The withering Doctor-Patient Relationship in India

-Dr Jupitora Dutta |

“Medicine is an art whose magic and creative ability have long been recognized as residing in the interpersonal aspects of patient-physician relationship.”

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Hall et al.,1981

On the surface of the earth Human beings are the noblest creation of God and, Doctors who take care of the physical pain and suffering of human beings are considered next to God. The ancient Indian physician Charaka once said, “A good physician nurtures affection for his patients exactly like a mother, father or brother. The physician having such qualities gives life to the patients and cures their diseases.”

Medicine is not a trade to be learned, but a profession to be entered. The practice of medicine has changed drastically in the twenty first century. There have been many positive as well as negative changes in medical sciences. The good age-old doctor-patient relationship ( D P R ) is in doldrums. The communication skills have almost been forgotten. Commercialization is the obvious agenda especially with the development of corporate culture in the health sector. The concept of privatization has added fuel to the fire. The patient who are willing to pay, feel that the life can also be purchased with money. This has resulted in soaring expectations.

The doctor–patient relationship is crucial to health care delivery. It is described differently by different disciplines such as psychology, physiology, psychotherapy, philosophy, sociology, health policymakers, and human resources. This relationship, which was seen as one between a healer and a sick person more than 5000 years ago, has now evolved to be considered as one between a care provider and a service user.

In the last decade doctor patient relationship has shown a great dip. The forces of increasing economic aspirations, stress levels, frustration due to urbanization, and high levels of competition, distorted and disturbed religious, and cultural values are adding to the intolerance among

the masses.This has also led to the sense of distrust toward the medical fraternity. A study suggested that nearly 75% of medical personnel in India have faced some sort of workplace violence. This study concluded that the 50% violent incident took place in the Intensive Care Unit of hospitals, and in 70% of cases, the relatives of the patients were actively involved.

Now a day‟s a general feeling of mistrust against medical fraternity is

prevalent, doctors are considered as traitor corrupt and money minded. This mistrust has resulted in increased cases of violence against doctor and hospital. Simultaneously, more and more cases of medical negligence are being filed in the court. Many doctor‟s practices have been ruined by fake cases with malafide intentions against doctor & hospital. Many famous doctors have hired personal security and hospital had hired bouncers for protection for their security. This has become the new normal in this noble profession. This mistrust is so haunting that many doctors have started propagating a concept that, treat every patient as potential litigant.

The medical profession diluted the direct role of the physician and as a result the patient-doctor

interface became multifaceted with more and more inputs available to the patient and the physician through the multilayered and nuanced administration of medical care in the postmodern era. In cases of unwanted results of treatment doctors were questioned for their competencies and knowledge which was just like challenging the undisputed authority of doctors in their own fields.

1.Doctor patient relationship Dynamics are changing because of a number of factors:

2.Patient perception about doctors has changed.

3.Status of doctors as professionals has come down.

4.Physician is no longer a physician but just a commodity in vast healthcare market.

5.There are increasing law suits against doctors, hospitals and clinics than in the past.

6.More and more clinicians are now resorting to defensive practice.

7.Doctors have to work under stress because of their nature of work, working in situations of life and death, treating critically ill patients with indefinite/unexpected outcome. This tells upon their relationship with patients and their relatives. This leads to a sort of burnout as in ICU workers

8.Doctors suffer from compassion fatigue because they have to work with people who are emotionally charged and are anxious.

9.Institutional and group practice have blurred individual DPR.

10.Mobility of patients – Patient is moving from place to place, country to country and finds it difficult to establish rapport with a particular physician and belongs to none.

11.Changing social trends and values – Consumerism is important these days and has affected the doctors as well. Media is playing a role in making doctor-patient relationship strained and doubtful.

There is an overall change in attitude towards positions of power and authority.

Intolerance and grouse against doctors is a global phenomenon but India seems to lead the world in violence against doctors. According to World Health Organization, about 8-38% healthcare workers suffer physical violence at some point in their careers. Many more are verbally abused or threatened. Public is almost behaving like health sector terrorists. The spate of increasing attacks on doctors by damaging their property and causing physical injury is not acceptable by any civilized society. The public is becoming increasingly intolerant to a large number of social issues because of poor governance and vote bank politics. There is a need to arrest the development of further distrust between doctors and their patients/relatives, otherwise it will compromise all achievements of medical science and adversely affect healing capabilities of doctors. Rude and aggressive behavior of the patients or their family members, and arrogant and lackadaisical approach of the doctor, adversely affects the doctor-patient relationship and the outcome of the patient. The doctors, hospital administration and government must exercise “zero tolerance” with respect to acts of violence against healthcare professionals. It is possible to reduce the incidence of intolerance against doctors but difficult to eliminate it completely. The healthcare providers should demonstrate greater compassion and empathy with improved communication skills. The hospitals must have adequate infrastructure, facilities and staff to handle emergencies without delay and with due confidence and skills. The security of healthcare providers, especially in sensitive areas, should be improved by having adequate number of security guards, frisking facilities, extensive CCTV network and availability of “Quick response team” to handle unruly mob. In case of any grievances for alleged mismanagement, the public should handle the situation in a civilized manner and seek redressal through Medical Protection Act and legal avenues. Laws to prevent violence against doctors do exist but they need to be made more stringent and implemented properly.

*Dr Jupitora Dutta,PGT, Kayachikitsha, Government Ayurvedic College and Hospital, Jalukbari , Assam