Whither the good old
family doctor ?
September 23, 2001
mending of the heart
September 9, 2001
For the sake of your
August 26, 2001
The heart is a unique
August 12, 2001
Begin the day with
a hearty breakfast
July 29, 2001
The trouble that is
July 15, 2001
Why people get
infections in the hospital
July 1, 2001
Beat the heat before
it beats you
June 3, 2001
Facing the ultimate
reality of life
May 20, 2001
Bitter truths about
May 6, 2001
How to cope with
April 22, 2001
All that stress can do
March 25, 2001
emergency: A ticking bomb
February 25, 2001
Importance of eye care
in the elderly
February 11, 2001
Not only years to
your life but life to your years
January 14, 2001
Early detection is the key
December 17, 2000
for health, fitness and more
December 3, 2000
November 19, 2000
What then has changed the scene? There
are a number of factors. The introduction of technology has changed
the image of the doctor for the patient. This has made him omnipotent
and fallible at the same time. The institutional and group practices
have further blurred the individual doctor-patient relationship.
Mobility of the patients from place to place and continent to
continent has added to this. Worse still is commercialisation of
medicine because of various reasons, particularly the high cost
technology, and the general societal trend of consumerism has
certainly affected doctors as well.
What rules, if at all
rules can be laid down, should govern the doctor-patient relation?
There are a large number of legal regulations. A lot is available in
the legal form as defined under Tortís law, Helsinki Code of the
World Medical Association of 1964 and revised in 1975, the Nuremberg
Code of 1945, Code of Medical Ethics of the Medical Council of India
of 1970 in our own country, the Guidelines by the Council for the
International Organisation of Medical Sciences of 1984 and now the
Consumer Protection Act. To my mind, it is the ethical behaviour both
on the part of the doctor as well as the patient which should govern
this very pleasant and fruitful relationship.
The doctorís role
The doctor needs
to pay full attention towards patientís symptoms, his story and
above all his anguish and sufferings.
Listening to the
patient is very important even if the diagnosis is written on his
face. This is one of the failings which a doctor should avoid as
this would leave the patient dissatisfied. After his clinical
examination and required investigations, the doctor should spend
time in analysing his problems and come to a tentative of definite
diagnosis depending upon the situation.
patientís confidentiality is absolutely essential and should
never be breached except in a court of law.
Maintaining of a
good record is very good both for the doctor and the patient
perhaps even more for the doctor. This often is the saving grace
for a doctor under some kind of blame.
Patient should be
offered choice and alternative not in a superficial manner but in
a very formal manner so that the patient has the feeling of
participation in the decision making. This will to some extent
depend upon the patientís intellectual capacity and social
Refer the patient
to a colleague in time and doctor should never sit on prestige or
hold on the patient longer than required. In an institute
particularly this is of great help in handling a complex problem
or a VIP patient.
In my personal
experience even if something has gone wrong, taking the patient
into confidence would help in most of the circumstances unless
there is an ulterior motive.
patient or the family need to be informed about the nature of the
disease which is not always optimistic or hopeful, but it need not
be traumatic. Somebody has said, "The truth may be brutal but
the telling of it need not be".
The consent taken
for any procedure should not be a mere formality but should be
explained to the patient fully in his own language and his own
Doctor should not
be judgemental about patientís personal habits or attitudes.
Should choose his
doctor or the hospital carefully and with awareness. Having done
this, full trust and faith should be reposed in the doctor.
full information about the illness and all the relevant social and
hesitate to ask as much information as he wants and clarify the
instructions without any hesitation.
Reports in case
of any drug reaction or other adverse happening.
the risk involved in a procedure or operation.
Should ask the
doctor for any alternative or choice available. This is his right.
Should know that
medical science is a biological science and lot of decisions are
made on the basis of experience and personal judgement. Many
things cannot be fully explained or predicted.
around with multiple doctors and alternative systems.
in heresay, rumours and not readily believe the facts printed in
the consent for any procedure, try to understand its implications
and ask for clarifications, it required.
differentiate between a complication or mishap and negligence and
not blame the doctor for every thing that goes wrong.
However, any member of dos and doníts
cannot fully describe the doctor-patient relationship, which is
ultimately defined by trust, compassion, empathy and goodwill. A
doctor should not look at his patient as a bundle of complaints. A
patient should look at his doctor with trust and hope but should
understand the limitations both of the doctor as well as medical