Changing doctor patient relationship

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Summary: Violence against health care providers is widely rampant and this has contributed to increasing cost of health care and added to patients’ sufferings. Relationship between a doctor and patient is essentially a relationship of trust and only this kind of relationship is in the best interest of patients because of their limited understanding of medical principles, practices and realities of the market place. Patients’ hostile conduct towards their doctors has been described as Hostile Dependency Syndrome.

Author: Dr Mahesh C. Jain is a practicing medical doctor and has written the book “Encounter of Science with Philosophy – A synthetic view”. The book begins with first chapter devoted to scientifically valid concept of God and then explains cosmic phenomena right from origin of nature and universe up to origin of life and evolution of man. The book includes several chapters devoted to auxiliary concepts and social sciences as corollaries to the concept of God. This is the only book which deals with origin of nature and universe from null or Zero or nothing.

http://www.sciencengod.com

http://curatio.in

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Changing doctor patient relationship

  1. 1. Changing Doctor Patient Relationship: “Hostile Dependency Syndrome”Summary: Violence against health care providers is widely rampant and this hascontributed to increasing cost of health care and added to patients’ sufferings.Relationship between a doctor and patient is essentially a relationship of trust andonly this kind of relationship is in the best interest of patients because of theirlimited understanding of medical principles, practices and realities of the marketplace. Patients’ hostile conduct towards their doctors has been described asHostile Dependency Syndrome.Hostile Dependency Syndrome reflects normal dependence of patients upon theirdoctors for their welfare, hostile conduct of patients towards their treatingdoctors and the ensuing violent, arbitrary and illegal conduct of patients towardstheir doctors.Nature of doctor patient relationship has undergone a profound change duringlater half of last century and particularly during the last 4 decades. Patients arebecoming increasingly hostile towards their doctors. Mass media and judicial actshave contributed in a great measure towards increasing hostility.For media every story involving doctor patient conflict is a hit and hot storywherein doctor’s side of the story is often ignored and for individual controversiesof doubtful merits, entire profession is painted in black. I have rarely come acrossnews in which prima-facei allegations against the treating physician are made out.Their sole motive is to sell their own publication and they know it well that suchstories are a hit among consuming masses. They are least bothered that suchbiased reporting does no good to the subjects for whose cause they areapparently fighting. This imbalanced, irresponsible reporting only increasesalienation of doctors from their patients and serves to strengthen the invisiblebattle line between doctors and their subjects i.e. patients.Judiciary relying upon its authority under law of torts has adopted the robe oflegislature and redefined doctor patient relationship from a natural relationshipbased on mutual trust to a legal relationship based on contract for service. Thiseffectively means that a doctor is duty bound to provide all the services to a
  2. 2. patient on demand but all the authority vests in the patient. It includes duty toinform and the duty to procure informed consent from the patient. It is the dutyof the doctor to educate the patient about his clinical condition and thetreatment to be undertaken to such an extent that patient is able to take prudentand pragmatic decisions before granting his consent. Judiciary in their wisdom hascompletely ignored patient’s ability to comprehend his doctor’s word. Moreoverjudiciary is completely oblivious to the ability of a doctor to treat a patient uponwhom he has no authority. A doctor is legally required to protect his patient’sinterests even in those situations where patient acts arbitrarily, whimsical,idiosyncratic and in utter disregard of his doctor’s advice. For example a doctor issupposed to provide discharge summary even when patient leaves the hospitalcontrary to medical advice.The traditional and the natural view that doctor patient relationship is essentiallya relationship of trust , the treating doctor being the best judge of his patient’sclinical condition and the treatment to be given, has been given a good bye.Patients are no longer satisfied with the only right given to them i.e. right toselect their doctor. Patients no longer feel that they are duty bound to complywith their doctor’s advice. Majority of patients in exercise of their right topersonal satisfaction think that they have a free will and no rule of conductapplies to them but at the same time they expect a doctor to be bound by ethics,morals, law and at the same time be able to or is rather duty bound to cater to alltheir individual interests, whims, fancies, wild and weird ideas. Patient would nothesitate to call themselves as customers and even law has recognized them asconsumers. Doctor’s legal liability towards his negligence has been blown out ofproportion. Patients often levy wild allegations and thus harass doctors beforevarious legal and administrative forums even when their allegations areambiguous and lacking in particulars of alleged negligence.Increasing hostilities have led to alienation of doctors from their patient’s welfarewhich is reflected in refusal to attend odd hour calls and majority of doctor’schildren opting for a profession other than medical profession (According to onesurvey 85% of doctors children do not want to become doctors). Doctors oftenagitate in pursuance of their demand for increased security. Hospitals haveemployed bouncers to keep trouble mongers off. In one Indian state, many
  3. 3. doctors keep arms and ammunition in their clinics for the purpose of personalsecurity.Hostilities and unreasonable conduct of patients and their attendants have led toa vicious cycle wherein doctors are progressively becoming more commercial andmanipulative whereas patients are becoming more hostile. Clinical acumen basedpractice has given way to scientific and legal evidence based practice in whichinstead of patient welfare, the doctor’s preoccupation is being on the right side oflaw irrespective of cost of treatment to the patient. This has made healthcarevery expensive and unaffordable for the great majority. Hence in USA, these daysthere is talk about Obama Care.Nature of doctor patient relationship: It is essentially a relationship of trust. Thereason being that no human being in his capacity as patient have sufficientknowledge and experience to be able to determine the best for him and chooseand demand accordingly. His treating doctor is the only person competent to doby virtue of his education, cumulative experience, knowledge, skills andmanagement practices. It is not possible to lay down law and legal procedures tomeet vast diversity of situations any doctor encounters in his medical practice.Therefore, for his well being patient is squarely dependent upon the treatingdoctor. Under these conditions, nature of relationship demands that patientsmust be modest while dealing with their doctors so as to draw maximum benefitout of cumulative experience of the attending physician. In this situation, the onlyright that can be granted to a patient is the right to select his doctor and this righthas already been granted to all the patients. But once a patient has chosen adoctor, he is bound to comply with his doctor’s prescription in his own interestand is bound to pay fee for services rendered. In my medical practice, I have seenthat even the most intelligent of patients are rarely in a position to control andregulate management of their clinical condition.Doctor’s perspective: Medical practices demand a holistic approach and require adoctor to utilize his total experience for the benefit of each and every patient.There are no stereotyped responses. Best medical practices have evolved over aperiod of 2000 years and are beyond a patient’s common sense. A doctordemands compliance of his prescription and fee for the services rendered.
  4. 4. Doctor’s only concern is clinical condition of the patient and its management. Adoctor can’t refuse treating a patient on grounds of personal enmity or likes andinterests. In the great Indian epic Ramayana, Ravana’s personal physician Sushainwas called upon to treat his opponent Laxman and Sushain never refused.Acts of a doctor are often amenable to peer-review but no member of judiciary,bureaucracy or legislature can ever be competent to judge a doctor’s acts orprescribe conduct rules for doctors. To extract the best out of a doctor, a patienthas to be modest and comply with his prescription and be ready to pay fee for theservices rendered. Trust, modesty and compliance are the 3 cardinal principles forpatients to better connect with their doctors. Quite often doctors encounterpatients seeking free consultation for one or the other reason and employ allsorts of tools and techniques to achieve their ends. But little they realize that thisis the beginning of doctor patient conflict.Patient’s perspective: Patient often tend to think that doctors are just like anyother businessman or service provider working in accordance with profitmaximization theory of a firm. Accordingly patients don’t hesitate to regardthemselves as consumers or customers of the attending physician. Patients notonly exercise discretion in selection of their doctors but also pass all sorts of valuejudgments about their doctor. They will interfere at each and every step of theway. Patients often demand doctors to satisfy their illegitimate and illogicalinterests, whims and fancies. On one hand they would elevate a doctor to thelevel of God and the next moment they can be seen indulging in reckless violenceagainst their doctors. Patients generally have a very poor idea of medicalpractices and realities of market place but want to dictate themselves under thepretext of seeking satisfaction, at times only because they are paying the money.Because of wide gaps in perception of doctors and patients, conflicts areinevitable and hence “Hostile Dependency Syndrome”.Hostilities against health care providers at all levels of social hierarchy have led toa shift from clinical acumen based medical practice to scientific and legal evidencebased practice. In the former, for a doctor, patient’s welfare is supreme whereasin the later being on the right side of law is the supreme consideration. The later
  5. 5. approach not only makes healthcare extremely expensive and unaffordable formajority of the patients but also acts contrary to patients interests in so manyways.So the best approach for a patient is to establish a relationship rooted in trust sothat the attending doctor feels responsible for his patient and makes his bestefforts to restore his patient’s health. But hostile attitude, raising unreasonabledemands or indiscriminately exercising his rights and opportunities is clearlycounterproductive. I have seen patients hurting themselves more often by theirown negligence rather than negligence on the part of their doctors. It is against this backdrop that http://curatio.in has been founded in order to helppatients in taking informed decision in the matter of selection of their health careprovider and reap the greatest benefit out of his cumulative experience. It issincerely expected that this initiative would improve doctor patient relationshipleading to decline in incidence and prevalence of Hostile Dependency Syndrome.Author: Dr Mahesh C. Jain is a practicing medical doctor and has written thebook “Encounter of Science with Philosophy – A synthetic view”. The book beginswith first chapter devoted to scientifically valid concept of God and then explainscosmic phenomena right from origin of nature and universe up to origin of lifeand evolution of man. The book includes several chapters devoted to auxiliaryconcepts and social sciences as corollaries to the concept of God. This is the onlybook which deals with origin of nature and universe from null or Zero or nothing.http://www.sciencengod.comhttp://curatio.in

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