I congratulate Parsi times on the theme of this New year issue. Relationships, in general, rest on universal values of trust, honesty and mutual respect. So why does society at large and the editorial team give a special place to the Doctor-Patient relationship? Let me illustrate this by the reaction of both doctors and patients to an event which took place a few decades back. A bench of the Supreme Court in 1995, when considering a case of medical negligence, tried under the Consumer Protection act of 1986, upheld the right of the patient to use this mechanism of redress. This effectively means that you equate suing a company for a defective product to suing a doctor because you did not get cured! In one stroke, this resulted in changing the hitherto sacred relationship of unconditional give and take into a transactional relationship of a consumer and service-provider. This was met with howls of protest by traditional doctors who felt that a relationship, involving life and death, could not be equated to the mere purchase or sale of service. Rubbing salt into the wound, services given free of cost did not come under the purview of this law! Lots of senior doctors felt this was an unfortunate development and a sign of deterioration in a relationship governed since time immemorial by a Hippocratic oath, to that of confrontation and mistrust. At that time, I remember a large number of patients supported the medical fraternity and felt the Supreme court judgement was harsh.
Cut to 2018, as recently as a month back, there was a book-launch of ‘Predators or Healers’, written by a former Health Secretary, and two doctors. It paints an extreme view claiming almost all doctors are corrupt. I confess I have not read the book, but am afraid of how such a book would impact the doctor-patient equation. Today, I cannot imagine that the patients would support the medical fraternity in large numbers, as it once did.
Patient come to doctors, when faced with illness, disease and discomfort, seeking a solution or a cure. The word ‘cure’ is derived from ‘I care’. Caring automatically elevates this relationship from a mere prescription and relief of symptoms, to one going beyond just buying a solution for a price in the form of a fee paid to a doctor. It is for this reason that one often seeks out the same doctor repeatedly. A doctor who is kind, empathetic and patient is preferred to those without such qualities. Moreover, the implicit act of consent given by the patient seeking treatment by sharing very confidential, personal information to a stranger governs this relationship. No sooner is this bond of trust established, the patient and doctor become partners in the quest to wellness and freedom from disease.
However, despite all pious pronouncements, the relationship has never been one of equals as it is governed by a knowledge-asymmetry, on account of the complexity of modern medicine. This is accentuated by the fact that an ill patient is physically and mentally fragile and vulnerable. Thus the attitude of “I know what is best for you” leads to a creeping arrogance and many patients became mere supplicants and accept the doctor’s words as divinely ordained! Over time, medicine became more complex and doctors needed to work harder to keep abreast with the latest developments. The patients, on the other hand, in the internet age have been able to effortlessly garner knowledge and feel that the knowledge-asymmetry has been reduced significantly. Patients now do not hesitate to question doctors, and do not swallow all advise unquestioningly.
If society has seen a moral decline in values, then it is inconceivable that the doctor-patient relationship will stay immune. Doctors who care and examine patients thoroughly and use their clinical acumen to arrive at a diagnosis have become a rarity. Medical schools have also become full of the common variety of doctors who, for want of a better term, are called ‘hyposkiliacs’ – or doctors whose clinical skills are poor and who feel that they need not touch the patient! They increasingly rely on diagnostic tests. In bypassing or curtailing the history-taking and physical examination, this high-tech approach weakens the doctor-patient bond and disallows one from even forming. The high-touch approach, by contrast, represents the traditional medical approach, ensuring that we treat the patient, not the disease. Large investments on equipment and increased use of expensive implants and medicines have pushed up the costs of treatment and medical professionals have knowingly or unknowingly become complicit in furthering the commercialization of medicine.
In the defence of doctors, patients too, at the behest of unscrupulous elements, target doctors and the threat of litigation has resulted in what is known, in common parlance, as defensive medicine. In this age of instant gratification and material demands the patients demand instant cures and pressurize doctors to change their approach to the treatment of ailment. The stresses and strains of busy lives in a metro with decreased attention spans along with anger and impatience, are also contributory factors to the malaise affecting the doctor-patient relationship.
Is this therefore the end of the road and have doctor-patient relationships reached a stage where doctors are soft targets and victims of violence? Is the erosion in trust and rampant violence just media driven in the era of fake news? I think not. According to me, as in all relationships, both are to blame. I am an eternal optimist and feel that amidst the noise, the predominant instinct of both, the doctor and the patient, is to work towards a positive outcome and both would love to see an improvement in this relationship. Doctors need to spend more time with patients, communicate effectively and work conscientiously in the interest of the patient, thinking of them as no different than one’s own family members. Doctors also must resist pressures from vested interests to over prescribe expensive investigations, drugs and implants. Patients, on the other hand, must realize that doctors are not infallible and never intentionally wish to harm the patients. They must not approach doctors with a suspicious, doubting attitude. A climate of caring and trust as opposed to neglect and doubt will result in a healthy doctor patient relationship. While we often think it takes two to heal a relationship, I feel, based on my experience, it really takes one to heal the relationship as the moment one extends a healing hand, the other is sure to respond. In conclusion, I fell that both, patient and doctor, need to think positively and act positively. As this New Year sets in, let us pray together that a healthy patient-doctor association will lead to universal wellness and good health for all!