Doctor’s Day: Need to rebuild trust with patients, say doctors
Medical practitioners from Punjab speak on the state of the profession.
Once considered next to God, doctors now often have just transactional relations with patients. The patient is a consumer, who pays a cost. Cases of violence and complaints of negligence are rising, straining the relationship more. On Doctor’s Day, we ask medical practitioners from Punjab four key questions on the state of the profession.
1. Why is the doctor-patient relation under growing strain?
2. How can this trust deficit be healed?
3. Are there enough legal safeguards to protect doctors from trial by media and assaults by aggrieved patients or their kin?
4. Should there be regulation in private healthcare?
Dr Jatinder Kansal, Punjab unit chief of Indian Medical Association
-Patients need to understand that medical profession is not a mathematical science or engineering. Patients’ expectations are very high when they visit a doctor, and they want quick and immediate care. When this need is mismatched with doctor’s efforts, the relation turns sour.
-Society should have more awareness. Doctors need to treat patients by rising above their caste and religion. Doctors also need to adopt more good practices.
-There are laws in Punjab too to protect doctors. But implementation has not been done properly. When anybody harms us or damages our property, it is a non-bailable offence. But many times even policemen are not aware of these legal provisions.
-I don’t think there should be government regulation in private healthcare — 70-80% of healthcare is being done in the private sector in Punjab and it’s already overburdened with rules and regulations. And whenever a private hospital charges a certain amount, it is for facilities, expertise and other amenities. You have to pay for good facilities.
Dr KP Singh, director of endocrinology, Fortis-Mohali
-There is a growing trust deficit in doctor-patient relationship. It has grown because patients tend to conclude their diagnosis based on internet research, which is not always accurate. I hope patients put in more faith in doctors’ diagnosis and follow their advice. The key to a doctor’s success is a happy patient, and patients must know that too.
-Patients and their attendants must be explained the course of treatment and the procedures to be performed. Attendants and patients must freely ask their queries and not be intimidated by a senior doctor’s presence. We are all there to help the patient recover.
-As for legal safeguards to protect doctors, the IMA takes up concerns related to this.
-There should be a clinical audit conducted by every private hospital, wherein it is checked which doctor has examined how many patients and what medicines are prescribed. An in-house committee should also be formed.
Dr KK Talwar, ex-director, PGIMER, Chandigarh
-Strain in doctor-patient relation started when corporate hospitals came in. There were cases when people thought treatments conducted by the corporate hospital were not even needed. People started coming back to government hospitals for a second opinion. So, the trust was broken and a perception was made about doctors, which was true to some extent. Then consumer laws came in and people started filing cases, which became a stress factor for doctors and led to a defensive practice of conducting several tests. This created confusion and mistrust.
-Medicine is a science of uncertainty. One cannot predict with 100% surety how a patient will respond. Doctors have a major role to play in creating trust. We also need to look at the Consumer Protection Act, which has only created confusion among doctors and patients. There is a need to put professionals in the decision-making bodies.
-Few state governments have strong laws to ensure safety of doctors. Other states should also become pro-active. It won’t only protect doctors but the system too.
-There should be regulation in the private sector. The Clinical Establishment Act, with some modifications, should be implemented in all states and adopted by all private hospitals. It will restore confidence of people in private health facilities.
Dr Rashmi Bagga, professor of obstetrics and gynae at PGIMER, Chandigarh
-Doctor-patient relation is under growing strain because of excessive workload in government hospitals. At times doctors do not communicate properly with patients. Because it is not easy for a layman to understand medical terms, at times doctors do not explain about the disease but explain the medication. This can lead to friction, as a patient feels the doctor has not examined him properly.
-Communication is the key. If a doctor can spare a minute and explain the problem, its treatment and the possibilities of the patient getting better, it satisfies the patient.
-As for safeguards against media trial and assaults by patients or their kin, at the PGIMER we do not face such issues. Most of the times, if any issue arises it is sorted out by communication.
-There should be regulation in private healthcare. Ideally, there should be a fixed protocol in every hospital that the doctors should follow evidence-based medicine. It will solve most of the problems.
Dr Sujata Sharma, principal, Government Medical College, Amritsar
-Patients expect extra from the doctors but don’t understand their limitations. There may be some doctors who are negligent, but that does not mean that all are. A doctor tries her best to save the life of a patient. But usually it is seen that patient do not realise what efforts are made by the doctors.
-I think awareness should be created in public to heal the trust deficit. People should be made aware of the duty of doctors and the limitations too. Whenever a patient is brought to the hospital in a serious condition, doctor also prays before God for him.
