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)
