- Why in news?
- Doctors’ perspective
- Patients’ perspective
- Major causes for fuelling the deterioration of the relationship
- Lack of Punitive Action
- Suggestions to improve doctor-patient relationship
- Way ahead
Deteriorating Doctor-Patient Relationship: Causes and Suggestions
Why in news?
- Most recently in Maharashtra where last month, in five separate incidents, doctors in public hospitals were assaulted by angry relatives of patients alleging negligence.
- These incidents of violence against doctors and subsequent protests by medical practitioners once again highlight that the doctor-patient relationship has changed for the worse.
- An Indian Medical Association 2015 survey of 500 doctors found that nearly 75% of the respondents had faced attacks and intimidation.
- From the perspective of doctors, especially in public hospitals, there is the pressure to provide emergency treatment even as the patient’s family and friends surround them expecting miracles.
- In many of the cases of assault, so-called local “leaders” demanding immediate attention for “their” patient led the charge.
- After working back-breaking hours in resource-poor conditions—one of the doctors attacked in Mumbai recently had worked for 36 hours almost non-stop when the incident occurred—their only “rest” is in hostels with abysmal amenities.
- Most attacks occur in public hospitals where the resources are stretched thin to cover a large section of the population and the doctors (mostly junior) are too overworked to deal empathetically with anxious and tense patients’ relatives.
- Public hospitals have to bear the brunt of this lack of trust as often patients are taken there after their condition has deteriorated in private hospitals and the family is resentful about the heavy expenditure incurred and poor treatment given.
- With increased availability of information from informal channels, patients’ families now desire informed participation in the treatment process.
- Generally, patients and their relatives overwhelmingly point to discourteous doctors and uncooperative hospital staff, insufficient diagnostic equipment and essential drugs and lack of information about the patient’s condition and the prognosis.
- They are also frustrated with being asked to buy medicines and services from private agencies outside the hospital.
- There seems crass insensitivity by private doctors towards patients who cannot afford their high rates. As a result, even doctors doing their best in difficult conditions are perceived as indifferent.
- When patients and relatives lose respect for doctors, the latter are seen simply as providing a service. And when customers are unhappy with a service, they vent their frustration.
Major causes for fuelling the deterioration of the relationship:
Commercialisation of the medical profession: Root cause
- Public perception of doctors as “life-givers” has drastically changed with the increasing privatisation and commercialisation of medical healthcare.
- The commercialisation process starts right from the medical education level where many students pay large capitation fees to gain admission through management quotas.
- As soon as such practices are allowed, medical education becomes an investment for future earnings. And if the medical profession is treated just like any other career, then problems are bound to crop up.
- Earlier, those who became doctors did so to help people. That was their sole motivation. However, today medicine is just another career option with private hospitals becoming money-making machines where doctors are given monthly targets to generate revenues.
- This has created the impression that doctors are untrustworthy, they push unnecessary treatments, and are not honest with patients’ relatives.
- In fact, hospitals have become places full of fear and dread rather than places of healing.
No more family doctors:
- One of the major causes listed was the diminishing numbers of general practitioners (GPs) in the society, which earlier used to cater to a limited population.
- These GPs, who looked after five or more villages, were taking ample time to discuss cases with the patients.
- The consultation involved a chat about the problems, medical examination, description of the diagnosis and a feedback from the patient.
- It was a win-win situation for the doctor and the patient alike, as they shared mutual understanding and trust.
Emergence of specialty and multispeciality hospitals:
- This mutual connect vanished after the emergence of specialty and superspecialty hospitals.
- Most of the specialised doctors collaborated with all possible hospitals, and started their own private practices simultaneously.
- As a result, specialised doctors didn’t have time to listen to their patients carefully.
- The problem started after diagnosis and treatment become a speedy affair.
- This resulted in poor communication between the doctors and the patients or the relatives, thus creating confusion.
Age of information:
- Earlier, unethical practices followed by the doctors went unnoticed due to lack of knowledge, information, restricted income, blind faith in doctors and limited number of superspeciality medical establishments.
- Literacy rate was low. So, whatever was told and asked by the doctors was taken as the final word by the patients and their relatives.
- Today, patients arriving at a clinic are armed with information they found on web. They want to actively participate in the therapeutic decisions and want all decisions to be informed and intelligent.
- Since the main concern of the medical fraternity was variable and the unreliable nature of medical information available on the internet, doctors stared perceiving such people as ‘problem patients’.
Population and disposable income
- Another major factor was the increasing buying power of the middle-class for quality western medicine.
- The Indian population spent 7% of its disposable income on healthcare in 2005, which increased to 14% by 2009-2010 and almost doubled (26%) by 2014-2015.
- With this trend, people are ready to pay higher amount for saving lives of their beloved and in return they expect best possible services. Poor services and negligence flares up the emotion of patients and relatives.
- Poor doctor-patient ratio in India, which is 6:10,000, (Maharashtra and Bihar have the worst ratios in the country) is insufficient for the growing needs of the people.
- Around 70% population resides in rural areas, where the ratio is six times lower. About 80% doctors, 75% dispensaries and 60% hospitals are located in urban localities.
Advancement in medical technology
- The advancement in medical technology was also perceived by the patients and relatives as the proof for saving a life.
- In the age of information and technology, patients and their relatives are able to raise their voice against the alleged malpractices.
- But in most cases, they believe that physical assault or vandalising a medical facility is the best tactic to resolve an issue.
- The causes of this outrage were inept redressal system and lack of initiatives taken by either the government or the medical fraternity.
- India has a pathetically low budget allocation for health services.
- Medical education pays little attention to this aspect and even if it did, the inability of the doctors to understand the socio-economic backgrounds of their patients ends up making a bad situation worse.
- When a crisis looms, as provoked by the recent clash between doctors and patients in Maharashtra, piecemeal measures are taken.
Lack of Punitive Action:
- Fourteen states have enacted laws to protect doctors and prevent such violence but enforcement is uniformly weak.
- Though the Indian Medical Association makes assaulting doctors a non-bailable offence punishable by imprisonment of up to seven years, nailing the guilty parties can be tricky.
- There hasn’t been a single conviction under the law enacted by Maharashtra state government since it was enforced in 2010.
- Police take a lot of time to book the accused and fail to file the charge sheet in time. The cases are not even heard most of the time.
- Only a handful of cases have been resolved since the enactment of the Medical Council Act, 1956.
Suggestions to improve doctor-patient relationship:
- A well-coordinated communication system rather than stringent laws or penalties is the need of the hour.
- Yet increased security is at best a piecemeal measure. It could backfire and drive a deeper wedge between the community and doctors.
- Senior doctors should initiate steps to teach their younger colleagues to communicate better with patients’ relatives.
- A future doctor will not only require medical skills but will have to learn sociology, psychology and acquire man management skills like effective communication and being a patient listener.
- The sheer volume of patients thronging the country’s public hospitals calls for deeper structural changes.
- Early and accurate detection doesn’t mean 100% surety of saving a life. Patients and their relatives must understand this. Also, this needs to be communicated clearly by the doctors.
- In cases of outrage, it is the duty of Medical Council of India to look into the issues and introduce a protocol where both the doctor and the patient can seek redressal.
- As per a research, passing or implementing non-bailable laws is not going to solve the problem. A system should be developed through which the issue or discrepancies in the doctor-patient relationship can be resolved.
Unless the larger questions of spending on health and enhancing the capacity of public hospitals to deliver more effective healthcare are addressed, doctors and patients will continue to be viewed as adversaries.