Patients need counseling, information and education

There has been an unprecedented increase in the number of patients visiting our healthcare centres over the past few decades as a result of constant rise in our population besides a proportional increase in the type and number of diseases suffered by the patients. Compared to a doctor-patient ratio of 1:2000 in India, as against WHO recommendation of 1:1000, J&K has one allopathic doctor for every 3866 people, as reported by Central Board of Health Intelligence, New Delhi. Despite the fact that our doctors have been working very hard to alleviate the sufferings of our ailing lot, as a result of this poor ratio they remain heavily overloaded with work and get little time to adequately counsel and educate their patients about their disease conditions and treatment options at their OPD clinics. This often results into lack of satisfaction among the ambulatory patients about their drug therapy and disease management process and some of them quite often prefer to get themselves treated at private clinics and nursing homes rather than at government hospitals. This void needs to be bridged by well-trained and qualified health professionals by offering patient counseling, health education and information services to our patients so that they don’t feel confused and inadequately informed about the medicines and diagnostic tests prescribed to them.

In the present time and age there is a need to fully equip and empower the patients with credible information and awareness about their disease and drug therapy since they have a right to know and be informed about their ailments as well as about the ways and means that are being employed to get rid of them. A well-informed and educated patient can participate in his or her own treatment and thereby help in decision making. He can help identify errors, if any, even before they occur. Counseling can help promote recovery, improve function and reduce his or her length of stay in the hospital. It can help improve quality of care, improve patient satisfaction and effective use of resources. It can also facilitate patients’ and families’ understanding of their health status, options, and consequences of care. Patients’ potential to follow a health care plan will increase and likelihood of any treatment complications will decrease substantially following effective counseling. 

Apart from diagnostic tests and drug therapy, patients need some empathy, compassion and sufficient attention to fully recover from their ailments. Instead of following a medical model, doctors, nurses and clinical pharmacists need to follow a helping model in patient counseling wherein instead of passively listening to their counselors, patients need to be actively involved in the counseling sessions; counselors must develop a mutual relationship of trust and respect with the patient rather than basing their relationship on their expertise and authority; counselor must assist the patient in identifying his health-related problems and exploring possible solutions rather than identifying problems and determining solutions all by himself so that the patient develops sufficient self-confidence to manage his own medical problems rather than depend completely upon the health professional; rather than establishing a parent-child relationship with the patient it must be a relationship on equal pedestal wherein concerns and sensibilities of the patient are duly respected and taken care of by the counselor and made equal partners in disease and drug therapy management.  This type of a helping approach relationship between health professional and the patient can go a long way in speedy recovery, better satisfaction, lesser disease recurrence and better quality-of-life of the patients. 

For result-oriented counseling sessions counselor has to overcome environmental barriers like excessive noise, difficulties in vision, congested areas as well as cultural barriers like persistent patterns of behaviour, habits, beliefs, customs, attitudes etc. Then there could also be other hindrances or barriers to communication like psychological barriers including emotional disturbances, depression, neurosis or physiological barriers like difficulties in self-expression, difficulties in hearing or seeing, difficulties in understanding etc. Use of audio-visual aids in counseling like phones, projectors, films, charts, posters, laptops, models etc could be of great help in delivering effective and fruitful counseling sessions that focus on personalized advice and medical assistance on taking medications besides information about the etiology, pathology, diagnosis, prevention, treatment, complications and clinical management of the disease. 

When patients are not clear on how to use their medicines (when to take, how long to take, what to do when doses are missed etc), it can result into therapeutic failure, adverse events, avoidable additional treatments & costs. Patient counseling in turn reduces errors in using medication, decreases non-compliance, minimizes risks and adverse drug reactions, maximizes benefits, improves therapeutic outcomes and patient satisfaction. It also assists patient in self-care, improved quality of his life, reduces overall healthcare costs to the patient, hospital, government and society. However only a well trained and professionally qualified counselor can acquire necessary verbal (including language, tone, volume, speed) and non-verbal (including distance, body language, eye contact, facial expression) communication skills required for effective patient counseling. He needs to be fully aware about how to prepare, how to open, how to deliver and how to close a counseling session. Patient counseling is more of an art and a skill than a science. A counselor needs to be as focused, goal-oriented and self-motivated just like a marketing executive in order to be successful in his patient counseling sessions. 