-I don’t think there are enough legal safeguards to protect doctors. A doctor performs her duty in a very critical situation. Whenever, something unfortunate takes place with any patient, the family are angry with the doctor without knowing the reality.
-There is no use of regulation in private hospitals until and unless the public is aware of facilities in the government hospitals. Allegations are leveled against private hospitals that they charge extra money.
Dr Manjit Singh Uppal, principal, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar
-Two factors have triggered strain in doctor-patient relation. One is the bringing of medical profession under consumer forums. Every doctor is facing constant threat. For proper documentation, he wants to get all investigations (tests) done to support his diagnosis and treatment. This puts additional financial burden on patients who think doctors are deliberately doing this. Second factor is the corporate hospital system which is run by the business class and not doctors.
-Trust can be rebuilt by doctors spending more time with the patients and clearly explaining the possible expenses and treatment outcomes. All private hospital should display their charges for different treatments and procedures. Government should also upgrade its hospitals and provide free medicine to the poor people.
-Legal safeguards for doctors are on paper alone, and are rarely followed. The media, public and police are too keen to press charges on the doctor without following guidelines of the Supreme Court. Doctors are under threat of being assaulted, so some have resolved not to treat serious patients.
-Healthcare is not a commodity, but the corporate world is making it one. So, there should be regulation to make the private sector accountable too.
Dr Hardas Singh Sandhu, ortho surgeon, formerly with GMC, Amritsar
-Patients don’t want to spend much but treatment is turning expensive day by day. Second, population is increasing but number of doctors is not accordingly. This causes dissatisfaction among patients. Doctor-patient relations are same as police-public relations. Dissatisfaction in the public is towards every department.
-There is dire need of improving doctor-patient ratio. It is also seen that young doctors show ego when they attend the patient. These doctors should change their attitude by learning from older doctors who deal with patiently gently. Education among the public is also necessary.
-For safeguards for doctors, there are some orders of the Supreme Court, but they are not fully able to protect doctors. Whichever you evolve the legal safeguards, it proves futile until and unless they are implemented strictly.
-If we set government regulation aside, good doctors regulate themselves. Doctors are educated people. Still, at a minimal level, regulation should be there. Most importantly, without implementation there is no use of regulation in private sector.
Dr Balwant Singh Sidhu, principal, Government Medical College, Patiala
-First, the doctor community, especially the younger lot, has become more commercialised and usually lacking in communication with patients. Concepts of faith between doctor and patient and even families and doctors have completely disappeared, resulting in friction.
-Education can address this problem as there is a dire need to bring changes in behavior of doctors, and they should be educated to show more empathy with the patients. At the same time, patients and kin need to understand that it is not possible to provide immediate relief always.
-Several laws and Supreme Court directions are already there for protection of medical practitioners, but there is poor implementation of these regulations. Free and safe environment will help doctors to provide their services in a better way.
-Instead of regulating private healthcare, the government should improve its own medical healthcare services. There is no doubt that private healthcare is marred with malpractices, but addition of government multi-specialist hospitals like the PGIMER will curb the loot by private hospitals.
Dr Sukhdeep Singh Boparai, ophthalmologist, Patiala
-Medical profession should not be held responsible for growing strain between doctors and patients. With government doctors being overburdened and private healthcare having exorbitant charges, people are losing faith in doctors. People have become more impatient.
-Both sides have to contribute a lot and play their part in rebuilding trust. Awareness campaigns, seminars and rallies will help. Doctors have to play a proactive role in satisfying patients and should give honest suggestions related to their health.
-Better implementation of laws will help protect doctors. The situation is far better than earlier times when doctors were vulnerable. Even state and central governments have recently come up with stringent laws against unruly behaviour by patients and their kin.
-The state government should come up with certain regulations for private healthcare. However, I believe that private entities should regulate themselves so that better health facilities can be provided to people from all spheres.
Dr Harprit Singh, orthopedist, Jalandhar
-Basic cause for strained relation of doctors and patients is the lack of trust. Trust has been eroded over the years partly due to malpractice by health workers driven by greed and partly on the other side, by patients who tend to blackmail doctors if some treatment goes wrong.
-This deficit can only be healed if commercialisation in allotting seats to doctors will be stopped and ethical practices are taught. The pay scale of doctors should be hiked so that they do not depend on quackery or commissions. Media should be restricted not to publish any comments by patients until matters are decided by courts.
-If laws for protection of doctors are there, they are poorly implemented, especially for the media. But now print media has been overtaken by social media, where no law works, or it works when it is too late.
-There should be regulation in private sector, in terms of price, quality and care. Grading of hospitals and their services should be done.
