Dr Nataša Ban Toskić
FAMILY MEDICINE SPECIALIST
The level of family support has a significant impact on how diseases turn out
Dr Nataša Ban Toskić is a family medicine specialist and the president of the Croatian Family Physicians Coordination (KoHOM), which is the largest vocational and professional cooperative of physicians practicing general/family medicine in Croatia. She studied at The Faculty of Medicine at the University of Zagreb and is currently employed at “Center“-Health Center in Zagreb.
She keeps no secrets when it comes to communicating with patients. “I am simply present. I persist. I strive to be as open as possible, to focus on each patient individually, and to give them enough time. I learn to actively listen and to be patient, even with myself“, she says.
What does a medical profession mean to you, and why did you choose family medicine?
For me, the medical profession is a life vocation, a dedication to continuous and complete personalized care, early disease detection and treatment, disease prevention and health care, and continuous patient care. As a student, I had no idea what family medicine was; in fact, it sounded monotonous and obscure to me. During my internship, I witnessed the beauty and satisfaction that comes from getting to know the patient closely over time, mutual trust, respect, and friendship. That bond grows stronger with each new physical or psychological crisis in a patient’s life when they seek treatment from their family doctor. As a result, the session turns into a reunion with an old friend. Furthermore, the range of difficulties that the doctor tackles keeps things interesting and minimizes monotony.
You follow your patients and their families throughout their life. What is your secret and how do you manage to build and maintain trustful and long-lasting relationships with them?
I have no secrets. I am simply present. I persist. I’ve been at the same office for 25 years, with the same patients, families, and neighbors. I observe, make notes, and remember. Every contact teaches me something. I try to be as open as possible, to focus on each patient, and to give them enough time. In every encounter with an individual patient, I ask a few questions about current events in the family, and often patients bring up family concerns without being asked, which is a really valuable source of information for the family doctor. I developed roots, much like a tree, which grows larger and deeper roots as it ages. Each relationship with an individual patient, as well as each relationship with specific members of a given family, is unique, as are relationships with other families. It is vital to be open-minded, adaptable, tolerant, and understand yourself, the doctor, as a unique individual with all of your good and negative qualities. Learn to actively listen and to be patient, even with yourself. Knowing how to admit that you don’t know or can’t do something, as well as how to take criticism, misunderstanding, and even rejection.
How important are family members in the outcome of the treatment of a patient, and what isyour approach and communication with them?
The best way for a doctor to treat a patient with emotional or social conflict-related issues is to monitor their behavior and how they handle pressure over a longer period of time. The level of family support has a significant impact on how diseases turn out. Misunderstanding, unrealistic hopes, or the family’s lack of interest all have a negative impact and exacerbate the patient’s pain. Most frequently, family members are also my patients. Regardless of the reason they visited the doctor’s office, I proactively and cautiously encourage a dialogue about each member of the family with them at every meeting. Along the road, I give them a few seemingly insignificant pieces of advise, usually concerning care, diet, the necessity to go through an examination or search that they have opted out of, and the risks that I have observed with them. I also inform the patient’s family members of the health hazards that they might be exposed to as a result of having a sick family member. The best way to communicate with the family, however, is to go on a home visit and meet in “their environment”, and a way to get a good insight into mutual relationships, lifestyle and habits, and the social circumstances of both the family and the patient. In doing so, it is necessary to show respect, appreciation and warmth. Of course, the patients and their family must believe that their privacy is completely preserved. The continual attention and close relationship with the family helped me to understand the essence of the family and how it operates. The opportunity to watch families develop over time gives me important knowledge that enhances the level of care I give each patient. Being aware of the shifting demands and expectations of family members and the effects these, along with other family relationships, have on a person’s health is one of the major issues.
When it comes to your patients, you have knowledge of their medical histories, risks and predispositions to particular diseases. How important is prevention, and how do you communicate this aspect with your patients?
Disease prevention is the most crucial aspect of a family doctor’s work, related to their knowledge of each family member’s medical history. I provide individual counseling through opportunistic screening, which means that I use the arrival of each patient, for whatever reason, to propose specific preventative actions based on that individual’s age, gender, family history, and lifestyle. I take use of the chance to explain why it is useful and important in a clear and acceptable manner.
In your daily practice you face difficult situations in communication with patients when delivering bad and unpleasant news. You should be empathetic but at the same time to ensure that the patient has understood the problem, options, the treatment, possible outcomes, etc. How do you manage these situations, and what do you think is essential for physicians to possess asskills and characteristics?
I must undoubtedly be familiar with the patient’s personality, attitudes, and past knowledge and experiences, as well as family experiences, religious and cultural understandings, social and economic conditions, and amount of family support. All this affects the form of personal approach to the individual, and that approach must be primarily with emphasized respect, privacy, simplicity of expression, essential human warmth, active listening, clear answers, often with physical touch – hand on hand, shoulder, sometimes a hug. I clearly emphasize that I am available to the patient for all questions and help in personal advocacy and in guiding and advocating through the healthcare system.
Research has shown that the continued impact of the Pandemic has increased physician burnout and depression. Do you think that hospital programs on improving mental and physical health of physicians would reduce negative effect?
So far, I have no experience or knowledge of the programs mentioned in Croatia. Of course, I hope for positive outcomes when they come to fruition. For many years, family doctors have helped and supported one another through various organisations, particularly the KoHOM, of which I am the present president. We communicate in closed groups through social networks around the clock, which keeps us stable and empowered. However, I must emphasize that the current situation in Croatian family medicine is alarming – it is on the verge of total personnel and organizational collapse as a result of the poor relationship between the health administration and almost all state institutions, as well as decades of complete neglect of the role of the family doctor in a sustainable health system and pillar of the welfare state (along with teachers and judges). This scenario deteriorated numerous times throughout the Pandemic, and we are seeing less and fewer family doctors; there is no interest in this area of healthcare. And unless such an institutional mindset shifts dramatically, no programs aimed at maintaining doctors’ mental health and lowering stress will be able to achieve their objectives.