Let it stay noble

COVID19 outbreak driving the unprecedented ongoing health emergency has grossly exposed gaps in infrastructure and human resource in health sector across the globe.

As the infection is yet to get a valid treatment, the element of fear is looming large on general public for losing life to this deadly virus.  During the course of this prevalent fear, Life savings institutions stand overburdened, where confusion and chaos has gripped health professionals as well as the general public.

Precisely, if the situation has put the medical scientists and global human saving institutes to crucial test, it has at the same time further dented the trust factor in doctor-patient relationship. This deterioration in doctor-patient relationship is not only affecting the social relationship but also the treatment of patients, as there is always a feeling of mistrust and suppression of facts.

Today is a reason to deliberate upon this once scared doctor-patient relationship in our own (J&K) context. Back-to-back incidents of man-handling of doctors by attendants of patients, in a Srinagar hospital last week, has once again brought the deteriorating doctor-patient relationship to focus. Doctors fleeing from the hospital to save themselves from the wrath of a few unruly attendants is shocking, it is enough to gauge the plight of health professionals especially the frontline doctors serving in Jammu & Kashmir hospitals.

International Journal of Community Medicine and Public Health  has defined the doctor-patient  relationship  as  “a consensual  relationship in  which the  patient knowingly seeks  the  physician’s  assistance  and  in  which  the physician knowingly accepts the person as a patient. Quoting Emanuel and Dubler, the Journal has suggested that the ideal doctor–patient relationship consists of  six  Cs:  choice, competence, communication, compassion, continuity, and (no) conflict of  interest.

If we peep into the past, we find no questions were raised about this noble service. A doctor would always remain in commanding position while dealing with the patients and patients, or their attendants, would never dare to argue with them. There would never be an iota of doubt on the integrity and treatment capability of a doctor.

Why has the trust in doctor-patient relationship faded away to such miserable levels? This is a million dollar question, especially in the context of our own hospitals. Ask any junior doctor, senior resident, or a doctor who is discharging duties as registrar in the hospital, they in one voice say that patients hardly trust them, and their treatment capabilities. “If we find a patient with minor ailment, we prescribe treatment and ask him to go home. But most of the patients lose cool, thinking that we have not shown interest in the ailment. At the same time, when we find a patient seriously sick, we prescribe medicine as per the protocol. This time the patient calls us agent of some pharma companies for prescribing medicines which are not available in hospital and are a bit expensive. In both situations we are at the receiving end,” a group of doctors while describing their plight narrated.

We have many times come across attendants manhandling a doctor if the patient is asked to stand in queue for consultation, or the medico’s treatment fails to provide any relief to the patients. A common thread in such incidents is that the doctors (JRs/SRs/Registrars) at the operational front have been the victims, as the consultants or heads of departments (HoDs) very rarely come across the patients in hospital chambers meant for public. Here I don’t think it would be unjust to blame these senior medicos for the kind of deterioration we have been witnessing in doctor-patient relationship. Many allege that some consultants/HoDs strike deals with pharma companies to run a product. This aspect of these senior doctors is not hidden and many times fingers were raised at them for acting as medico marketers – an extended arm of pharmaceutical companies. Generally speaking, this behavior of senior medicos, who are responsible for running a human saving institute have been actually responsible to shake the trust factor in doctor-patient relationship. Patients have been forced to doubt the treatment protocol of such medicos. Since these senior medicos are not in direct contact with most of the patients, the doctors down the line like JR/SRs and Registrars are left to face the fury of public for none of their faults.

It’s a common notion in public that in the name of curing kidney pain, stomach pain, gall bladder disorder etc., some of the money-minded doctors perform surgery when such disorders can normally be treated with oral medication. This style of functioning goes against the Hippocrates’ oath. They seem to have vowed to prescribe unnecessary medicines and tests to the patients. These doctors don’t believe in what Hippocrates said; “Let diet be your medicine.  It never comes to their mind to prescribe fresh fruits, vegetables and good diet to their patients, rather than tonics, syrups, synthetic multi-vitamins, specially to children.

Take the case of spurious drugs. It’s a huge concern confronting us on health front. Our doctors’ community has been very vocal on spurious drugs flooding our hospitals and markets. They have been blaming administrative authorities for allowing a spurious drug to enter the J&K markets. But who is responsible to make these drugs to reach to the patient? Obviously, it’s this breed of ‘holy men’ playing a key role in spreading this menace. They are influenced to prescribe these spurious drugs. So they are one among key players to legalise the entry of these drugs into the markets, and even into the government institutions like hospitals and dispensaries. Such doctors acting as marketing agents of pharma companies behave like business functionaries.

So our healers turn into profit earning entrepreneurs! Bribing doctors by the pharmaceutical companies, directly or indirectly, to prescribe their respective brand of drugs is an old, and worldwide phenomenon. But in our state it has now reached an alarming proportion, jeopardizing patients’ interest, seriously more than ever before. This unethical drug promotion has emerged a serious threat to our society.

To conclude, let me again quote from the pages of International Journal of Community Medicine and Public Health. The journal has summed up the current doctor-patient relationship scenario as: “In  last decade  doctor  patient relationship  has  shown  a great dip. The forces of increasing economic aspirations, stress  levels,  frustration  due  to  urbanization,  and  high levels  of competition,  distorted and  disturbed religious, and cultural values  are adding to the  intolerance among the  masses.  This has  also  led  to  the sense  of  distrust toward  the  medical  fraternity.  A  study  suggested  that nearly  75%  of  medical  personnel  in  India  have  faced some sort  of workplace  violence. This  study concluded that the 50% violent incident took place in the Intensive Care Unit of hospitals, and in 70% of cases, the relatives of  the patients  were actively  involved. Nowadays a general  feeling of  mistrust against  medical fraternity  is prevalent,  doctors are  considered  as traitor, corrupt  and money minded.”

Meanwhile, patients and their attendants have to show greatest regard and honor for doctors who are tirelessly working on the operational front. Let they be given threat-free environment to treat their patients.  This is only for the benefit of society at large. And doctors on the forefront need lessons on mass communication skills to stay safe, those at the backend responsible for deterioration in doctor-patient relationship need to be dealt with sternly.

(The views are of the author & not the institution he works for)