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 Table of Contents  
SHORT COMMUNICATION
Year : 2020  |  Volume : 10  |  Issue : 6  |  Page : 300-302

Doctor–patient relationship: Rust in trust


Institute of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India

Date of Submission03-Nov-2020
Date of Acceptance11-Nov-2020
Date of Web Publication24-Dec-2020

Correspondence Address:
Dr. Bhuwan Chand Panday
Institute of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi - 110 060
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/cmrp.cmrp_49_20

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How to cite this article:
Panday BC, Choudhary PK. Doctor–patient relationship: Rust in trust. Curr Med Res Pract 2020;10:300-2

How to cite this URL:
Panday BC, Choudhary PK. Doctor–patient relationship: Rust in trust. Curr Med Res Pract [serial online] 2020 [cited 2021 Jan 25];10:300-2. Available from: http://www.cmrp.org/text.asp?2020/10/6/300/304822



In the year of 2019, two cases of violence against doctors were reported. In June, a junior doctor of a medical college[1] in Kolkata was nearly killed and in September an old almost-retired physician from an Assam tea estate was killed[2] by the respective relatives of the deceased patients, who anyways had succumbed to their illnesses. Although the incidences appear different, the thing common between them was the violence, unprecedented, misdirected and committed by the poorly literate. These incidences against doctors if could be attributed to the recklessness of the ignorant, the intellect and the discerning, who are expected to act with humility and prudence, are not far behind in the apathy. The outbreak of COVID-19 and the concurrent manhandling of the medical fraternity by the government and public alike has brought the focus on the pathetic situation again. What had occurred in the past will continue in the future too, albeit progressively parlous and ironically common. The killing has, if stopped for some time now, the violence hasn't.

These incidences question, how did this relationship between the society and doctors which had prevailed in an unwritten social vow of extreme mutual trust and obligation, nose-dived from those of faith and credence to that of doubt and disbelief. Ancient Indian surgeon 'Sushruta' described this relationship as 'the patient doubts even his relatives but has faith in doctors, he surrenders his body in the doctor's hand without any doubt….' The deterioration thus has not been sudden but must have taken decades. So what happened?

The first cause is the advent of consumerism and its antecedent, industrialisation, leading to the nuclearisation of families. Family now is quite a young couple, with 1–2 children, striving to earn handsomely for a lavisher life style, materialistic possessions and avaricious pleasure, but practically no time for leisure or socialisation. This robs them of support from siblings, guidance from elders, help from the neighbourhood and succour from friends. Hence, at the time of a medical crisis, as in COVID, a young family with practically no experience for critically arduous situations has no one for advice, support and solace, except each other. The lack of support, dwindling workplace performance, inadequate family time and rising treatment costs drain the people monetarily, physically, mentally and emotionally. They start doubting the doctor's ability, integrity and commitment in caring of their patients, a perspective that has consolidated with the crisis.

Man dies, kin goes on the rampage in hospital over 'medical negligence'.[3]

The second cause is the unrestrained and unregulated media which somehow always portrays the medical fraternity in a negative light. They give disturbing, annoying and at times acrimonious statements, be it print, broadcast or digital. They take a killing for news where the relatives have argued, manhandled and beaten physicians and physicians have lost their organs, or lives. With the COVID catastrophe, the media only has become more hounding.

'Despite paying a hefty fee, the doctor was rude and showed no emotional concern over the condition of our dying patient'. The third cause is the Consumer Protection Act, a law which was made to protect the patient's interests but robbed the relationship of its sanctity, made every patient a potential litigant and the doctor a perceived seller of his services, not a healer. The medical fraternity could be taken as a service industry, but expecting every time a positive result is a long shot. Medicine has its limitations and no one is born immortal.

The fourth cause could be the government's apathy towards healthcare. The monumental failure in the COVID crisis has only brought this in the open. The government-run healthcare is plagued by low budgeting, lack of resources and political interference and a conspicuous absence in rural areas where the majority of population resides. The government's health-for-all schemes though exist in principle, accessing them is marred by barriers, forcing half of our population, urban or rural, to opt for private healthcare. Private hospitals, if far-off, cost money, time, livelihood and likely deterioration of the patient's condition, giving rise to anger and frustration, culminating into violence. Besides, the recent trend of governments trapping the privately run institutions, to provide healthcare, at a near-loss remuneration, will only drive the hospitals to more unsavoury practices.

The other possible causes are a skewed doctor–patient ratio, lack of proper laws and the seeped-in corruption from medical education to policies to practice.

