Deteriorating doctor-patient relationship – A cause of concern
A good doctor-patient relationship is considered to be the most important part of the field of medicine and healing. This relationship is usually developed in an environment where a patient has full faith and trust in a doctor, and equivalently a doctor also tends to a patient with the utmost care, empathy, dignity, and respect.
But in the case of Kashmir, it is a common notion that doctor-patient relationship has been deteriorating over the years due to the mistrust between the two. Eventually, both, the doctors and the patients are usually seen making complaints against each other. The local newspapers report frequently about clashes between the doctor and a patient or attendants of a patient, particularly occurring in the public sector hospitals. For an instance, last month (on January 7), a lady doctor at Chest Diseases Hospital in Srinagar was beaten by one of the family members of a patient who died in the hospital. The family accused negligence on part of the doctor for the death of the patient. On the doctor’s complaint, police filed a criminal case against the relatives of the deceased for thrashing and beating the doctor.
Experts say that the lack of infrastructure and manpower in the health sector, rising stress level among the people (including doctors) due to certain reasons, the tremendous workload on medical professionals, ingenuine expectations from the doctors, and so on and so forth, are some of the causes responsible for deteriorating doctor-patient relationship in Kashmir.
They say J&K is one of the places in India where doctor patient ratio is at its lowest. As per the Directorate of State Health Services & National Health Profile 2018, Jammu and Kashmir has one Allopathic Doctor for the population of 3060, while the World Health Organization (WHO) has set 1:1000 as a doctor-patient ratio.
The experts also say that some doctors despite getting handsome salaries from the public health sector spend most of their time at their private clinics, which eventually takes a heavy toll on the patient care in government hospitals where they are supposed to provide their services. This eventually is causing dissatisfaction among the patients and their disregard towards doctors.
This newspaper, every now and then, has been carrying news stories and reports to identify the loopholes and lacks in the health sector.
To ascertain the reasons for the deteriorating doctor-patient relationship in the Valley, Kashmir Images spoke with some prominent doctors. They were kind enough to share their views with us explicitly. Read on:
The good doctor-patient relationship always involves the 2-way exchange of gratitude and understanding. This relationship is developed on the basis of regard and trust towards each other from both sides.
I will not hesitate to acknowledge the fact that the doctor-patient relationship has not been that good in Kashmir in recent years. And, that is why sometimes we observe unpleasant incidents occurring. Occasionally, we hear the complaints —mostly genuine — from both sides.
However, in this regard, I can only explain the doctor’s perspective on the basis of my 20 years of service in the government health sector. Although I agree that at times some doctors are not able to give satisfactory hearing, accurate counselling to all the patients while treating them, one has to understand doctors too do not have always a conducive environment to work in. For instance, a doctor who should see 20 or 30 patients a day, sometimes faces a rush of the patients to the extent that he or she is bound to see more than 200 patients in a day. In such scenarios, you cannot expect the doctor to pay equal attention to every patient. In the hospital outdoors, a doctor has to see a number of patients in a specific period of time. Sometimes he or she might not be able to satisfy every patient. Thus we see complaints.
Also, sometimes a doctor gets irritated to see the overcrowding even inside the hospital wards. Seeing a number of attendants sitting around the bed of a patient, doctor genuinely get irritated. Then the attendants start complaining that the doctor misbehaved with them. Once I saw a number of relatives of a patient coming inside the ward carrying baskets full of fruit and other eatables. I was surprised to see so many people simultaneously coming inside the ward to visit the patient. Such scenes are really irritating for the doctors.
That said, I don’t deny that sometimes a doctor might be at fault but, we must understand that doctors are also human beings. He or she cannot be alert and faultless all the time. Unfortunately, ever since the emergence of social media, each and every such unpleasant incident is reported out of proportion, sending out a notion that nothing is okay in the health sector.
As far as the health department is concerned, we have been taking continuous measures to ensure improvement in the mechanism and system in the health sector. For instance, the vacant posts are being filled to bridge the gap in the doctor patient ratio. Also, the department is trying to ensure comfort to the doctors by reducing their work hours so that they are not overburdened and they are able to give their best.
All these initiatives are made to ensure patients are treated well. However, as I told you earlier that a good doctor-patient relationship involves reciprocation of gratitude from both sides. It is our collective responsibility to ensure we develop a cordial and good doctor-patient relationship.
In civilized and developed countries, where human lives are valued and humans are given due respect and dignity; a general physician deals with 30 to 50 patients a day. A specialist sees a maximum of ten patients, and a super-specialist sees five patients a day. However, in the case of Kashmir, a doctor on average sees more than a hundred patients a day. In government hospitals, they are forced to have a workload by the incompetent administrations, and at their private clinics, their greed forces them to deal with innumerable patients. This trend has its repercussion for both – the doctor and the patient. When a doctor works like a machine, he or she forgets the fact that a patient is a human body with emotions and feelings besides biology. Most of the time they even forget the ethical principles of medicine like listing the history of a patient, learning about his or her food habits, genetic issues, and so on. They are always in a hurry, overburdened and exhausted. Their exhausted state of mind even hampers their research, which otherwise is an important part of their profession. They don’t update themselves because they don’t have time to read about the day-to-day updating and modernizing of medical science.
I feel sad to say that many of our doctors in Kashmir are not doing medical practice; they are just earning the money. They consider their patients as customers. It is no secret that some of the doctors even get a hefty commission from the pharmacy companies to prescribe their brand of medicine. A doctor is supposed to be a messiah (a saviour). He or she is supposed to educate the patient about the disease that the patient is grappling with. William Osler, a world-famous Physician (1849-1919), has famously said: The good physician treats the disease; the great physician treats the patient who has the disease.
