Benefits of patient-doctor relationship

I HAVE just read an interesting article in the Health section of TIME magazine (Sept 3-10) titled “Placebo’s new power”.

Placebo pills have long been used in clinical trials to facilitate researchers in comparing the efficacy of a particular treatment or new drug being studied. However, it was not so much the suggestion that placebo pills may one day be used as part of an actual medical treatment that got me thinking. Rather, it was the psychological concept behind this postulation – the patient’s mind and how he or she perceives the treatment received – that made me wonder if such findings can be applied in our current healthcare system.

Although I am not a healthcare professional, I wish to offer some insight into the current situation most patients face at a clinic or hospital. Please understand that it is not my intention to offend any medical staff or officers who often work long hours and have to deal with many patients, each with their own set of quirks and problems. However, based on my experience as a patient under long-term follow-up in a clinic for a chronic health issue, there is still room for improvement when it comes to providing proper service and treatment to the society at large.

For starters, it needs to be reiterated that within the healthcare sector, service and treatment are two distinct aspects that go hand in hand. When a doctor decides on a set of medications for a particular ailment based on his/her knowledge and experience, the criteria for providing proper treatment to a patient have been fulfilled.

However, provision of the prescribed treatment does not necessarily mean that proper service has been given. For instance, a timepressed doctor may be curt or appear to be in a rush to conclude the diagnosis as soon as possible, leaving the patient quite clueless about their condition. The same patient may then be directed to a pharmacy or dispensary where the harried staff give out the prescribed medications with the minimum set of instructions but little or no explanation about them, often due to the large number of patients visiting a clinic or hospital per day.

Under such circumstances, an objective analyst would agree that the patient has been treated but the service provided may affect the patient mentally or emotionally. In the end, the patient may (out of pettiness or lack of personal responsibility) refuse to follow their treatment course as instructed by their doctor or pharmacist.

This may seem like a trivial matter, especially since the patient’s psyche is usually not taken into serious consideration unless it involves psychiatric conditions. However, this may impair the efficacy of the intended treatment or medication. As such, one’s service can be viewed as embodying an important psychological element in the healthcare sector.

In the same vein, I feel that most patients are being treated like exam candidates, whereby target laboratory results and other monitoring parameters need to be achieved and maintained. The human element and empathy are often lacking during medical staff-patient interaction.

While I personally understand the importance of such targets in ensuring one’s health, quality of life and reducing the risk of certain diseases, not every patient may be able to grasp these concepts. As a result, some patients (such as my elderly relative who is also under regular clinical follow-up) may end up being fearful and apprehensive.

On one particular occasion, this relative was so intent on achieving a proper blood sugar result before his appointment the following day that he chose to fast beyond the required duration suggested by the nurse. He fainted and had to be monitored at the emergency department due to his sugar levels being too low (a condition called hypoglycaemia).

When the healthcare staff are too busy or too pressured to take the time to explain such matters to their patients beyond the rudimentary dos and don’ts, it is as though the patient has been shortchanged. This is not the fault of any individual or profession in particular. However, a warmer and more compassionate approach can go a long way in improving health outcomes because patients would have a better understanding of the reasoning behind certain medical decisions and be encouraged to take greater personal responsibility in caring for their health.

Even so, the patients themselves need to change their mindset. Many mistake “fast service” for “effective and efficient service”. While waiting for my monthly prescription to be refilled, I often hear other patients complaining of the snaking queues during peak hours and long waiting times. Some would loudly proclaim to their seat neighbours that they already know all their medications and that it is a waste of time having to hear the same thing over and over again at the dispensary.

I found it slightly amusing yet disrespectful when, during a visit to a clinic the previous month, a patient ahead of me in the queue brushed off the pharmacist with a “semua ubat saya sudah tahu (I am already well versed with all of my medications)” comment before demanding to be registered for a drive-through service to save time during the next appointment. Such patients seem to only focus on the service aspect of the healthcare sector and not on their actual treatment regime.

Instead of actually asking appropriate questions that may help them have a better understanding of their disease and the medica- tions required to control it, they seem to view their clinic appointments as some burdensome chore that needs to be done with as soon as possible.

Others behave like customers at a wet market or economy rice stall, cherry-picking their “favourite” medications while disdainfully rejecting the others. This is not an observation that I have conjured out of thin air just to prove a point because I myself have witnessed such scenes when accompanying an elderly relative for his appointments.

I feel both parties – the providers and recipients (patients) – need to appreciate the psychological aspect within the healthcare sector to ensure better end results. A relationship between a patient and a healthcare provider that is based on honesty, compassion and understanding can have a positive impact on everyone and would be a good remedy, in conjunction with the effective treatments that are already in place in health facilities.

To quote the American Medical Association mentioned in the TIME magazine article: “Physicians can produce a placebo-like effect through the skilful use of reassurance and encouragement, thereby building respect and trust, promoting the patient-physician relationship and improving health outcomes.”