by Dr K K Aggarwal
Doctors meet people from all walks of life and social strata in their day to day practice. And, these patients have different levels of awareness about their illnesses. Broadly speaking, patients can be classified as either “aware” or “unaware” about their illness. But, this is a very simplistic classification.
There are four levels of awareness – ignorant, informed, empowered and enlightened. These levels have been defined based on the ability of the person to retain the knowledge or information that has been taught or given to them.
Ignorant patients depend on the doctor to make their decisions about the necessary interventions and treatments, with no questions asked. They are ignorant of their disease and do not participate in decision making.
Then there are informed patients. These patients have some information about their disease and will have few questions for the doctor following which they usually accept the line of management as suggested by the doctor.
The next level is empowered patients. These patients have several more questions for the doctor, they cross check facts and are an equal partner in decision making regarding their treatment.
Enlightened patients seek the opinions of many. They experiment and are only then convinced about the proposed line of treatment. Realization takes time for patients with this level of awareness. There will be multiple sessions of counselling, before these patients are convinced.
Patients can also be classified on the principle of “suno – samjho – jano - karo” given by the sages. This means hearing, listening, knowing and wisdom. We should hear, listen, understand and convert it into wisdom. Hearing means that you hear anything but listening means that you should learn its meaning. Understanding means you should understand its value in your context and wisdom means you should practice it, re-practice it and learn intricacies of its implications.
Rabbi Dovid Rosenfeld, a known scholar has classified four types of students in a different way. He describes them as a sponge, a funnel, a strainer, and a sifter. The sponge absorbs everything. The funnel brings in on one side and brings out on the other. The strainer lets out the wine and retains the lees. The sieve lets out the flour dust and retains the fine flour.”
This classification is according to the ability to retain the knowledge taught to them. The sponge retains everything, but is unable to distinguish between correct and incorrect points or between significant and insignificant ones. He is devoid of the power of discrimination. The funnel is the one for whom information goes in one ear and out the other. He has no focus on the lecture. His hearing and the mind are in different directions. The strainer discards the wine – the significant material, and retains the lees – the incorrect or insignificant points. He’s the sort who remembers all sorts of trivial or useless details of the material he studied. Most students try to remember the foot notes of a book and forget the common things. Finally, the sieve retains the fine flour – the significant material, and discards the dust – the inconsequential details. He is the one who understands the lecture by its main five points and remembers them in the form of sutras.
Miscommunication is at the root of many doctor-patient disputes.
When counselling a patient, the doctor has to understand the level of awareness of his patient and his level of awareness has to match with that of his patient to avoid any discordance in communication.
[Inputs from Dr Ved P Mishra]
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