Why has doctor-patient trust eroded?

NOW, the private sector was accorded a bigger role. What should have been provided by the government was now taken over mainly by the corporate sector for which profit has been the only motive without any consideration for the marginalised sections.

Doctor-patient relationship is a pious one, based on trust and faith. That is why a patient feels better going to a certain doctor; but the same medicines given by another doctor may not lead to the same improvement. In routine cases, the patients wait for long without complaining so that they can meet the doctor they trust. This relationship is important because it is a question of one's own body or of kith and kin with whom he is emotionally attached. Any untoward happening during the course of treatment is not acceptable. But, if the existing relationship has been on strong bonds, there is a possibility of rapprochement. It is not a small thing that even today, patients treat a doctor next to the god. That is a result of faith bestowed upon by a patient on a doctor, who is seen not only as a healer of one's medical sufferings but also a counselor on personal and family matters. The godly image of the doctor is developed in the eyes of the patient because of the conviction that the doctor would always be ethical and his or her conduct would be based on moral principles.

But this relationship has been weakened in the last few years. There is a lot of talk about many doctors being unethical. There is a feeling in the people's mind that doctors fleece the patients either by overcharging or over-medication. This needs to be examined in broader perspective.

Any profession is a reflection of contemporary socio-economic setup. There has been a time when the doctor in our region – a vaid, would not charge anything from the patient and be content with whatever was given to him in offering – the dakshina. The same was true for the teacher – the guru. Those were the times of limited knowledge and limited resources. Education was the right of a few selected from the socalled upper castes. Health care was comparatively more liberally available to the ordinary people, even though the vast majority of population was left to the mercy of the faith healers, particularly the poor and the marginalised sections.

With changes in the system and the entry of modern scientific medicine in the health scenario, the situation has started changing. There was extensive research and new drugs came up, which needed marketing. Thus, medicine started becoming a business. There was a time when the young students wanted to be doctors because they thought that it is a noble profession and they can serve the society by ending the sufferings of people in addition to a financially secure life and social status as a doctor. It was an overt feeling.

Change occurred rapidly when the socio economic relations in our country were redefined. There was a paradigm shift in 1980s. The government started shedding its responsibility from health care and decided to change its role from a provider to facilitator. Even though, the private sector has been the major healthcare provider earlier too, its role was limited to only the basic or secondary level healthcare. Advanced tertiary healthcare was the government’s domain. Now, the private sector was accorded a bigger role. What should have been provided by the government was now taken over mainly by the corporate sector for which profit has been the only motive without any consideration for the marginalised sections.

This is the time when in the competitive market healthcare professionals too got affected. The cuts and commissions began from the diagnostics stage and then even in the referrals. Pharmaceutical sector started bribing the doctors to prescribe their products. This weakened the trust of the patients. Even though a small number of doctors were not involved in such deals, the image of profession as a whole got affected.

Medicine is a distinct profession where we serve the sick and infirm. It has a bigger responsibility and should be powerful enough to withstand the impact of market pressure. Whereas doctors owe responsibility to bring back the doctor patient relationship on strong footing, it is also for the society to see that aspirations of doctors are fulfilled, and all doctors are not viewed in the same light.

The writer is senior Vice President – Indian Doctors for Peace and Development, Former Chairman – Ethical Committee, Punjab Medical Council and Member – Core Committee ADEH (Alliance of Doctors on Ethical Healthcare).