Dr Tushau Prasad, Emergency Physician, Wockhardt Hospitals highlights that the unique relationship between doctors and patients has been a topic of debate and interest and has been described by many psychologists, philosophers, sociologists and legal experts for several centuries. At the centre of this relationship is the patient’s trust and doctor’s integrity to uphold ethical standards resulting in a reliable, effective and durable relationship
In the business world, it is said employees make customers happy. In medicine, it is no different narrative, happy doctors make patients happy, which results in better outcomes. What makes doctors happy? At the core of medicine practice is the doctor-patient relationship. Most physicians today will share that one of the main reasons they chose to practice medicine was to help people and build relationships with their patients over time.
The doctor-patient relationship is a central part of health care and the practise of medicine. A doctor patient relationship is formed when a doctor attends to a patient’s medical concerns and is usually through a consent.
The unique relationship between doctors and patients has been a topic of debate and interest and has been described by many psychologists, philosophers, sociologists and legal experts for several centuries. At the centre of this relationship is the patient’s trust and doctor’s integrity to uphold ethical standards resulting in a reliable, effective and durable relationship.
Doctor-patient relationship (DPR) is crucial for patient outcomes, especially during an emergency like the COVID-19 pandemic. Doctor-patient trust is the cornerstone of the treatment, which tends to involve communication and satisfaction. It is a known fact that a healthy and positive doctor-patient relationship has the power to influence the healthcare quality and empower the patient to deal with their disease during a pandemic. This relationship can be nurtured by valuing the patient as a person and managing the power imbalance, commitment and physician’s competence and character.
India has a unique set of cultural, socio-political and economic aspects that may influence the doctor-patient relationship in a unique way.
The COVID-19 pandemic directed us to change how we evaluate, treat, and interact with our patients. Maintaining all of the necessary safety measures have pushed us to find newer ways to comfort and connect with patients even though we can’t hold their hand or share a smile through our mask. Patients have had to make adjustments as well; they’ve had to learn new ways to relate to their health care team. But in spite of all of the new hurdles created by the virus, there do seem to be some lessons in all of this that will improve the doctor/patient relationship.
Here are a few things that the pandemic brought to light:
- Eye to Eye communication matters: We never appreciated how much we relied on our patients’ visual signals, facial gestures, and subtle body language movements until they were taken not available due to different precautionary reasons. When we started talking to our patients by telephone, we quickly learned how difficult it was to fully gauge their experience when there was no movement of the body or facial connections to go with what we were hearing.
- Self-examination can be a useful method: Touch and feel have always been an inseparable part of the practice of medicine. When patients are in pain, we often want to feel for tight muscles, tender points, the temperature of their skin, and test for things like nerve function and muscle strength. But the need for social distancing precautions and the emphasis on practicing virtually through teleconsultation has meant that our patients have become more involved in their own examination process.
- Many patients interacted virtually with their doctors for the first time. Doing so has been difficult for some patients. But, it gives us a chance to see them in the setting of their own homes. This visual of a patient’s home environment can help doctors, physical therapists, and counsellors about the patient’s life. It is possible to build a stronger bond, understand them deeply and create a positive impact in one’s life.
Patients’ trust could be built over time by spending more time listening to the patient; being transparent with them regarding the disease and the proposed care plan; acknowledging patient challenges and limitations; showing empathy and compassion; stating unavoidable conflicts of interest upfront; and regular physician retraining or re-skilling to remain competent, among other things. More importantly, systemic changes will bring about a paradigm cultural change.
Medical education programmes can be important entry points for strengthening the doctor–patient relationship and the subject of doctor– patient relationship needs to be attentively revisited in their development and implementation. Attention also needs to be paid to the ethical code of medical practice. We need to provide legal frameworks to ensure that the rights of both doctors and patients are protected. These measures will go a long way in fostering positive relationships between doctors and patients.
We need to reiterate that patients need to be treated holistically – catering for their physical, mental and social needs. Doctors too need to better understand not only the patients’ sickness, but also their social, cultural and economic profiles and, above all, their expectations. Policy-makers and health services implementers need to explore how best they can reorient policy to realistically and objectively achieve better doctor–patient relationships. I believe this will be an important consideration towards universal health coverage.
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