Murtaza Rashid, Mudasir Firdosi, Shahnawaz Kaloo
The doctor-patient relationship is one of the most sacred relations. The patients’ trust their treating physician with secrets which they would not disclose sometimes even to their close relations. They trust the physician with their loved one’s wellbeing and life. Nothing probably can be more distressing than finding oneself or nears and dears in a hospital. There is uncertainty, nervousness, and fear of losing someone very close to heart. It can be a lifelong nightmare for a few. The patient expects someone to listen to their pain and agony. The wet eyes and frowned eyebrows are searching for a patient ear and saviour for a cure. Unfortunately, the patient-physician relation can turn ugly at times. We can attribute many causes to such conflicts but if we have an understanding of a few basic principles we believe most of these ill-timed confrontations are avoidable. The ideal patient-physician relationship is not limited to treatment only. It starts with trust. In turn, the physician also trusts the patient to comply with the given advice. Treatment is mutual. It cannot be one-sided.
Patients have rights which include:
1) Know details of his disease.
2) Best available treatment.
3) Accept or refuse treatment (if mentally competent and alert).
4) Know the Pros and Cons of the treatment.
5) Seek a second opinion.
6) Full privacy and dignity.
7) Take time to decide and think about the treatment.
Patients need to be responsible too. No treatment can probably be effective without the mutual understanding and acceptance of both patient and the physician. It is a collective effort. Responsibilities of a patient include:
1) Compliance to his treatment and advice of physician.
2) Preventive measures to stop spread the infection to others.
3) Be truthful to your doctor in each and everything even for non-compliance.
4) Do not abuse verbally or physically a healthcare worker if you are not happy with their services. There are laws to report such negligence.
5) Discuss your concerns with your own treating physician rather than others.
6) The whole team of physicians, nurses, health care assistants, and pharmacists to name a few are there to help you. Appreciate their efforts when due.
7) Respect the rights of other patients too. Hospital property belongs to all and needs looking after than deliberate damage.
These are the basic principles which must guide us to have an effective healthcare system. Many patients complain that the doctor came in, showing off to his juniors and nurses, and barely acknowledged I was there. ‘I felt like a stuffed exhibit in a museum’. Our healthcare needs to be patient-centric. Our duty as doctors is to tell patients about their problem, how it is affecting them, discuss a plan with them professionally and compassionately. A patient may forget your name but he won't forget how you made them feel when they needed you most. Patients/attendants on the other hand too must listen patiently and respect hospital policies/timings. Our hospitals are overburdened. The doctor is a human being, with lots of responsibilities. Remember they can breakdown too. They are facing tremendous challenges daily due to non-availability or dearth of PPEs, medicines, equipment, beds, staff and other resources. They are at additional stress of catching infection and carrying the infection to their own families as well, hence putting their lives a risk for betterment of their patients. No doctor would ever want to harm his patient knowingly. Though we must emphasize medical negligence is not so uncommon. There must be stringent laws to report such episodes and rapid action taken against the offenders. Reporting such cases should be made easy and simple for the patients/attendants. An independent committee should thoroughly investigate the case. There are countries where medical negligence can lead to revoking a medical practitioner’s license temporary or permanently beside the financial settlements. In the nutshell, as we mentioned earlier the patient-doctor relation is of mutual understanding and respect.
However, we cannot equate the healthcare system with a doctor. It is much more complex than what meets the eye. The healthcare system has been in shambles in Kashmir from a long time despite having dedicated and best-trained doctors. There is a lack of proper administration, organization, support staff, equipment, and medications, just to name a few. But any failure is usually ascribed to the treating doctor than the system as a whole which does not help. For example, the lack of an appropriate number of nurses on a ward or availability of a bed is an administrative issue which a treating doctor cannot sort out there and then. Unfortunately, for a relative of a patient in distress the doctor becomes the face of the problem and is usually at the receiving end of complaints and at times gets manhandled by emotive attendants. The pandemic of COVID 19 has brought this problem to its worst.
People are being advised to stay home and not visit their relatives in the hospital and rightly so and no attendant is allowed on the COVID wards as per the protocol. However, in a place like Kashmir where attendants do most of the nursing for the patients how will this work? Attendants care for basic needs, food, and water, call doctors, buy medicine from the market and run around to make sure the patient is getting reasonable help. If there is no attendant, who will tend to these needs? People cannot be left to die for water and food. Again, the protocols around COVID 19 are just bureaucratic without much professional input and thought. A place which does not have enough hospital beds and ventilators is putting every suspected case in hospitals and quarantine centres, strangely fumigating streets and houses creating more stigma than actually addressing the practical problems.
Even the best healthcare systems around the world failed to cope with the COVID 19 and we cannot do better if there is no reflection and reason in command. Sad incidents of people dying for want of basic care and unfortunate incidents of doctors being beaten by emotive relatives are just symptoms of the underlying longstanding problems of healthcare in shambles. The professionals need to be in charge of managing this extremely difficult situation weighing up what is possible and what not and how the limited resources can be put to best use than random pen pushers showing off their power. Sadly many people will die as this illness is still not treatable and is unpredictable. The stigma created hasn't helped either and is putting additional lives in danger as people are not coming forward and some denying the problems completely due to deep mistrust of administration. This is not surprising in a conflict zone like Kashmir where different rules are applied to different sections of people. The local population is being advised to stay home but tourists, labourers, and yatris coming from outside are allowed roaming free. The civil society needs to rise to the occasion again to support each other and do whatever can be done in such dire circumstances. The hospitals and medical fraternity need support both morally and materially to make a positive difference and reduce the number of deaths by this dreaded COVID 19.
In the end, we must remember words of great Tinsley Harrison;
“No greater opportunity, responsibility, or obligation can fall to the lot of a human being than to become a physician. In the care of the suffering, he needs technical skill, scientific knowledge, and human understanding. He who uses these with courage, with humility, and with wisdom will provide a unique service for his fellow man and will build an enduring edifice of character within himself. The physician should ask of his destiny no more than this; he should be content with no less"
About the authors:
Dr Murtaza Rashid is an Emergency Physician, Saudi Arabia.
Dr Mudasir Firdosi is a Consultant Psychiatrist, London, United Kingdom.
Dr Shahnawaz Kaloo is a Consultant Radiologist, New Delhi, India.
http://www.risingkashmir.com/news/patientphysician-relation-doctors-are-also-humans-364074.html
