Tuesday, February 18, 2020

Trust in today’s patient doctor relationship

Trust in today’s patient doctor relationship

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

On Monday, I was invited to participate in Apollo Republic Health Conclave and there was a discussion on trust deficit in today’s patient doctor relationship.

Over 2 crore people are seen by Doctors daily which amounts to 730 crore patients in a year. Incidents of major violence occurring once or twice in a year does not amount to calling mistrust against medical profession as widely prevalent issue.

On one hand It is needed to have strict anti-violence law within the purview of Clinical Establishment Act or National Medical Commission act, on the other hand we also need changes in the way patient doctor relationship is thought today.

We all know there are four types of patients and all need a different handling.
First one’s are ignorant patients who have 100% faith on the doctors and go by their decision.

Second are informed patients with some science background. They are aware about illness and Wellness and needs proper counselling.

Third are empowered Google friendly patients who would not only like to be counselled but also wants to be a part of shared decision making.

Fourth are the most important and the enlightened patients who believe in taking multiple opinions both National and internationally and believe more on Google then on an individual opinion.

All categories may get hurt if their respective trust is lost. Their expectations are also different,

Most of the educated people today wants a share decision as they are educated and empowered.

In the medical practice we also take needs to take lessons from the way advocates and judges’ practice. They don't believe in spot decision or diagnosis even in emergent situations. They take time to listen to arguments, reserve the order and when in doubt often take a joint decision by number of judges sitting together.

We also need to learn from the judicial system that to review a case it must be filed in front of the same judge and not the second judge. All judges know that individual opinions may differ. To file a review, you must approach
a double bench and not a single bench. If you are still not satisfied you can appeal up to a full bench.

When a patient comes to us, he has not come to us for a life he has lived but advise for a life which is yet to be lived. Therefore, for us his age is 100 - present age and we should plan a Wellness plan for him to live rest of his life and not only concentrate on his present illness alone.

Vedic medicine has taught us that there are two states of Mind sympathetic and parasympathetic. Every patient or his or her relation is in a state of acute stress or a sympathetic state of mind and needs both treatment and counselling at the same time.

We also must understand from principles of Bhagavad Gita that a person in acute confusion like Arjuna will require multiple sessions of counselling like 18 such sessions between Arjuna and Krishna.

Doctors are considered next to God and therefore they have no right to be in a sympathetic state of mind while treating a patient. They need to relearn staying in parasympathetic state of mind. The two main components of para sympathetic state are beneficence and non-maleficence.

Two sympathetic states of Mind interacting with each other will only end up into a disaster.

Sympathetic state of anger or ego last only for 10 seconds and hence manageable and preventable.

What the patients expects is ALERT (acknowledgement, listen to them, explain to them, review what they have understood and thank them)

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