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It is indeed with a heavy heart that I write this obituary about the slow and steady decline and painful( to many of us in the field ) death of a healthy patient-doctor relationship which was based on trust, confidence and respect.
Having been in the field for over four decades, I have witnessed the peak glory of the medical profession and unfortunately the nadir in the recent past as well.
There was a time when we were young, the family doctor was seen as a God, friend, philosopher and guide in addition to being just a doctor for the family. The entire family would be at the front gate to welcome him/her and the younger ones would vie with each other to carry his bag. The most common answer any youngster would give about what he or she wanted to be was, without hesitation, to join MBBS and be a respected well-known doctor. The best and the brightest worked very hard for many long years to become successful doctors and alleviate the suffering of human beings.
How sad that the very same profession has been maligned and the doctor once considered as God has become the Devil. Verbal and physical threats, abuse, vandalization of hospitals and work places is a day-to-day day affair now. The situation has become so bad that many doctors fear practicing medicine and are seeking early retirement or alternate professions. None of the youngsters or even their parents want to get into the medical profession. As I see it, this decline has happened very rapidly in the last couple of decades.
I have pondered long and hard about the reasons for this intense distrust between the patients and the medical professionals and more importantly, about the solutions to restore the Sacred Doctor- Patient Relationship. The following, I feel are the problems and the possible solutions.
In my opinion, some of the reasons for the steady decline in this very important relationship are as follows:
The huge increase in cost of treatment
There has been a dramatic change in the cost of therapy because of the ability to take care of very sick people, in the intensive care units, who in the past would not have survived at all.
Advances in technology, infrastructure, consumable costs and drug costs have shot through the roof.
Obviously the patients bear the brunt of this as, unfortunately most of the times as the 3rd party insurance is not available to the vast majority .
Misconceptions of what constitutes negligence
In general, if the cost of therapy is very high and one has to pay from one’s pocket, it is a huge financial strain. In these situations, most people tend to equate a poor outcome with negligence.
Unfortunately, many a times people also equate a known complication of a procedure as negligence
Corruption and Unethical practices
A few black sheep in our profession have seriously damaged the reputation of the medical community by indulging in corrupt practices like kick backs, doing unnecessary testing and expensive procedures, pharmacy-doctor nexus etc .The wrong doing of a small number of people has tarnished the image of the entire profession and destroyed the trust patients had in their doctors
Lawless behavior for extortion
There is also an element of goons/goondas and unsavory elements in the society taking the law into their hands and indulging in blatant extortion, especially when the bills are high and the results are not as expected. This should be put down with an iron hand by the law enforcement agencies
Media coverage
At times an advertent or inadvertent coverage of events might promote mistrust and suspicion amongst the patients and the families. At the same time, the media could play a great role in creating harmony ,trust and awareness among both the parties of the need for a healthy mutually beneficial relationship. It could also be a watch dog by exposing unethical and corrupt practices.
It’s not too late for us :The Community and the Medical fraternity need to work together to revive the trust and wonderful relationship which the doctors and patients had earlier shared.
My mantra for this is
Be a compassionate doctor who empathizes with the patient.
Inculcate excellent people and soft skills in dealing with patients and the family right from the training days.
Be honest, transparent and ethical in dealing with patients.
A well informed patient who after discussions with the medical team understands the condition, course, complications, outcome and more importantly actively participates in the care plan and is aware of the all the nuances involved
Frequent communication between patient/family and the doctors explaining the situation in layman’s terms yet in an honest and accurate fashion.
A good financial counselor to interact with the patient and family to explain costs and the reasons for the escalating costs.
Offer a second opinion and may be even facilitate one when dealing with a difficult or complex problem, unexpected outcomes or in case that the family is not comfortable with the care being delivered
Once again, the role of the media is crucial in being very balanced in the reporting of perceived medical negligence. By and large the media can play a very positive role in creating awareness about the nuances of modern healthcare and fostering a healthy patient-doctor relationship. They also could play a major role as watch dogs for the society in curbing unethical practices.
The medical fraternity and the regulatory authority (the medical councils) should come down heavily on the people and organizations indulging in unethical and corrupt practices which have caused a huge damage to the reputation of the large group of honest doctors.
All of us care-givers, insurance companies and government should work together to get universal medical coverage to bear most, if not all of the costs of healthcare which would substantially mitigate the burden of the patient and the family and thereby de-stress them.
If we are able to achieve this, it will foster a healthy relationship between healthcare givers and the community at large. Our world can then be a much better and healthier place to live for all of us.
Let’s all work overtime and put in all the resources at our command to fulfill this much needed revival of trust-based healthcare.
Dr. H Sudarshan Ballal, MD, FRCP (London)
Chairman – Med Adv Board & Medical Director – MHEPL,
Manipal Hospitals, 98, HAL Airport Road, Bangalore-560017
Email: s.ballal@manipalhospitals.com
Disclaimer: The views expressed in this article are of the writer and not of the hospital.
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