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Stringent laws, penalties won’t help improve worsening doctor-patient relationship: Study

mumbai Updated: Mar 17, 2017 15:28 IST
Sadaguru Pandit
Doctors

Dr Rohan Mhamunkar, a senior doctor at the Dhule civil Hospital, was assaulted by 15 to 20 relatives of a patient after he requested the family to shift the patient to another hospital owing to unavailability of a neurologist. (HT photo )

A well-coordinated communication system rather than stringent laws or penalties is the need of the hour, stated the team of researchers who recently studied the worsening doctor-patient relationship across India.

Published in the International Journal of Applied Research and Studies, the research was a joint effort between the faculties of Navsahyadri Education Society, Pune and Smt Laxmibai Radhakishan Toshniwal College Of Commerce, Akola.

“Most of the (research) papers published on these topics were by the medical people. To some extent, it was inclined towards one group,” said the authors, Prof Sachin Divekar and Dr Varsha Sukhdeve, talking about the reason for their research.

In Maharashtra alone, more than 45 doctors and medical staffers have been subjected to violence by patient’s relatives in the last three years.

“Great transformations happen in social, technical and medical field, which dilute the relationship,” said Prof Divekar while focusing on the reasons for the failing doctor-patient relationship.

Diminishing concept of family doctors, emergence of specialty and multispeciality hospitals, age of information, well-informed patients and certain practices followed by doctors and patients alike are said to be the major causes for fuelling the deterioration of the relationship.

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.” the paper mentioned.

Experts added that 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,” said Prof Divekar and Dr Sukhdeve .

They add that 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

“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,” pointed out the researchers.

They mentioned that 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,” said Prof Divekar.

Researchers added that 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 recognised in the research 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,” said Dr Sukhdeve.

Focusing on the matter, researchers pointed out that poor doctor-patient ratio in India, which is 6:10,000, 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,” said Dr Sukhdeve.

Advancement in medical technology

Researchers added that while the changes in medical technology, including special ventilators, artificial pulmonary surfactant to help infant lungs develop and neonatal intensive care helped decrease mortality, the advancement was also perceived by the patients and relatives as the proof for saving a life. “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,” said Prof Divekar.

Consumer rights

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 researchers mentioned in their study.

They added that the causes of this outrage were inept redressal system and lack of initiatives taken by either the government or the medical fraternity.

“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. Only a handful of cases have been resolved since the enactment of the Medical Council Act, 1956,” said one of the researchers.

Need for change

Talking about the necessary change in the attitude of doctors, experts said that 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.

“We have to develop a system through which we can resolve the issue or discrepancies in the doctor-patient relationship. Passing or implementing non-bailable laws is not going to solve the problem,” said the researchers.

They also mentioned that at least regional doctors’ associations and patients or social activists can sit together and work out solutions to tackle the issue.

Also read: Maharashtra to increase security for docs, restrict number of relatives visiting patients

Karnataka better than Maharashtra at protecting its doctors