Patients need to be categorized and prioritized for their counseling needs on the basis of their disease conditions like epilepsy, asthma, diabetes and disease severity; drug therapy complexity like multiple formulations; patients belonging to special age-groups like pediatrics, elderly; specialized drug delivery systems like rotahalers; literacy level; sight or hearing impaired or disabled patients; patients receiving medicines with special storage, usage and precautionary requirements; patients allergic to medications; patients who are mentally or terminally ill; patients using appliances or those taking three or more medicines at a time; patients who tend to skip, self-medicate or misuse medicines quite often. Based on this categorization patient counseling plans need to be chalked out with a view to address personalized needs of the individual patients. There is no “one pill for all the ills” scheme or any one “fit for all” solution that can work uniformly for all the patients in counseling.

Every patient has a right to know what is happening to him, a right to ask questions, seek answers and know the therapeutic plan being offered to him besides a considerate and respectful care. Every patient has a right to receive complete information from a physician about his diagnosis, treatment plan, prognosis, specific nature of a proposed treatment or procedure in addition to a disclosure of the risks involved and information about other medical alternatives. They have a right to seek privacy during discussion of one's medical condition and while undergoing medical care. They can expect all records related to medical care to be kept confidential. Patients need to be well informed about the necessity of treatment, alternative modalities of treatment, risks of pursuing the treatment, including inherent complications of drugs, investigations, procedure, surgery etc. They must be informed about the duration of treatment, prognosis of his disease without any attempt to exaggerate or minimize the gravity of patient’s condition as well as regarding all expenses and break-up thereof.

A patient’s level of awareness regarding a disease, its symptoms, and available treatment options significantly affects the quality and efficiency of treatment that a health care professional can deliver. A practitioner has a right to recommend but the ultimate right to make a final decision must always vest with the consumer and therefore the patients must have the choice to say NO as and when desired by them. There is need for recognition that patients have rights which can transform the doctor-patient relationship from an authoritative and paternalistic one into a true partnership. Where a patient’s medical records or case study are being used for research or teaching or if a patient is enrolled as a participant in a study, it should be ensured that informed consent has been obtained or the patient’s identity is concealed to protect his privacy.

Many people in Kashmir harness certain conventional attitudes and beliefs towards health, drugs and disease, most of whom are not based on any logic or rationale. A health professional has to first understand the patient’s approach and belief towards the prevailing disease condition and the prescribed drug therapy that shall go a long way in enhancing his existing rational knowledge base and alleviating his ill-conceived notions, if any, about the disease or the drug therapy. The counselor must recognize the complexity of counseling in order to come out with the most appropriate approach to make the patient realize the risk-benefit ratio of the drug regimen. Information must percolate in a very simple, lucid, unambiguous and lucrative manner so that it is easily understood, retained, recalled and applied by the patient during the course of his treatment. Patients should be inherently motivated to comply with the directions owing to their well-pronounced advantages. Worldwide it has been observed that well informed and educated patients show better patient satisfaction and improved therapeutic outcomes. 

In order for the patients to use their medication appropriately, safely and effectively it becomes necessary for them to be well informed and adequately educated about their disease as well as drug therapy. Unless patients understand their illness and medications well, it will be a bit unrealistic to expect them to comply with their physician’s instructions and adhere to the drugs prescribed to them. Non-compliance in turn can result into failure and ineffectiveness of drug therapy. For better results and therapeutic outcomes our patients need to be fully aware of their disease pathophysiology and therapeutic regimen. Clinical pharmacists having undergone sufficient training and internship in these aspects of medication management are best suited to provide these pharmaceutical care services to their patients.  All they need is legal and statutory authorization to offer these services followed by appropriate positioning in the healthcare system to deliver these services.