1) The document discusses poor patient compliance with doctor's instructions, with both doctors and patients viewing each other as one of Gandhiji's three monkeys - dumb, blind, or deaf. 2) Doctors expect blind obedience from patients, but compliance rates are often only 50% due to doctors not listening to patients, explaining things clearly, or understanding them. 3) The document advocates for doctors to engage with patients respectfully as partners rather than expecting blind obedience, and to track compliance using technology and expert patients to improve outcomes for both parties.

1. Information Therapy
Doctors, Patients &
Gandhiji’s 3 Monkeys
Doctors and patients, both seem to (tragically) think that
the other one is a Gandhiji’s monkey, either dumb or blind
or deaf!
By: Dr. Aniruddha Malpani
I
was invited to give a talk
recently on improving
patient compliance. The
healthcare brand wanted to
learn more about what they
can do to improve the number
of patients who sign up for
the surgery which they so
obviously need.
Poor patient compliance is a
big issue today. When a doctor
52 Health Biz India January 2014
gives patients instructions
(do these tests and take these
medicines), the doctor expects
blind obedience from the
patient. After all, the doctor is
the medical authority, and if
the patient has come to him for
his advice and is paying for it,
isn’t it logical to conclude that
he will follow the advice given?
Well, time for a reality check.
The fact is, patient compliance
can be as less as 50 per cent
(or even more), especially for
patients with chronic illnesses.
A lot of patients will not take
the medicines which the doctor
prescribes – and this is very
frustrating for doctors. This
is why most doctors think of
their non-compliant patients as
being one of the three monkeys
of Gandhiji. They start
believing that patients who do
not follow their orders are:
• dumb, because they do not
understand what’s good for
them; or
• blind, because they do not
see the consequences of not
listening to the doctor’s
orders; or
• deaf, because they don’t
seem to listen to anything
which the doctor tells them,
no matter how much time
he’s spent educating and
counseling them.
Doctors will often get fed up
and say – if the patient does
not want to listen and wants
to reduce their life span by
ignoring what I tell them, then
that’s their problem – I have
done my best.
Ironically, patients also
believe that their doctors
resemble these three monkeys!
They usually believe that
doctors are:
• deaf, because they refuse to
listen to them;
• blind, because they do
not seem to care about or

2. understand their feelings or
preferences; and
• dumb, because they do not
bother to explain or share
information; and do not
understand that they are
speaking in a completely
foreign tongue which the
patients cannot comprehend!
Both these worldviews are
valid, which is what makes it
more tragic; as poor patient
compliance is bad for both
patients and doctors.
This is why it’s important for
doctors to engage with their
patients and not treat them
as monkeys who are going to
blindly obey everything they
tell them. Some doctors still
treat patients as puppets, who
will do everything they are told
to do. This is not true, and
patients need to be treated with
respect and empathy. Good
doctors are able to do this
efficiently, so that their patient
compliance rates are far better
than those of other doctors.
Tracking compliance
Sadly, compliance is not
something which most doctors
track. Most are blissfully
unaware of what a big
problem this is. Every doctor
believes he is exceptional – and
most bad doctors are blind
about their own defects. They
happily continue to delude
themselves that their patients
will do to everything they tell
them to!
This is why it’s so important
to develop tools which track
whether patients are following
their doctor’s advice. This is
where technology has such a
big role to play. Technology
can allow us to monitor
patient compliance – for
example, by reminding patients
to take their pills on time; and
digitally recording when they
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Information Therapy
have done so.
Expert patients can also help
to improve patient compliance.
They can share the strategies
which they use personally to
motivate themselves, so that
they are able to comply with
their doctor’s instructions.
Because they speak a language
which patients understand,
patients are likely to be far
more compliant when told
how to do what the doctor
tells them to do by expert
patients. Smart doctors tap into
the expertise of their expert
patients in order to improve
compliance levels amongst
their patients.
Tailor your style
For complete patient
compliance, the doctors too
have to work on themselves. It
is high time doctors improve
their age-old style of working.
Lots of doctors don’t like
entertaining questions from
their patients and prefer that
their patients just passively
follow their advice. If patients
want to discuss alternatives
or options, they get irate.
This approach is like being
one of those monkeys (deaf).
They feel that when patients
do their homework or try to
explore options, they just end
up confusing themselves. They
also believe that this approach
suggests that the patient does
not trust the doctor – and that
this kind of doubting attitude
will interfere with healing
and result in poor medical
outcomes. What is the ultimate
vital point here though? Isn’t it
to cure the patient? Then why
can’t doctors tailor their style a
bit to accomplish the same?
Doctors with egos
One reason doctors refuse to
adapt their style is that most
doctors come with a baggage
of egos. It may pinch to hear
this (especially coming from a
doctor) but somewhere down
the line, all doctors will agree
that it’s true.
And from where does the
ego set in? Well, doctors have
a high opinion of themselves.
They have usually been toppers
in school, who were always
complimented and appreciated
Many doctors do
prefer an aware
patient, who asks
questions and
explores alternatives
Health Biz India January 2014 53

