Deteriorating State of Patient-Healthcare Relationship

The Union Health Ministry is now pushing for a stringent punishment to people indulging in violence against doctors, says Savitha Kuttan

Patient Healthcare  Relationship, Savitha Kuttan, Union Health Ministry, Indian Medical Association, Omnicuris

In September this year, an elderly doctor in Assam’s Jorhat district died after being brutally beaten up by an unruly mob agitated over the death of a tea estate worker. The 73-year-old doctor who had retired much earlier was serving the hospital without even taking any remuneration for his services.  Unfortunately, such mind-numbing violence against doctors has become a regular feature in India.
According to a study by the Indian Medical Association, a whopping 75% of doctors have faced some sort of abuse at some point in their lives. Such is the stress of being a medical professional that over 60% of doctors admitted in a Survey that they found themselves unable to treat patients without fear of violence.
Being the face of the healthcare sector, doctors end up becoming scapegoats for a larger rot in Indian healthcare – arising from a series of factors including shortage of healthcare practitioners, poor accessibility and awareness issues. The Union Health Ministry is now pushing for a stringent punishment to people indulging in violence against doctors. While this is a welcome move, it is not sufficient. Intervention is required on a larger scale to rebuild the deteriorating relationship between patients and the healthcare sector.
The deteriorating doctor-patient relationship: What triggers the trust deficit?
It is common knowledge that India is woefully short of doctors. With an average of one doctor for every 1445 people, long and grueling wait times are an everyday reality for patients. Worse still, with a bulk of hospitals, doctors and specialists concentrated in urban areas, the accessibility rate falls further short in small towns and rural areas. Even patients living in tier II and tier III cities often have to travel long distances for specialist care. The travel time, cost and emotional stakes worsen the situation. In a lot of cases, patients do not end up getting proper standard of care at primary centers, and have to spend quite a lot of money and energy travelling to tertiary centers in metros, with their physical and mental state deteriorating along the way.
Our medical infrastructure remains grossly unequipped to cater to the needs of a large population which often triggers anger and frustration among people who end up venting out their misplaced anger on doctors. Earlier this year, when the Encephalitis tragedy broke out in Muzaffarpur claiming many lives, a prominent television journalist was found vociferously criticizing, almost heckling an on-duty doctor, thrusting at him questions that she should ideally have thrown at the government. Insensitive media coverage, pronouncing epithets like ‘Dr Death’ on some wrongdoers, further exaggerates the perception that doctors are to blame for the rot in Indian healthcare.
Low doctor-patient ratio also implies that a doctor has to rush with patients and has just limited time to give to each one of them. Doctors, particularly those practicing in public hospitals work long and grueling hours, often attending to hundreds of patients every day. This lack of interpersonal approach in treatment deeply impacts the patients’ perception of a doctor and furthers the trust deficit. At other times, diagnosis of a problem and referral at primary care level takes longer than it needs to take, negatively impacting health outcomes in case of serious diseases. This is particularly true in case of small towns and villages where practicing primary care doctors do not get sufficient time to upgrade their skills and knowledge.
Lack of provision of insurance for OPD services and preventive health check-ups is another neglected subject in our country. Even though OPD services account for a bulk of out-of-pocket expenditure, the case of medical cover for OPD remains grossly unaddressed.
The psyche of patients
Lack of awareness among patients is an important aspect that drives poor health outcomes in many cases. Sometimes patients delay approaching a doctor, unaware of the seriousness of their symptoms or lose substantial time attempting alternate medicine. Many patients do not check themselves into a healthcare facility till their condition gets critical. Lack of insurance penetration and out of pocket expenditure on health care not only deters people from seeking treatment early, but also drives anger and frustration.
A number of steps are needed to change this awareness gap. We need doctors and hospitals to improve their communication with patients at every level. At the same time, they must also develop an empathetic approach to medicine. With easy access to information through the Internet, ‘Dr Google’ is another challenge doctors face today. Having ‘googled’ their symptoms already before seeing the doctor, a number of patients today are not only more aware but also more confused. Doctors must therefore take sufficient time to address all their concerns and answer all their queries in detail to ensure they place their complete trust in them.
The road ahead
With the medical profession increasingly being seen as dangerous, many bright young students are today refraining from entering into the field. Reports have shown that in many colleges, seats for specialties like Cardiology are remaining vacant as medical students worry about difficult working conditions and grueling hours. For a country already starved of specialists, this loss of talent will be difficult to bear. It is imperative therefore that multi-pronged and multi-staged steps are taken to address the problem at hand.
Stringent laws for both unethical doctors and violence perpetrators
It is the responsibility of the state to ensure a congenial working environment for doctors, and the government should create provisions and laws to mitigate attacks on medical personnel. Any assault on doctors must be made a cognizable offense, and it should be the onus of the accused to prove their innocence.  We also need a medical ombudsman to address patient grievances in healthcare. At present, a legal case takes over 10 years to close. If the doctor has to skip duty every time for a case hearing, it’s a huge drain on the doctor pool. Cases should be fast tracked and exemplary punishment instituted for defaulters.
Improve accessibility
The need to make available more hospitals, more doctors and specialists across the country must be given the priority it deserves. Even the government’s ambitious scheme Ayushman Bharat cannot be fruitful when there are not enough hospitals to treat patients. Opening more medical colleges and converting at least 100 district hospitals in underserved areas into medical colleges over the next 10 years must be a prime agenda. Increasing the number of MBBS and PG seats in medicine to fill the demand of doctors and specialists is also urgently required.
It is equally important to improve the state of primary health care so that doctors are accessible to all people and diagnosis and referrals are achieved in time.
Improve communication
The medical community must take it upon themselves to change the way they communicate with patients, beyond the cursory requirements of taking consents on paper. Doctors need to get the message across to their patients without using medical jargon at every step of treatment. Often, doctors just prescribe medication and do not take enough time to adequately explain the disease and its possible implications to patients and their attendants. Setting the right expectation from treatment is very important, so that in no way are the patients kept in dark about their prospects. Hospitals must also institute counselors to counsel patients and their families and conduct counseling sessions in an empathetic way.
Fighting the perception battle must also be given the priority it deserves. If a miniscule percentage of doctors are involved in unethical practices, this must not be allowed to create a disproportionate bias against the community at large. There should be quick mechanisms to bring unethical doctors to justice so that a few dirty fish are not allowed to spoil the reputation of the pond.
Savitha Kuttan is CEO of Omnicuris.