi nikala hai (Everything is opposite. The stuff on the right is on the left and vice versa. Plus she had her GB removed for stones) ". With a disappointed expression , my junior was like, " Yeh pehle nahi bata sakte the maa-ji" (Couldn't you have told me this before!). She would have definitely told him ,if he had asked her. After all Radiology (and medicine for that matter) is only as clinical as you want it to be.

      As always there are two sides to the coin. The amount of cases each doctor sees every day in any of the government hospitals is huge. But that does not give us a reason to disrespect them in any way. May be for me its easier to say all this. Being on the para-clinical/ non-clinical side we do not have to interact with many patients. My clinical colleagues handle so many patients day in and day out and we can't expect the same from them. Or in fact they may be even better than us at handling patients, communicating them their reports. But for others who aren't as good as them , the next time a patient asks you this question " "Dactar sahab , report kaisa hai? ", please spare a minute and do let him know the same in a language that he understands.

This is so true!!

P.S. Please do let me know your views in the comments.