3. Information Therapy
Sometimes it’s the lopsided
doctor patient ratio in India
which makes it a problem for
doctors to spend enough time
with the patients. It’s much
more effective for them to just
tell patients what to do, leaving
no time-window for discussion
open, so they can minimise
the time they spend with each
patient, and improve their
throughput, allowing them to
attend more efficiently to their
A good doctor
should tailor his
approach according
to the patient’s
needs
54 Health Biz India January 2014
for being the best. This tends
to make them proud of their
skills and hence they have
a low opinion of laypeople
who aren’t as proficient about
science and biology.
Also, medical colleges train
doctors to be paternalistic; and
it is embedded in their minds
that they are supposed to take
care of their patients and make
the right kind of decisions
for them, because they are
the experts. This can lead to
conflict when the patient and
doctor don’t see eye to eye.
Lots of doctors find it hard to
treat their patients as equals,
and often end up telling them
what to do, as opposed to
explaining or discussing their
problem with them.
crowd of waiting patients.
This leaves many patients
unsatisfied, as the doctor
makes the decision without
enlightening patients about
alternate options.
An alternate approach
Being egoistic or resembling a
monkey are not the only two
options. Doctors can follow
an alternate approach. In
fact, there are doctors who
discuss all possible options
with their patients and also let
them make a choice about the
treatment procedure. These
doctors allow patients to
choose what they feel is their
best option, rather than try to
decide for the patient. They feel
it’s the patient’s prerogative
to make decisions, and since
they cannot read the patient’s
mind, they are happy to let
him decide for himself. They
see their role as a facilitator or
coach. They don’t like patients
who just want the doctor to tell
them what to do. Instead, they
prefer an aware patient, who
asks questions and explores
alternatives.
The latter approach seems to
be more sensible as the doctor
treats the patient as an adult
and a responsible partner.
However, there are some
patients who don’t like these
kinds of doctors and often
complain that such doctors
aren’t able to make up their
own mind! These types of
patients prefer authoritative
doctors who tell them what to
do, as opposed to giving them
options and choices. They
don’t like to weigh the pros
and the cons of their condition
as they feel their opinions
could create more confusion.
They get paralysed when asked
to analyse.
Such patients prefer to
consult senior doctors who
tell them what to do, akin to
a father figure. They don’t
want to use their own mind
and want to trust experts
and professionals to make
critical decisions for them.
Personally, I don’t believe one
type of doctor is better than
the other. According to me,
a good doctor should tailor
his approach according to the
patient’s needs.
If a patient expects an
authoritative figure, then
giving him options will not
satisfy his needs. On the other
hand, patients who are wise
and want to discuss their
options, should be offered that
opportunity. Doctors need to
learn to be flexible.