Doctor Patient Relationship

Relationships in general rest on universal values of trust honesty and mutual respect. So why does

society at large give a special place to this relationship? Let me illustrate this by the reaction of both doctors

and patients to an event which took place a few decades back. A bench of the Supreme court in 1995 when

considering a case of medical negligence tried under the Consumer Protection act of 1986 , upheld the right

of the patient to use this mechanism of redress. Thus in one stroke this resulted in changing the hitherto

sacred relationship of unconditional give and take into a transactional relationship of a consumer and a

provider of service. This was met with howls of protest by the traditional doctors who felt that a relationship

wherein questions of life and death were involved could not be merely equated to any purchase or sale of

service. To rub salt into the wound, the services given free of cost did not come under the purview of this

law. Lots of doctors, particularly the senior doctors saw this as an unfortunate development and a sign of a

deterioration in a relationship governed since time immemorial by a Hippocratic oath to one of confrontation

and mistrust. At that time, I remember that a large number of patients supported the medical fraternity and

felt the Supreme court judgement was harsh. Cut to 2018, as recently as a month back a book was

launched named Predators or Healers written by a former Health Secretary, and two doctors. They paint

an extreme view that almost all doctors are corrupt. I confess I have not read the book, but am afraid of

how such a book would impact the doctor patient equation. Today, I cannot imagine that the patients

would support the medical fraternity in large numbers.

A patient usually seeks the help of a doctor when faced with illness, disease and discomfort seeking a

solution or a cure. The word cure is derived from the derivative which means I care. Caring automatically

elevates this relationship from a mere prescription and relief of symptoms to one of going beyond just

buying a solution for a price in the form of a fee paid to a doctor. It is for this reason that very often one

seeks the help of the same doctor repeatedly, so a doctor who is kind, empathetic and patient is preferred

to ones who do not have this attitude. Over and above the implicit act of consent where a patient who

seeks treatment gives very confidential, personal information to a stranger governs this relationship. No

sooner is this bond of trust established, the patient and the doctor become partners in the quest to

becoming well and free from disease.

However, despite all our pious pronouncements the relationship has never been one of equals as it is

governed by a knowledge asymmetry which is on account of the complexity of modern medicine. This is

accentuated by the fact that an ill patient is physically and mentally in a fragile and vulnerable state. Thus

the attitude of “I know what is best for you” led to a creeping arrogance and many patients became mere

supplicants and accepted the doctors words as divinely ordained. Over time medicine became more

complex and doctors needed to work harder to keep abreast with the latest developments. The patients

on the other hand in the internet age have been able to garner knowledge effortlessly and feel that the

knowledge asymmetry has been reduced significantly. Patients now do not hesitate to question the

doctor and even try and show that they will not swallow all advise unquestioningly.

If society has seen a moral decline in values then it is inconceivable that the doctor patient relations will

be immune to societal pressures. The doctors who care and examine the patient thoroughly and use their

clinical acumen to arrive at a diagnosis have become a rarity. Our medical schools have also become full

of the common variety of doctors who for want of a better term are called “hyposkiliacs”. These are

doctors whose clinical skills are poor and who feel that they need not touch the patient. They increasingly

rely on on diagnostic tests and their overuse on account of their easy availability has become rampant.

In bypassing or curtailing the history-taking and physical examination, the high-tech approach weakens

the doctor patient bond and prevents it from ever forming. The high-touch approach, by contrast,

represents the traditional medical approach, ensuring that we treat the patient, not the disease.Large

investments on equipment and increased use of expensive implants and medicines have pushed up the

costs of treatment and medical professionals have have knowingly or unknowingly become complicit in

furthering the commercialization of medicine. In defense of doctors, patients too at the behest of

unscrupulous elements targeted doctors and the threat of litigation has resulted what is known in

common parlance as defensive medicine. The stresses and strains of busy lives in a metro with

decreased attention spans along with anger,rage and impatience are also contributory factors to the

malaise affecting doctor patient relationship.

Is this therefore the end of the road and have doctor patient relationship reached a stage where doctors

are soft targets and victims of violence? Is the erosion in trust and rampant violence just media driven in

the era of fake news? I think not and according to me like in all relationships both are to blame. I am an

eternal optimist and feel that amidst the noise and din the predominant instinct of both the doctor and the

patient is to work towards a positive outcome and both would love to see an improvement in this

relationship. Doctors need to spend more time with patients, communicate effectively and work

conscientiously in the interest of the patient thinking of them as no different than one's own family

members. Doctors also must resist pressures from vested interests to over prescribe expensive

investigations, drugs and implants. Patients on the other hand must realize that doctors are not infallible

and never intentionally wish to harm the patients. They must not approach doctors with a suspicious

doubting attitude. A climate of caring and trust as opposed to neglect and doubt will result in a healthy

doctor patient relationship. While we often think it takes two to heal a relationship, I feel that based on my

experience it really takes one to heal the relationship as the moment one extends a healing hand the

other is sure to respond. In the end I would like to say that both patient and doctor need to think positively

and act positively. On this day as we read this let us pray together that a healthy patient doctor

association will lead to universal health for all.