Why it’s docs vs patients today

Doctors and patients are suspicious about each other like never before. What ever happened to the bond they once enjoyed? Today is World Doctors Day

How did the bond of trust between doctors and patients break? Why are doctors afraid of patients, and patients distrustful of the doctors they once considered Gods?

The recent strike by doctors reflects an alarming reality: doctors want protection from patients and their relatives. Patients see doctors with equal suspicion, the most common complaint being that they rip them off.

“A general mistrust has crept in towards doctors in all specialities. But painting everyone with the same brush is wrong,” says Dr Pratima Murthy, professor and HOD of Psychiatry, Nimhans.

Patients tell stories about how they ended up doing test after test just because the doctors insisted on them. Or how a relative was kept in the ICU for ever, how an illness drove them to debt. And how doctors did not accept results from labs they were not aligned with.

“Doctors are hand-in-glove with diagnostic laboratories,” says Laxmi Sanjeev, homemaker, whose mother was the victim of a mistake by a reputed neurosurgeon.

She says she has seen doctors create situations in which patients and their relatives get emotionally blackmailed.

“The doctors are just out to make a fast buck,” she says.

A noted retired neurosurgeon who did not want to be named, says doctors often prescribe tests because they don’t want to go just by their intuition.

“Because of various rules, regulations and the Consumer Protection Act, doctors are now scared to make a clinical diagnosis unsubstantiated by laboratory investigations,” he says.

In earlier years, the patient gave a history and that formed the basis of the doctor’s diagnosis.

The clinical examination merely confirmed the diagnosis and laboratory investigations were meant as paperwork for insurance.

Doctors must use their discretion and not routinely prescribe tests and procedures, says Dr Naresh Bhat, former president, Indian Society of Gastroenterology.

“If it’s critical to taking a decision, I will do a test. Otherwise, I won’t do one. This way, we are able to minimise the number of tests in my unit,” he says.

Not everyone follows that policy, of course.

An international journal recently wrote about ‘hyposkillia’---doctors having fewer skills than ever before. The doctors substitute skills with diagnostic tests, and that is a bad trend, Dr Bhat says.

“In my unit, no corporate manager will come and tell me I’m not doing enough tests or procedures. That’s because I have credibility, I have the reputation. But a junior doctor may get manipulated or threatened,” he explains.

Patients often sniff out unethical practices. “We can figure it out if there is a pharmacy-level tie-up: only if I go to a particular store do I get the medicine,” says Shashidhar Rajarao, software engineer and a diabetic.

He says trust is gone, so he evaluates his doctor’s prescriptions, which he would have never done in the past.

Dr Bhat says that is not necessarily a bad thing.

“I don’t think it’s possible to have implicit faith in every doctor. Why should you? You have to check with others about the doctor’s reputation. Why would
you not do that?” he wonders.

Dr G D Ravindran, professor of medicine and ethics, St John’s Medical College, expresses says if medicine is an industry, standard operating procedures must apply.

Given the exorbitant cost of medical education, it is possible many doctors compromise and think of making a ‘quick buck’ with the help of unnecessary procedures, he says.

Many hospitals in Bengaluru offer good services at reasonable rates, according to Dr Srinivasa S, state secretary, Indian Medical Association.

“The IMA definitely talks about the ethics of the doctor-patient relationship. We have taken the Hippocratic oath and we follow that. The IMA protects both doctors and patients,” he says.

Dr Ravindran says rules already exist to stop doctors from profiting by prescribing diagnostic tests and procedures.

“The ethics questions and solutions are all listed out. But what is called for is their implementation,” he says.

Since the labs and the doctors are equally guilty, one party will not complain against the other, he reckons.

“People have to put pressure to change the attitude,” he says. “Unless society changes, nothing will change.”

The debate takes back many patients to an era of greater confidence in the medical system.

“My mind often goes back to our village doctor,” says B S Divakara, 56 years old, industrialist who suffers from diabetes and hypertension. “His sincere concern and passion for his job are etched in my memory.”

Divakara says that doctors see just a bundle of disorders and chemical upheavals, and not an individual.

But that doesn’t mean he doesn’t trust his doctors. “Although I have heard horror stories, luckily, I have never experienced them personally.”

Hospital declaration

The Indian Medical Association’s ‘self code’ of regulations for hospital and clinical establishments states:

“We ensure non-indulgence in any activities that are unethical or illegal such as… accepting any gifts, cash benefits or monetary grants or gratification from the drug, equipment suppliers or similar health care agencies. Our administration continuously monitors and ensures that no staff indulges in any such activities.”

Few hospitals display this message anywhere on their premises.