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December 2015, Volume 65, Issue 12

Letter to the Editor

Counselling: An issue that needs emphasis

Syed Askari Hasan  ( MBBS, DOW Medical College, Karachi Pakistan. )
Aisha Zia  ( MBBS, DOW Medical College, Karachi Pakistan. )
Mehwish Zehra  ( 3rd Year, MBBS, Karachi Medical and Dental College, Karachi, Pakistan. )

Madam, I want to bring up a very important issue that I witnessed during three months of US clinical experience. Counselling has a role equivalent to therapies in treatment and more importantly in the adherence of the treatment prescribed by the practitioner to the patient. It helps to build up rapport between a physician and the patient, and makes a patient understand that the doctor is viewing him as a whole entity and not just with reference to the disease. Working in both Pakistani and American setup made me realise the important difference does not often lie in the diagnostic workup or the treatments prescribed but in the counselling of the patient. An important point that doctors in our government setup might bring up is the patient load, which needs to be acknowledged1 but this is something that is present in the American setup as well2 and should not undermine the importance of counselling which has two- tier advantage as discussed earlier.
Several studies have shown positive reinforcement of the effect of counselling on outcomes. A study shows that if pregnant women were accurately counselled about the normal pregnancy weight gain then majority showed adherence and good outcome.3 Similarly counselling patients about their lifestyle such as smoking, alcohol consumption, safe sex and exercise is a common practice which may lack in our setup. This leaves a remarkable impact on the patients\\\' psychology and makes them more inclined to follow the guidelines given by the practitioner religiously. Proper counselling can also decrease the stress and anxiety level of patients as shown by a study in which cancer patients receiving proper counselling were at ease throughout the course of their therapy.4 Researchers have built models for clinical trials in which counselling has been given immense importance especially for cancer patients.5
It cannot not be emphasised enough that proper time given to counselling is beneficial to patients in every regard and also gives a sense of satisfaction to the practitioner as it is shown to have better outcomes. Therefore counselling should be an essential part of training to undergraduates and should be implemented by all practitioners with its full essence.


1. Saeed A, Ibrahim H. Reasons for the problems faced by patients in government hospitals: results of a survey in a government hospital in Karachi, Pakistan. J Pak Med Assoc 2005; 55: 45-7.
2. Pimentel MT, Flanagan H, Philip BK, Urman RD. Qualitative analysis of barriers to efficient operating room turnovers in a tertiary care academic medical center. J Med Pract Manage 2015; 30: 30-5.
3. Wrotniak BH, Dentice S, Mariano K, Salaam EM, Cowley AE, Mauro EM. Counseling about weight gain guidelines and subsequent gestational weight gain. J Womens Health (Larchmt) 2015 June. [Online First]
4. Poroch D. The effect of preparatory patient education on the anxiety and satisfaction of cancer patients receiving radiation therapy. Cancer Nurs 1995; 18: 206-14.
5. Li WH, Chan SS, Wang KM, Lam TH. Helping cancer patients quit smoking by increasing their risk perception: a study protocol of a cluster randomized controlled trial. BMC Cancer 2015; 15: 490.

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: