System has failed us including the intellectuals.

Dear Sir,

Editorial, “Our intellectuals have failed us–System of a Down” by Sundeep Mishra in Indian Heart Journal, Volume 69, Issue 2, March–April 2017, Pages 133–135 has very appropriately and rightly stated that medical fraternity is currently on cross-roads as on one hand are issues like medical mal-practice and negligence are gaining attention and on the other hand issues like loss of respect and violence against medical professionals are creating a lot of stress among medical practitioners. But I do not agree with the observation that most of the problems ‘seem to stem from a failure, active or passive on the part of medical intellectual and their inability to speak/take action against the evils that have crept up within our profession’.1 I think it is one of the many but minor factors contributing to progressively deteriorating loss of faith and trust between medical profession and general population leading to increasing dissatisfaction in doctor–patient relationship and increased violence against medical profession.

Overview

The doctor–patient relationship has been and remains a keystone of health care system, which forms the foundation of communication, clinical examination, diagnoses, planning investigations and treatment, affecting compliance and influencing healing and treatment outcomes.2 The doctor–patient relationship has been discussed, written, debated extensively in the past as well as in modern medical literature and has received philosophical, sociological and literary attention since Hippocrates.3 Human beings are considered to be the best creation of God and doctors are considered to be created by God to take care of pain and sufferings of human beings, that is why doctors are considered to be only next to God. On the other hand medicine is unique among all the subjects as it combines science with art. A chronic, progressive and fast dissatisfaction is creeping in doctor patient relationship affecting the society at large, like never before. In past people believed that doctor will not do any harm to the patient or misguide because of monetary considerations and if sometimes happened to the patient, it was considered to be the God's will, that mutual trust benefited both and strengthened with time. But in last two decades or so, slowly but steadily the trust which cultivated the doctor patient relationship started to erode and attained the shape of a crisis or a demon in 21st century where society does not hold medical profession in high esteem it used to in the past. Today the general perception is that commercial considerations override the professional, ethical and social commitment of medical professionals and this phrase, ‘Doctor, I salute you. You are just like Yam raja, the God of death. While Yam raja takes away life, doctor takes away the patient's life as well as his money’ sums it all. Most frightening part is that enormous progress in medical science made in this era has not translated in strengthening the doctor–patient relationship rather has lead to progressive deterioration.

Probable causes leading to deteriorating doctor–patient relationship include, erosion of medical ethics, corruption in health care system, commercialization of medical education, corporatization of health care, inequity in health care delivery, technological development in medical science, regulatory vacuum of law enforcing agencies like Medical Council of India, State Medical Councils, Consumer Protection Councils, The Law Courts and various professional associations, ever increasing social degradation and intolerance in society, lack of communication, empathy, honesty and transparency, negative media projection leading to general belief that doctors are the greatest villains, insufficient and old medical curriculum devoid of teaching empathy, sympathetic communication and ethical practice, increasing literacy, awareness and accessibility to information for the society and failure of medical intellectuals to speak against the medical malpractices.

Way forward

Chairman Mao said, the first step in solving a problem is calling it by its right name,4 only then it can be discussed, setting priority and after appropriate consultation, choosing solutions. We have outlined briefly the factors affecting doctor–patient relationship which deserves our serious attention and high priority.3 Trust in the doctor and the healthcare system is important for patient satisfaction, compliance and partnership toward successful aging and better disease management. So conceiving, formulating and implementing various strategies to reduce patient distrust and mistrust are an important component of delivering modern healthcare.5 I strongly feel that solutions to curb violence against doctors and improved trust between the patient and the doctor can’t be isolated from other socio-economic problems plaguing increasingly market oriented Indian society. I think deteriorating doctor patient relationship is a symptom of collapsing capitalistic society, social degradation, progressively increasing intolerance, increasing distrust and suspicion between doctors and patients, which is multifactorial so solutions, we need to address all the factors together requiring a complete overhaul of the existing economic system, heath care system including medical education, filling crucial gaps in communication between doctor/patient/relatives, sympathetic attitude instead of mechanical attitude, curbing low-level political bullying with tougher laws both for medical negligence and violence against doctors, removing frustrating shortfalls in the public health system along with strengthening and promoting low cost efficient universal public health care incorporating global vision and local actions keeping in mind aspirations and hearts of sick people will shape the solutions to increase trust between doctors and patients that will decreasing violence against doctors. Professional organizations should play a proactive role to ensure ethical medical practice and medical intellectuals need to speak up. Definitely curriculum should be changed to incorporate necessary communication skills, etc. Media can play a larger than life role in improving the image of medical profession, projecting role models amongst the doctors, which will definitely motivate other medical professionals to follow ethical, empathic and patient friendly practice. Educational programs for physicians should include the practical skills necessary for recognizing and responding to violence. It is important to be able to differentiate between angry, frustrated, or “difficult” patients and those who may actually cause physical or emotional harm.

Conclusion

Deteriorating doctor–patient relationship, loss of trust and ever increasing violence against doctors is dominating our lives like never before. A violent society is detrimental to the wellbeing of the society as a whole and in particular to practice of humane medicine and negates all the ‘achievements’ of modern medicine. It is our combined ethical responsibility to respond strongly and firmly to restore trust between doctors and patients to curb ever increasing violence against doctors. Since causes for deteriorating doctor patient relationship is multifactorial, so the solutions to restore that trust has to be integrated, multidisciplinary where all stake holders should strive to transformation of doctor's mentality and build trust between society and medical profession along with strong punishments for both perpetrators of violence against doctors as well as medical negligence. No doubt it seems impossible, but we must do our bit before it is too late and beyond repair.