Before I conclude, let me also say a few things about the behaviour of Kashmiri patients as well: In Kashmir, patients are mostly ignorant, innocent, and impatient. Above all, they are ‘kaan kay kachchay’ (gullible). They believe rumours more than a professional doctor. That is why we see them changing their doctors like they change their clothes. Even sometimes they change their doctors to treat their lifelong diseases like diabetes, hypertension, and hypothyroidism, hoping that the next doctor might give them some ‘miraculous medicine’ which will heal them once for all.
Also, they believe more in peer faqeer (supposedly spiritual healers). Even sometimes they like better to consult some salesman on the pharmaceutical shops and ask them to get advice and medicines for their ailments. On the basis of my more than forty years of experience, I can tell you that it is very difficult to treat a Kashmiri patient physiologically. And, this is one of the key reasons; we don’t see a good patient-doctor relations ship developing here in the Valley.
It is faith that brings an ailing person to a doctor. The definition of faith can be understood by looking at how a person goes to a barber to trim his beard knowing that the barber has a sharp-edged razor, which can prove lethal, in his hands. Yet the person goes and gets his beard trimmed. That is faith. And, we have never seen or heard that a barber did cut the throat of the person while trimming his beard.
Similarly, a patient gives his or her life into the hands of a doctor. And the doctor knows that he or she is dealing with a fragile human life. Yet, a doctor does not hesitate to treat the ailing person. This is all about the doctor-patient relationship.
However, things have changed to some extent since Google came into our lives. Now, before visiting a doctor, patients try to google out the information – which is mostly misleading particularly for a non-professional. This has shaken the unconditional faith that used to be there once upon a time, and eventually, ruined the doctor-patient relationship.
Also, most of the patients themselves decide to go to specialists without knowing what disease they actually are suffering from. In developed countries, a patient is never given direct access to a specialist. A patient has to go to the primary health care centre first, where he or she is investigated and then referred to a specialist, if needed. After proper investigation, primary care physician suggests and advises what to do. Here in Kashmir, if someone has a headache, he or she decides to go to a neurologist, without knowing the real cause of his or her headache. Then, due to the unguided treatment, the patient is not cured, and then he or she starts going from one place (doctor) to another. This is one of the biggest causes that we see a deteriorating doctor-patient relationship here.
Then, social media has ruined this relationship further. If death of a patient occurs unexpectedly, the relatives of the deceased take social media to blame the doctors’ negligence. Social media warriors start spreading the same narrative without waiting for the outcome of investigation by the law enforcing agencies. This trend has brought a bad name to the medical profession, which otherwise is a very noble profession. Do you think a doctor would deliberately do something to harm the patient? Even if there are such charges against a doctor, he or she should face the law of the land, not the rage of social media. I strongly believe that social media has furthered the trust deficit between a doctor and patient.
Last but not least, we must understand that we do not have an up-to-the-mark infrastructure and manpower in Kashmir. We cannot compete with the West and Europe in terms of the health care system. For instance, we have one doctor for the population of 1880 persons in J&K —almost equal to our national average. But in the US the doctor-patient ratio is 2.5:1000. In places like UK and Australia the figures for the doctor-patient ratio stands as 2.8:1000, and 3.4:1000 respectively.
Having said that, I would say we have improved a lot and the process of improvement is continuous. When I became a doctor almost 50 years ago, we had nothing here. I remember that even blood urea nitrogen (BUN) test would not be done in SMHS those days.
Let me begin with a quote from Hippocrates, who is considered the father of medicine. In 460 BC, he said, “No matter how competent you are as a doctor, you are not a good doctor if you are not empathetic towards your patients.”
To simplify it, I would say that you are not a good doctor if you are not caring. I believe that the doctor-patient relationship is important even more than the competence of the doctor. Because to be a doctor is not only about competence, rather is more about faith, attitude, and behaviour of the doctor. If a doctor is not able to communicate with a patient; and is not empathetic, caring, and kind enough to a patient; does not put a warm hand on the patient’s shoulder; does not shake hands with a patient; and doesn’t take the emotional aspects of the patient into consideration; he or she cannot be a good doctor.
Sadly, the majority of us have not developed the essential component of patient care – a good doctor-patient relationship – over the years. And, I have been voicing my concerns about this for a long time.I have observed that most of the patients leave hospitals dissatisfied, not because of the incompetence of the doctors but because of the bad behaviour of the doctors and paramedical staff.
Possibly, the reason for this misbehaviour of doctors is that during the MBBS courses, the prospect doctors are not taught this aspect of patient care, which otherwise is as important as giving treatment to a patient. They are not taught medical ethics and they are not taught how to communicate with the patients. Sometimes we see even senior doctors misbehaving with the patients, except when they are in private hospitals and clinics. Have the senior doctors been behaving nicely with the patients, the juniors would have imbibed this behaviour.
Furthermore, let me also tell you that most of our doctors are not doing what they are being paid for. We see government sector doctors are running private hospitals in Kashmir. This is happening in Kashmir only. I am not against the private health sector. But it should not grow at the cost of the public sector, where poor patients go. Doctors in government hospitals are public servants and they are being paid hugely to serve the people, who come to these hospitals. Unfortunately, they serve more in private hospitals and at their clinics. There are indeed some exceptions, but usually, a surgeon who does two or three surgeries a week in the government hospital operates upon more than two dozen patients a week in the private setup. Even some of them bring their patients from their clinics to get them free investigations in the government hospitals. This is a mafia existing here.
In this scenario, how could one expect a good doctor-patient relationship to develop here? Having said that, I would say that we need to work to ensure that the situation changes for good.