Sunday, October 7, 2001		Keeping fit

Trust is the basis of doctor-patient relationship
B.K. Sharma

THOUGH society still accords the medical profession a fair degree of respect and considers it somewhat different from other professions disturbing trends are evident. There are complaints against hospitals, clinics and individual doctors. This is unhealthy both for the profession as well as the patient.

The doctor-patient relationship is one of the most unique and privileged relations. The only relation, to my mind, which stands above this, is the mother-child bond. The other relationship which can come near it is that between a teacher and disciple. A patient to a doctor is at once a dependent child, an eager student, a friend and a person needing advice, help, sympathy, understanding and hope.

In our own culture, the ancient physician, Charaka, said a physician must be fearless, merciful and tolerant. "A good physician nurtures affection for his patients exactly like the mother, father, brothers and kinds. The physician having such qualities gives life to the patients and cures their diseases", he said.

The famous physician and teacher, Sir William Osler, who worked in Canada, the USA and Oxford, was an exemplary doctor when it came to treating a patient and teaching a student. He wanted the doctor not only to give him his best but employ sense of humour, cheer his patients when everything looked bleak and dark. His famous quote, "Not to take the hope away from the patient under any circumstances ...eternal hope which comes to us all", should be remembered by all.

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 Tort’s 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 doctor’s role

• The doctor needs to pay full attention towards patient’s 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.

• Maintenance of patient’s 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 patient’s intellectual capacity and social background.

• 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.

• Whereas the 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 level.

• Doctor should not be judgemental about patient’s personal habits or attitudes.

The patient:

• Should choose his doctor or the hospital carefully and with awareness. Having done this, full trust and faith should be reposed in the doctor.

• Should provide full information about the illness and all the relevant social and family background.

• Should not 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.

• Should understand 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.

• Avoid shopping around with multiple doctors and alternative systems.

• Avoid believing in heresay, rumours and not readily believe the facts printed in non-professional publications.

• Carefully read the consent for any procedure, try to understand its implications and ask for clarifications, it required.

• Should 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 don’ts 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 science.