All is not well in the doctor-patient relationship
Sajjad Bazaz
National Doctors’ Day is celebrated on July 1st every year in India since 1991. This day holds importance for acknowledging personal sacrifices of doctors to ensure the health and well-being of their patients; to highlight advancements in medical science and the achievements of doctors; to serve as a reminder of the importance of health and regular medical check-ups; and to reinforce the importance of doctor-patient relationship.
Let’s take this opportunity to deliberate upon the issues confronting doctors as well as patients in our region (J&K) adversely impacting the performance of the health sector. Incidents of unhealthy developments trapping our doctors’ community on the wrong foot are very common in our region. These incidents trigger dual anger among masses. First, the majority of opinions gather against the ‘unholy’ practices of our medical doctors. Second, groups in defense of these holy professionals vomit anger against those who expose their ‘unholy’ deeds. Amid these developments, the sacrosanct chord in doctor-patient relationship has only weakened over a period of time.
Doctor-patient relationship
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 the six C?s: Choice, competence, communication, compassion, continuity, and (no) conflict of interest.
Here I am reminded of an old proverb that “Doctor is the second God on this Earth”. Genuinely so. For a patient, it’s the doctor who can rescue him from the clutches of death. This unflinching faith on doctors has never challenged their status as ‘second God’. We observe that a common man will fight for one or two rupee with a vegetable /fruit vendor but will never confront a doctor on treatment pricing. The reason is simple: For him this ‘second God’ is the only fervent hope to save him from getting consumed by a disease.
But do our ‘holy’ professionals (doctors) fit this adage? Over a period of time, this holy profession has been witnessing unholy trends at our place. These ‘holy men’, of course not all of them, have engaged themselves in trading politics rather than treating patients. Besides, they have developed an attitude to look upon a patient as a money generating machine and don’t hesitate to employ all strategies to make money out of their illness. It makes them no difference whether the condition of the patient improves or worsens. Whatever they value is just money, not anything else!
If we slightly 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 his 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.
Fading trust in relationship
Why has the trust in doctor-patient relationship faded away to such miserable levels? 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 his ailment. At the same time, when we find a patient seriously sick, we prescribe medicine as per the protocol of his ailment. This time the patient calls the agent of a pharmaceutical company for prescribing medicines which are not available in the hospital and are a bit expensive. In both situations we are at the receiving end,” a group of doctors while describing their plight narrated this. We have many times come across attendants manhandling a doctor if the patient is asked to be in a queue for consultation or the medico’s treatment fails to provide a 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 head of departments (HoDs) very rarely come across the patients in hospital chambers for the 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 the doctor-patient relationship. Most of the time, these consultants/HoDs are busy striking deals with pharma companies to run a product across patients. 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 for shaking 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 mass patients, the doctors down the line like JR/SRs and Registrars who are mostly out of touch from such deals are left to face the fury of the 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 are normally treated with oral medication. The style of functioning of most of the doctors in our region which includes some leading doctors reflects the opposite of Hippocrates’ oath. They seem to have vowed to prescribe unnecessary medicines and tests to the patients; prescribe lethal drugs, like antiretroviral, chemotherapy, or give ECT to their patients and frighten them with unnecessary comments, opinions or advice.
Menace of spurious drugs
It’s a huge concern. Our doctors’ community has been very vocal on a wide range of spurious drugs flooding our hospitals and markets. They have been mainly blaming administrative authorities for the menace. But who is responsible for making these drugs to reach the patients? 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 the one among key players to facilitate the entry of these drugs into the markets and even into the government institutions like hospitals and dispensaries. Here this segment of doctors engage themselves as marketing agents of pharma companies and act more as business functionaries.
Skewed drug prices
Speaking specifically in the context of J&K, the controversial increase in the prices of drugs is a continuous process and is not less than a tsunami for the patients. pharma trade tricks galore well under the nose of authorities eating the savings of gullible patients. Even as you see the cost of the medicine plainly displayed on its cover, the actual cost price of the drug remains invisible. It’s wrapped in so many layers like maximum retail price (MRP) that almost no one understands what’s really happening. The maximum retail price (MRP) printed on most of the drugs or a n healthcare article is already loaded with unbelievable margins ranging from 100 to 1000 percent!
Here, depressing instances galore in abundance when even a financially sound family had to sell-off their assets to meet treatment expenses. Any savings become the first casualty when it comes to availing healthcare facilities – be it diagnostic tests or purchase of medicines. Not only savings go, money is borrowed to foot the medical bills. Ultimately, acute miseries engulf such families.
The high cost of life-saving drugs has been consuming the life of a patient more than the disease itself. Here every unit responsible for the pricing and distribution of life-saving drugs like stockists, retailers, carrying and forwarding agencies and other liaison agents are involved in the loot at the cost of a human life.It is not a surprise to see the drugs, whose prices are ceiled as per the Drug Pricing Control Order (DPCO) decided by the NPPA, are being sold at two to ten times of the original cost in local markets. As per the DPCO rules, the traders cannot sell these drugs at a profit margin of more than 16%.
Points to ponder
Why can’t there be treatment guidelines issued by the government for the doctors in terms of prescribing medicines and conducting periodic prescription audits? Can’t we end this nexus between the doctors and the pharmaceutical companies by invoking a regulation wherein the companies are asked to follow disclosure norms stating expenses incurred on gifts to doctors? Why can’t we have a ‘Sunshine Act’ where disclosure of all financial transactions and transfers of value between manufacturers of pharmaceutical / biologic products or medical devices and physicians, hospitals and covered recipients are made mandatory? ‘Sunshine Act’ will reveal actual pharmaceutical-marketing expenditures of individual drug companies. If the expenditure is found contributing disproportionately to the total expenses of the company, the regulators can immediately put strictures and force the company to stop unethical influencing of doctors. It can also have a huge impact on the medical expenses of patients as the controlled marketing costs will bring down the prices of medicines. There is a need to frame comprehensive legislation to make these holy professionals accountable to the system. This alone will help to strengthen the trust in doctor-patient relationship. More importantly, it will restore the credibility of the holy profession in the region.
(The author is former Head of Corporate Communication & CSR and Internal Communication & Knowledge Management Departments of J&K Bank)
