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Doctor – Patient Relationship; The Growing Paradox Of Indian Healthcare

One of the biggest paradox in Indian Healthcare market is the on and off relationship between the doctors and patients. From Bhagwaan to Shaitaan (on being asked to pay the bill), from appreciation to resentment, from pedestal to hospital bed; the extreme sentiment defining the relationship has been the painful reality of Indian Healthcare system.

Violence against medical practitioners is on the rise, not just in India, but all over the world. But, the situation in India is unparalleled. The IMA (Indian Medical Association) reports that over 75% of all doctors in India face some form of verbal or physical violence from patients and their families.

Though the Prevention of Violence against Medicare Persons and Institution Act is applicable in 19 Indian states, it has failed to protect doctors from such recurring incidences of violence and vandalism. Healthcare comes under Essential Services Maintenance Act (ESMA) which in fact is heard only when the administration wants to crush the protests by the doctors. ‘Essential services’ demands a special treatment from the society in general and the governments in particular, so that there is no stone left unturned to make it congenial for the best outcomes, as it is an essential service.

Let us understand the reasons behind the compounding violence and aggravation in the society.

Growing negativity and distrust

Violence against doctors and the deterioration in the doctor-patient relationship today is the result of the growing negativity and increasing distrust towards the healthcare sector because of the negative portrayal of the sector. Social media is largely unregulated and tends to spread negativity more than positive content. Cases of medical failure are most often sensationalized through social media, emanating suspicion in the general public towards medical practitioners. Doctors, who were until recently seen as a saviour, are being painted as demons. A case in point is, during a recent World Cup match, one of the most repeated advertisements was by a prominent insurance aggregator website showcasing rising bill with a blood filled thermometer, whoever made that campaign is ill informed about the medical sector.

Understanding the mob

There is also growing mob frenzy in the country that needs to be mapped. India is witness to skewed distribution of healthcare infrastructure, with most of the healthcare facilities concentrated in the metros. Patients from smaller towns often have to travel long distances along with their loved ones for treatment. The time and cost of travel, emotional trauma compounds the situation. When patients do not receive proper care at primary care centres and spend excessive time and money reaching proper tertiary healthcare services in metros, quite often resulting in deterioration in the patients’ condition owing to long distance travel.

This brings to the most painful reality of the Indian healthcare dynamics – private healthcare are wary of venturing into the hinterland. The government should look at ways to incentivize the healthcare sector, encourage setting up of tertiary care centres in the tier 2 and tier 3 cities, thereby taking best of healthcare closer to the people so that critical illnesses due to distance can addressed.

Patient doctor psyche

It has been seen that people reach the hospital only at a critical stage, which calls for urgent hospitalization and at times intensive care, leading to an escalation of cost of treatment. There is no denying of the fact that ICU treatment is expensive worldwide. In India however, the cost of intensive care is one of the lowest in the world. Another notable point is, in smaller towns and rural India, insurance penetration is dismal and the patient has to spend money from his/her own pocket for the treatment.

Hospitals often witness situations wherein patient relatives go on frenzy on seeing the medical bill and refuse to pay. Often, they seek guaranteed medical results in return of the cost. We need to understand that a doctor tries his level best to save every life. If someone loses their near and dear ones, they hold the doctor and the hospital responsible for their loss. The relatives and their acquaintances need to understand that every patient is different and every disease is not curable. Which doctor does not want a good outcome! Indian Doctors & Hospitals are capable of outcomes as good as the best in the world and that is why we see an influx of international patients.

The flip side of this coin is why do we have misguided public? Certainly there is a bigger picture and its appreciable that a doctor in India has far more patients to see as compared in the west and hence time given to the patient is comparatively less. Certainly simplicity of communication, tone and manner becomes paramount and probably the first milestone that need to be crossed while explaining the disease to the patient. Is it in a manner they understand or using medical jargon, thus pushing them to Dr. Google. If we don’t communicate simplistically how will they understand? Having said that, it surely does not give the public the right to violence.

Skewed doctor patient ratio

The healthcare sector in India is severely understaffed when it comes to doctors. Firstly, it is not easy to become a doctor, it requires years of hard work, study and experience to become one The doctor patient ratio in the country is lopsided with one doctor per 1,453 people as against the WHO recommended ratio of 1:1000.In tier 2 and tier 3 cities where 80% of the population resides, the situation is worse. Scenarios of patient/relatives creating ruckus over waiting period is quite common in India – even delay of an hour is intolerable. Compared to the developed countries where the average waiting period for OPD patients is one month.

Way forward

The solutions have to be comprehensive & proactive and not ‘band aid measures’. We need to have preventive, anticipatory & therapeutic approach to. They have to be at the level of the hospitals, State Governments & the Central Government. These measures should not only be by way of guidelines but should be enforceable guidelines monitored by the regulatory authorities.

It is important to educate people that violence against doctors can inhibit the advancement of quality healthcare services in our society. If one suspects medical negligence, they should resort to legal procedures, instead of physically or verbally assaulting hospital staff.

It is imperative that the State ensures a congenial environment in the hospitals – both government & private hospitals. The government must create laws and provisions that mitigate such attacks. An assault on doctors should be a cognizable offence alike an assault on public servants on duty. The Law against Medicare Violence is available for some years but it has not worked for various reasons. It needs to be strengthened. One effective way of strengthening it is to make it akin to Dowry law or Domestic Violence Law. The onus should fall upon the accused to prove himself not guilty. Hospital violence is equal to (if not worse) Domestic violence, in terms of the damage that it causes.

Consider ‘no-fault liability’ for compensation in medical negligence (in place of Consumer Courts, which are causing acrimony between healthcare seekers & givers) as is available in New Zealand, Sweden & Denmark. This will not only provide simpler, broader & quicker mechanism for compensation but will also remove acrimony. It will help improve doctor patient relationship. We can work out its nitty gritty to suit Indian Scenario.

Further, there should be an ombudsman to handle customer grievances in the medical field. Currently, a medico-legal case takes 5-15 years to get closed. For the doctor to leave his or her duty and travel every time for the case hearing is a big drain on the already inadequate pool of qualified doctors.

Indian doctors are considered the best worldwide and the healthcare sector has been witnessing a steady growth of patients from around the world and is already becoming an international medical hub. Violence against the fraternity, only spreads doubts and creates trust deficit. The biggest challenges is that the key stakeholders doctors, hospitals, state & central policy makers, industry associations work in silos and they need to come together to a larger consensus to deliberate on how to build a better India. – India Times

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