The sacrosanct relationship between the doctor and the patient perhaps is at a tipping point. The paternalistic medicine has ceased to exist. Doctors playing the role of a medical advisor and guiding on what must be done, is slowly becoming a thing of past. Trust in doctors may not be completely eroding but is certainly grinding down. Patients are now immensely educated through the internet, however its use (misuse) via Social Media platforms is dangerous and often the reason for trust deficit; patients and doctors must evolve to this fact. Often poor communication and unrealistic expectations form the basis of deteriorating trust and thus it is time to redefine the doctor patient relationship in India. 

You wouldn’t want someone you don’t trust handling small, everyday matters for you, much less diagnosing a health condition or performing a complex surgery. Trust is the foundation of any relationship, and a doctor-patient relationship is no exception. With this background let’s look at some key aspects to build trust in the 21st century.

Open Two-Way Communication

The single most important aspect is open communication. A doctor is expected to listen to patient’s problems, symptoms and ask relevant questions in order to arrive at a diagnosis. Gentle manners, undivided attention and compassionate communication form the hallmark of good doctor communication. Similarly, patients are expected to convey all information, symptoms and events leading to the problem. However embarrassing or subtle the point may be, the information must be shared with the doctor for him to arrive at a correct diagnosis.  Patients and their families must remember that doctors are trained professionals and only humans, rude or aggressive behavior towards doctor or other healthcare professionals is not only distracting and stressful for these caregivers, and it can also lead to error of judgement. Patients must understand that NO doctor ever wishes any harm to the patient. While it is expected for patients to ask for queries and questions regarding their problems and disease, an irrational interrogation of medical decisions or doubting the ethics will only add to delayed diagnosis and inadequate care.

A doctor should offer a patient and their family with options, and decisions should be mutually shared. Yes, we can tell them what we think is the best option; however, ultimately, the patient and their family are making the decision. Doctors must also act like educators, point patients towards right resources on the internet for reference and protect them from wrong information which is available there. This will help in confidence building. Often an open communication on other opinions helps build a lot of trust.

Cost of healthcare delivery

In a country where majority of healthcare is privately driven, the cost of healthcare is rising daily. Though insurance and some government policies have bridged the gap, it still remains out of reach for a large section of the population. While most doctors and healthcare facilities are sensitive to this issue and do their bit, it remains a challenge. In India we provide quality healthcare at a very economical rate compared to the world and healthcare professional’s remuneration is only a small part of the total cost. But to deliver quality care, one needs infrastructure, equipment, quality checks and standardization, this is where the cost escalates. Our patients need quality healthcare and therefore the cost will have to be shared. Government, insurance, tax exemptions on equipment and infrastructure etc. are some of the key elements to reduce cost burden to patient. While healthcare is now being considered an industry, it is rather unfortunate that some see it as a client and provider relationship. While it is important to bring accountability in healthcare, it cannot be at the cost of disintegration of trust. As I often feel that patients and doctors are one team in caregiving, with a single goal of making patients better. There should not be any ambiguity in understanding this.

Practicing medicine is becoming more difficult than ever before. There is an evolvement of technology and innovation from all corners. Data has become more quantified and we are regulated to follow new guidelines. Our time is being constricted, while more and more is expected from healthcare providers. On these lines, patients have time constrains as well, because they are going through a similar turmoil at their work place, financial burdens and emotional stress. But there are only so many hours in a day and both sides need to balance and redefine how they will interact with each other to optimize care.

Dr Rahul Pandit, Director-Intensive Care, Fortis Hospital, Mulund, Mumbai