A fragile relationship Building trust
The matter of trust in patient-doctor interactions.
TRUST is the basis of the social contract between society and the medical profession in most jurisdictions. This stems from the belief held, since time immemorial, that doctors will always act in the best interests of patients.
It is difficult for patients to explain why they trust their doctors.
It is often described as a “gut feeling” about the doctor’s interpersonal skills like caring, compassion and concern, as well as their technical competence.
Although patients have separate impressions about a doctor’s interpersonal and technical competence, it is more difficult for patients to distinguish how the two impressions interact to colour their judgment of whether they can trust a doctor.
Managing expectations
In the past half century, the changing expectations of patients have impacted on the patient-doctor relationship.
Before then, the relationship had been paternalistic, and to a certain extent, that still predominates today in many settings.
The imbalance in the knowledge between patients and doctors have been narrowed by increasing access through various sources. Some patients today are better informed about their medical conditions, investigations, procedures and care options.
On the other hand, there are still many who have incomplete or inac- curate information.
The information proliferation may be contributing to expectations of unrealistic and perfect outcomes.
The print and electronic media often report and/or depict advances and improvements in outcomes that are not possible in every clinical situation.
Doctors have also contributed to these unrealistic expectations.
When and if the perfect outcomes are not achieved, there are possible medico-legal consequences, particularly when there are adverse events.
Communication technologies are expanding. Web portals, emails, electronic health records and health applications provide opportunities and challenges to the patient-doctor relationship.
The introduction and growth of these technologies are rapid. Regulators and doctors encounter challenges in assessing their effectiveness in the delivery of safe care.
Furthermore, doctors and healthcare facilities have a fiduciary duty to ensure patient confidentiality, which is challenging in the virtual world.
Social media has introduced new complexities in the patientdoctor relationship.
It undoubtedly increases connectivity, with potential benefits and risks. However, doctors have been cautious in its use and are guided by continuing commitment to patient confidentiality.
Many doctors have learnt the hard way how easily accessible and enduring online information is.
Facing challenges
Good medical practice requires the maintenance of appropriate boundaries – a professional distance between doctors and patients.
This means setting limits on the nature of the relationships with patients and their families, as well as treating family members and friends.
Changing values and behaviours, communication technologies and social media are posing challenges to this sine qua non of medical professionalism.
All medical students are taught to treat their diverse patients and healthcare staff equally and fairly.
This means respecting, recognising, appreciating and valuing every patient and staff member as an individual.
It also means no discrimination, irrespective of the patient’s ethnicity, culture and religion.
Fairness means conformance to rules and standards; making judgments that are free from bias, discrimination and dishonesty; and being just to every patient and staff member.
These basic tenets of the medical profession are undergoing challenges, so much so that there are questions as to whether these values are internalised in medical graduates today.
The behaviour of some doctors in Malaysia and abroad have undermined trust in the patient-doctor relationship.
Some examples include the description of vaccines as najis by a Health Officer and a photograph of a junior doctor performing an intimate examination.
Others include disclosure in court of photographs of a female patient’s private parts without her consent, and usage of the doctor’s semen in artificial insemination.
There are several ways one can ensure that the doctor and his/her recommendations and/or advice are trustworthy.
The names of doctors registered with the Malaysian Medical Council (MMC) can be obtained from its website www. mmc.gov.my, together with the annual practicing certificate and place of practice.
One can also check with the MMC whether a doctor has been found guilty of unethical conduct.
The qualifications of specialists and their specialty can be obtained from the Academy of Medicine and Health Ministry’s (MOH) National Specialist Register (NSR) website www.nsr.
org.my. It is important to make sure that the doctor is not practising outside his/her field.
This problem is particularly common in aesthetic practice, in which doctors of different specialties practise.
Information about doctors practising aesthetic practice and their scope of practice can be obtained from the MOH.
Regulators in other countries like Singapore, Australia, New Zealand and Britain have similar information on their respective websites.
There are doctor-rating websites in developed countries, in which patients share their experiences and reviews of doctors.
Finding your doctor
The relationship between a patient and doctor takes time to develop. It is advisable to have a regular doctor, usually a general practitioner (GP), to manage the common illnesses that afflict everyone from time to time.
It may take several consultations with several doctors to find a reliable GP that one is comfortable with, but the end result is worth the effort.
Ask the doctor if there is anything that is unclear.
All doctors have a duty to provide sufficient information to a patient for informed decision-making. If the doctor does not take questions seriously, then find another doctor.
Ask a nurse or other hospital support staff who they go to for advice and treatment. Hospital staff know who the good doctors are in their facility.
A second opinion is advisable if one is not comfortable with a doctor’s recommendations or advice.
The second opinion can be from another specialist(s) in the same field or one’s own GP.
Be cautious of doctors who advertise too much about themselves. The quality of a doctor is often inversely proportional to the size of the advertisement.
Active participation in one’s own healthcare is recommended.
Although doctors have medical records of their patients, they usually do not contain the personal experiences of patients when they are sick.
Recording one’s experiences and medical history is useful for other doctors who have to manage problems in emergency situations.
It is also useful in the management of chronic diseases.
Although there is often focus on unethical doctors, the majority of doctors practise ethically and place their patients’ best interests first.
Unfortunately, this does not make it to the media.
Doctors often provide healthcare over and above their normal duties.
Examples include the provision of pro bono care to the underprivileged, and continuous care to patients in the operating theatre and/or intensive care unit. associated with. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information. Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. The views expressed do not represent that of organisations that the writer is