The first time I sat across a patient as a newly crafted doctor, I realised that the stethoscope, to detect cardiac murmurs, wasn’t the hardest tool to use. Words were.
It was a small public healthcare OPD room, the kind where the wall paint has long given up to the invasion of black fungi, and the fan makes a sound like it has its own diagnosis. A middle-aged woman had come with her teenage daughter. The diagnosis was a simple somatoform disorder. Explaining the psychological origin of her symptoms was not simple.
I spoke for five minutes. The pair stared at me expressionlessly, nodded politely, and walked out. They never returned.
Later that evening, my senior told me, half joking, half rebuking, “You spoke to her like a textbook. She came for a doctor, not for a viva.” That day I realised: clarity isn’t about how much you know, but about how well you translate it for the person relying on you.
In recent years, the NMC’s CBME curriculum made AETCOM (Attitude, Ethics, and Communication) formal. But the truth is, AETCOM has always been part of the hidden curriculum in medicine. Earlier, we learned these skills from watching seniors, often unintentionally. Some were brilliant communicators; others were like younger me – textbooks full of jargon.
I still remember a reputed senior surgeon during my internship who would not walk but storm through the wards. He would diagnose and plan management of patients in under a minute, but left trails of confused patients in his wake, which the juniors later had to manage. One day, an old patient pulled my sleeve after rounds and asked, “Beta, did the doctor say I’m getting better or worse?” I realised that he had been spoken to, not with.
There was a gap between the information given and the information understood. Another realisation that dawned upon me was that all seniors teach us something. Some teach us what to do. Some what not to do.
Patients Remember How You Make Them Feel
Years later, as I sat in my modestly well-settled private practice. I was visited by an elderly person who used to come to consult me from about 450 km away. The patient had improved on medications, and it was just a matter of monitoring the dose, side effects, and compliance. Thinking of what an ordeal it must be for him to travel 450 km just to consult me, I referred him to a doctor in his locality who also happened to be an acquaintance.
A couple of months later, the patient returned to my clinic with a smile on his face and said, “Sahab, the other doctor prescribed me the same medicines, but didn’t have a minute to spare for my worries.”
When Words Heal as Much as Medicines
Years ago, during my residency, while I was in a busy OPD, a patient who I had just consulted returned to ask me, “How many per cent of people on this medication experience the side effect that you cautioned me about?” I dismissed him with an air of arrogance, “What will you do with the data? It is my responsibility to manage anything that happens to you.”
Weeks later, another physician prescribed medications to my own mother for some illness, and I had a similar question crop up in my mind. Being from a medical background, I was simply able to look it up and understand. But that was the moment I reflected that maybe the concerns our patients have are completely natural and need to be addressed.
Ever since then, I made it a rule to allow my patients and their relatives to put up their questions, if any. It takes a few more minutes, but it improves patient satisfaction.
Why AETCOM Matters, Especially Now
Today’s patients Google before they consult. They compare doctors, demand explanations, and expect transparency. While half the information in untrained hands has its own perils. I still consider that it’s empowerment. And empowerment requires doctors to evolve.
AETCOM tried to formalise what generations of medical education struggled to convey: that medicine is not only a science of diseases but a therapeutic relationship between humans.
The CBME framework emphasises breaking bad news sensitively, obtaining informed consent properly, respecting autonomy, addressing cultural beliefs, and communicating uncertainty without losing credibility. Most of these skills were earlier learned only by trial and error. If anything, the newer curriculum doesn’t teach students more medicine; it teaches them how to be better doctors.
A Few Lessons for Young Doctors
• Speak so that your patient understands, not so that your professor would be impressed.
• Do not hide behind medical jargon. It never cured anyone.
• Ethics is not a chapter to be memorised. It is something to be inculcated.
• Treat communication as a part of the treatment, not as an option.
• And above all, remember, patients come not only for relief but for how you make them feel.
In the end, medicine is a profession built on two foundations – knowledge and therapeutic alliance. We spend a lot many years acquiring the first.
It takes a lifetime to understand the second.
Dr. Vijay Niranjan
Associate Professor
Department of Psychiatry
MGM Medical College, Indore
Wow