Monday, August 24, 2009

Trusted Advisor: does it exist in the realm of patient – medical doctor relationship?

I learned about the concept of being a trusted advisor from a training on how to understand client’s needs better. I unfortunately forgot to copy the book so I could not really check the exact definition.

But in essence, being a trusted advisor means that you put off your own agenda and put the other person’s views and thoughts and worries in front you, and being ready to REALLY listen. It is not about offering immediate solution, rather, advising and discussing a solution based on the other party’s needs and issues.

by David H. Maister (Author), Charles H. Green (Author), Robert M. Galford (Author). A very useful book - tells you a lot on how to gain real trust, very applicable to everyday life

I loved the concept. I found it very useful in doing my role as a research consultant.

I thought about it when thinking about what I have to go through now.

A confusing journey

Since last year, my husband and I have been trying to have a second child. Not because many people have asked us, “So when are you going to have another child?” (such an annoying habit!), but more because Tara has been asking for a little one with whom she can play with. We also feel that it is about time we have another one. We often feel sorry thinking that Tara is alone with the adults at home.

So we have been going back to the doctor. I intentionally went back to the same doctor and hospital where we have successfully had Tara, because they know my history. We had Tara not without difficulty. I have a physical condition where my body actually reacts negatively to Cip’s sperm. A condition called anti-sperm antibody. Before we had Tara, I had to take some medicine and undergo some procedure to suppress the antibody. And Alhamdulillah, finally we had a baby.

I was under the impression that I would just need to undergo the same kind of procedure when I went back to the hospital. It turned out, that the doctor who handled my case was no longer in this hospital. He was being replaced with another doctor, who offered another solution, while all I actually wanted to do was just to repeat the previous procedure. My reasoning was very simple: if it worked 4 years ago, what reasons should it not work now? (unless God has forbidden it to work this time). But, this doctor said that with the advancement of technology and all, the new treatment is better. Of course, since we had no idea about medical science, we went along with it.

This treatment is called PLI (don’t ask me what it stands for, forgot already). The procedure involved taking Cip’s blood, and a process where the white blood cells are taken and injected to me. This is supposed to lower down the level of antibody that I have, to a more acceptable level that it will no longer kill the sperm. Each procedure cost us more than a million rupiah. And as a start, I had to take three shots within a period of six months (one shot every two months).

And so, we did it. After two shots, I had to take a blood test to check the level of the antibody. Nothing happened. It was still as high as ever which meant, my body still kills Cip’s sperm. Then the doctor told me that I had to go through other tests to check my body’s resistance to protein, all kinds of protein. He said this test should help me to avoid food that may trigger the level of the antibody to get high. So together with the PLI shot, a certain diet will work better to lower it down.

I underwent the test. It is the same test that you will have to undergo for testing allergic reactions. They tested me for 40 things, by making 20 pricks on the skin of each of my arm. From egg yolk to horse’s fur (or, the essence of it, they said it was produced in France), cockroach’s essence to carrot’s (yes, apparently these have high protein content. Sometimes it is useful to undergo these ridiculous procedures to know some things!).

The result: I was not allergic only to horse’s fur (huh?, and what is the relevance anyway since I am not a jockey). And I had to avoid all kinds of food – from tomatoes to seafood. Pretty annoying. But, I went through the diet. Caused me a lot of headache every single meal time. Still, I thought what was the harm in trying.

Then another PLI shot after a month of that crazy diet. Then another blood test. Another same condition – nothing happened to my antibody. And finally I said to Cip, that’s it, I am not going through any of these stupid procedures anymore. And I also refused to go back to the hospital, or to the same doctor.

Not long ago, a friend of mine referred me to another doctor in another hospital. We went there last week. He offered two options: insemination (which he said is still risky with my condition since it is still possible that the antibody kills the sperm once it is inside), or in-vitro fertilization. He explained to us why these options. His explanation made sense. But still, I could not help wondering why on earth none of these doctors, ever looked at my history?.

Why didn’t they ask me to show them what I went through in the past, how we got Tara?. Why didn’t they even bother to check on the medicine list that I took in the past?. There must have been something that worked there. Why didn’t they put off their own agenda? (of course I understand in-vitro will produce more money both for the doctor and hospital!).

Is this what we have to accept and live for as patients?

I may not be this annoyed if not for the fact that we had gone through something in the past, and we believed (God willing) that it worked. But these doctors, just did not pay attention to it. Which makes me wonder, so why should hospitals have patient’s status anyway?. If it is not going to be looked at again, when patients come back to the hospital with the same condition, then why bother spending money on those pieces of paper, wasting God knows how many trees, for those statuses?. Is it about wanting to protect own's pride, rather than looking at other doctor's treatment to a patient that may have worked in the past?. Or is it simply, for economy reason? (because the protein test that I took, was done in the clinic apparently owned by the doctor from whom I got PLI treatments. Pretty obvious, huh?).

And why bother ‘interviewing’ patients if there is no REAL interest in the first place to know what he or she has gone through in the past?. I felt that there was sympathy in the last doctor in that other hospital that we went to. But still, I think he could have asked more questions, than just right away putting those two (expensive) options on the table for us.

I guess none of us will ever understand on what basis do doctors give options to patients. And I guess different from marketing research where clients (think) they understand what their options are, most of the time, we don’t know nor understand what our options are in the face of medical science. Nevertheless, should we be taken for granted for our lack of knowledge in the field?.

And I am not sure if the concept of Trusted Advisor will ever be applied in the field of medical science here in Indonesia. I don’t think it is difficult to apply it. Though I have experienced how hard it is to put off my own agenda when I am with clients, still, the result of trying to do it, is immense. Being really ‘trusted’ is expensive in human relationship, and it goes a long way, for a long time.

Right now, I just don’t know how and who to trust when it comes to solving my medical condition. I hope soon I will know.


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