These unwarranted circumstances can get amalgamated to bring in, among the patient party, frustration, intolerance, arrogance, loss of faith and buckling of the trust in the treating physician, leading to deterioration of the doctor–patient relationship.


  So What Could be Brought up for Forbearing? Top


The changes obviously would not come in a day. It is easier to create chaos and difficult to contain it. Hence, its undoing will not be an individual's effort either but involves all the stakeholders, patient and family, physicians, society, media and the government, in equal measures (55).

A medical crisis is not always precedented and every treatment carries risks, but a better mental, emotional and financial preparedness helps. Familial support and advice, particularly from seniors, with their experience and perspective, can provide empathy, assurance and support, and the element of faith during the crisis and beyond (48).

We hope to see the society coming out of the grasp of consumerism and make itself cordial, comfortable and trustworthy based on mutual love, respect and faith. This may bring down the distrust and the streaks of violence against health professionals (40).

The media could constructively contribute in disseminating the truth and cut propaganda, and negativity surrounding any event. It should curb the first to give the news instinct with a half baked preposition, and wait for the final outcome.

Government is expected for the development of healthcare to get involved with a sounder commitment in providing equipment and infrastructure for practice and research. The public health sector needs more budget, the private sector encouragement with proper incentives and doctors need protection from violence because the laws exist, but implementation suffers from Achilles' heel. So the administration could put itself together to make the 'Universal health coverage' a reality for everyone and everywhere.


  At Our (Doctors) Level: Can They do Something, More? Top


A doctor's schedule is exhaustive, harsh and stressful. They have to balance between the patient demands, government regulations, societal pressures and perpetual availability, along with loss of personal life and missed family time. Multiplied by the decades of practice, does not make it an easy job. Further, the stress of managing critically ill patients in this pandemic, hospitalised for long with meagre hope of recovery despite the best possible efforts, takes a toll on physical and mental endurance. A crisis which even the society and the government has abandoned, the doctors stand beside, with the dread of getting infected and bringing it home, while carrying on with the draconian decrees of the politico-bureaucratic combination. It makes physicians feel like warriors imprisoned in an alien land.

On the other hand, the physicians, coming from the same society, suffer from the same plethora of problematic psyche-anxieties of vulnerability and loneliness, deprivation of societal support and institutional apathy. Why is it not possible in such a scenario for the doctors to take the route of escape or make a mistake? (56).

It is obvious that we cannot change the societal norms, but what we can introspect and ask 'can we fix our houses first: settle our anxiety, reign in our yearning and cool down our psyche'. The ancient Indian physician 'Charaka' has described a good practitioner '… nurtures an affection for his patients exactly like a mother, father or brother… and cures his disease'. But now, the times have changed. Compassion, knowledge and good intentions are not sufficient as the patients seek 'shared decision-making'. Diligent communication thus has become the key to this relationship. Communication builds trust and trust instils faith and bonding.[4] So sometimes, unsolicited and unbiased advice is welcomed if the patient's current medical condition is likely to influence patient's or family's (or society's) future.[5] And what could be a better time than now to come around when the whole of the society is looking at us with albeit doubt and dread.


  So, is There a Way? Top


Though we are expected to lead by example, this would not guarantee that all the incidences of violence will cease. The patient's and party's arrogance, attitude, intelligence quotient and emotional quotient cannot always be modified. Until the people change, the society, the governance or the allied institutions will not change.

The future looks bleak. However, belief and hope float, as always. One day when we come out of this looming crisis, we expect the government to improve infrastructure, the laws for violence against doctors implemented; the fraternity granted independence from the political clutches; the private players incentivised and the doctor–patient ratio lightened. Similarly, the society may hope to see doctors, with more respect, trust and faith for our diligence and deliverance, as we have been and somehow be in the future too, in the upper echelons of intellectual society, ready to take the torch of 'health for all' truly forward.

Acknowledgement

The authors would like to thank Dr. Jayashree Sood.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
2.
3.
4.
Dorr Goold S, Lipkin M Jr. The doctor-patient relationship: Challenges, opportunities, and strategies. J Gen Intern Med 1999;14 Suppl 1:S26-33.  Back to cited text no. 4
    
5.
Honavar SG. Patient-physician relationship – Communication is the key. Indian J Ophthalmol 2018;66:1527. Available from: https://www.thehindu.com/news/cities/mumbai/should-doctors-go-beyond-advising-patients/article28630056.ece. [Last accessed on 2020 Dec 01].  Back to cited text no. 5
    




 

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