Dr CS Pruthi, cardiologist, Jalandhar
-Due to heavy investment in the medical equipment and high cost of implants, cost of treatment has gone up substantially, and this has drastically influenced people’s perception. People compare cost of the case rendered by a specialist medical professional with the old times, when there used to be one medical officer for the entire village, who was cost-effective. Another reason is propaganda by media, which has projected doctors as exhorting money from masses.
-There is a need for a lot of positive counselling of patients’ attendants at each stage by ensuring strong and clear communication. Media should not jump to conclusions or publish sensational stories of organ theft and malpractices.
-Most violent incidents occur in ICU, and most hospitals in India lack adequate security personnel. At night medical officer play the role of doctor as well as security guards. There is no established protocol against violence at the hospital. In instances of patients’ death, people who have no faith in judiciary believe in exacting immediate revenge.
-Healthcare in India is already regulated by a number of agencies, and hospitals comply with a number of legal guidelines and legislations that ensure a standard level of care is delivered. Medical field is one of the most challenging, and too much regulation is not favoured.
Dr Jagat Ram, director, PGIMER, Chandigarh
-The doctor-patient relation is under growing strain because, these days, the number of patients has increased manifold, and thus a doctor does not get enough time to devote to a particular patient. At times we see doctors are not very empathetic too.
-To rebuild the trust, first, a doctor should do his job with perfection and follow ethical practice. Whatever procedure or treatment he provides, should be done only if required and under ethical practice. If a doctor is following ethics, a patient will automatically trust him. A doctor must also be empathetic.
-As for safeguards for doctors from trial by media and assaults by aggrieved patients or kin, laws are there but there must be stringent punishment for those who attack doctors. These days, people have become very aggressive and violent. An attack on a doctor must not be tolerated.
-Government makes several rules and regulations but all are for government hospitals. I believe norms should be the same for government and private hospitals, and there should be some regulations on private sector.
Dr Raj Bahadur, V-C, Baba Farid University of Health Sciences, Faridkot
-Ever since there has been commercialisation of medicine, and the patient is considered a consumer, the doctor-patient relation has slowly changed. It has made the doctors overcautious, resulting in getting more investigations (test) done and thus raising the cost. This hurts the pocket of the patient, adding to the stress.
-The trust deficit has to be mutually addressed by both doctor and patient. Instead of spending more time on investigations, the doctor needs to spend time on listening to the patient giving the healing touch, rather than advising treatment by merely looking at the investigations. Patients need to examine capability and reputation, following which he should have total confidence in the doctor.
-As for protecting doctors, It is unfortunate that safeguards, legally and physically, are quite less, and many times doctors have to bear the wrath of an agitated person or group that may or may not be related to patient.
-There should be stringent regulation on private healthcare as private organisations are profit-making ventures and frequently exceed limits of charging. Care and comfort are two different things, and in private organisations the emphasis is more on comfort.
Dr William Bhatti, director, Christian Medical College, Ludhiana
-Trust deficit arises as patients, after getting information from the internet, believe that they have acquired equivalent information to that of the doctor. Also, communication gap between patients and doctors increases the problem.
-The only solution to the problem is communication between the patient and the doctor as they would be able to clarify the issues being faced at both ends.
-Physical assault is no solution for any problem. There are rules to restrict patients, and FIRs are also lodged; but many times the patients move out of the line and attack doctors, which is condemnable. Stringent action should be taken in these cases.
-Regulations have already been formed by Indian Medical Association and other organisations and both patients and doctors are aware of these. Doctors should follow the same and work with transparency.
Dr Sandeep Puri, principal, Dayanand Medical College, Ludhiana
-Lack of effective communication is the only reason behind increasing trust issues between patients and doctors. Patients and their relatives do not follow guidelines and fail to absorb the outcome, due to which the problem arises.
-The only solution is proper documentation. Doctors should tell patients and their relatives about the fears, and the patients and their relatives should also give in writing that they will accept the outcomes.
-The law and the rules are in place for protecting doctors, but sometimes these are not implemented properly. Sometimes, police also act against doctors without properly inquiring into the complaint of negligence due to undue pressure. However, the public should not take the law in their hands as the judiciary is in place.
-Allegations of commercialisation are made against doctors but, if some kind of policy is to be framed, it should for all professions, such as lawyers too. The doctor is also giving services, and it is not that the patient is not told about the charges upfront.
(Interviewed by Ravinder Vasudeva, Tanbir Dhaliwal, Navrajdeep Singh, Surjit Singh, Parampreet Singh Narula, Harsimran Singh Batra and Gagandeep Jassowal)