off record
Shaukat Ali Jawaid

Suffering in Silence


During my professional career of over forty years, it was for the first time that I had a chance to attend a symposium which was unique in many respects and where all the speakers talked about the patients and highlighted the importance to listen to the patients. Normally what happens is that most often the patient going to a doctor with the hope of finding some remedy to the disease he or she is suffering from, has hardly told their story, or have not yet finished explaining their disease and their sufferings in detail that the prescription is ready. Hence it is heartening  to note that both the healthcare professionals and the Pharma industry has come to a point which will go a long way in promoting ethical medical practice in this country.

This academic activity was organized by the Academic Department of Psychiatry and Behavioural Sciences at Fatima Memorial Hospital Lahore which was sponsored by a multinational pharmaceutical company Eli Lilly. Using the latest advances in information technology, the organizers had connected to guest speakers not only in Canada and UK but at numerous departments of psychiatry in the country and eminent psychiatrists like Prof. Khalid Mufti in Peshawar and Prof. Ijaz Haider in Lahore. Not only that patients were also invited to share their feelings how they felt and how they were now coping with their disease. In short, perhaps for the first time a sincere effort was made by all the stakeholders to promote mental health services in the country.  Suffering in Silence by patients with mental illness was the theme of the symposium and it was largely attended by psychiatrists and psychologists. Mental Healthcare Professionals and departments of psychiatry at home and oversees who were linked through conferencing facility not only made presentations but also participated in the interactive deliberations. Yet another interesting features of the symposium was the Videos of the Patients describing their disease and the Video of auditory hallucinations. Prof. Imran Ijaz Haider the organizer of this symposium with his team and Eli Lilly deserve to be commended for setting a unique tradition for other professional societies, organizations and pharmaceutical companies to follow. Above all this academic activity was also approved for CME credit. On the whole the programme went on very well except a minor technical difficulty wherein it took some time to screen the Video of one of the presenters besides a little delay in getting connected to one of the presenters. Clinical proceedings of all the presentations in the symposium appear in detail in a separate report being published in this issue.

These days there is too much emphasis on improving communication skills of the healthcare professionals and it is mandatory to attend workshops on communication skills for the postgraduates. However, I feel that apart from that, the doctors also need to be trained in”listening skills” which is a part of clinical skills but unfortunately it is not being given much importance these days despite the fact that careful history taking and physical examination of the patient helps in reaching correct diagnosis in most of the cases which can then be confirmed through various investigations and tests.  However, the new generation of healthcare professionals seems to have become slave of the modern gadgetry and feel pleasure in ordering too may tests and investigations some of which are not necessary and a vast majority of the patients cannot afford them.

Let me also share with you another incident. It relates to those days when we had just over a dozen psychiatrists in Pakistan. One of the eminent psychiatrists came to see me in my office and said, “Shaukat Sahib, do you know that ever since I have developed this nerve deafness and cannot hear properly my practice has almost doubled and there is a significant increase in the number of patients who come to consult me”. I just laughed at it (so was the case with the psychiatrists with whom I shared this story at a meeting in Karachi last year). Looking at me he said, ”you have started laughing but you have not yet heard the full details.”  I asked him will he like to share the secret of this success and increase in the number of his patients despite the fact that he cannot listen to them properly, how he can make correct diagnosis and then treat them. He said that what he has done is that he has acquired the services of two young competent doctors who are now getting training with him. When the patients come, they are first seen by them. They listen to the patient’s complaints and prepare a detailed history note with signs and symptoms on a Performa which I have specially prepared. After initial examination by these young doctors, then patients come to me. They start talking and I keep quiet most of the time and give the patient enough time to say whatever he or she has to say. At times I can listen little bit but the patients are extremely satisfied that I have given them a patient hearing. They have developed trust and confidence in me. Once the patient has finished, I look at the case history and order a few tests or investigations which are further required besides writing the prescription. It has worked wonders and that is how my private practice has increased a lot. The problem with the doctors is that they do not give time to the patient, do not listen to them with the result that then they go to the quacks and faith healers who listen to them patiently and exploit the situation.  The take home message “Listen to the patient”. This was the issue which was addressed in detail throughout this symposium by almost every speaker.

 There were lot of pearls of wisdom in every presentation but I would particularly highlight two,  one from one of the patients who narrating his story had advised the audience to have “contentment”. This is a blessing from God Almighty. Once we become contented, be honest with ourselves and with the profession which we have chosen, work hard, do not look for short cuts  as there are not any  on the road to progress, establish credibility,  do not run after the money,  money will run after you.  Secondly Dr. Ali Madeeh Hashmi’s advice to his professional colleagues to “broaden their reading as literature has a lot to teach the doctors” must be given a serious thought by all the healthcare professionals. 

Note: Both the young doctors who used to work with that noted Psychiatrist whose story I have shared with you, having done their Fellowship in Psychiatry are now noted psychiatrists in their own right.

Tail Piece: Leaders should lead as far as the can and then vanish. Their ashes should not choke the fire they have lit- H. G.Wells.