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Trust deficit plagues healthcare services

The Tribune 2019-01-09 06:39:00

Dr Soham D BhaduriThe tainted image of the medical profession is often regarded as the main reason for the increase in attacks on doctors, courtesy conflict of interest, prohibitive private care costs and overstretched public facilities. Little attention is paid to the rise in awareness and expectations of people with respect to healthcare services.
Mayhem: Cases of violence against healthcare providers have shot up in recent years.

Healthcare commentator

IN October 2018, a student leader reportedly manhandled an intern at AIIMS, Patna. The doctors clamoured for enhanced security; strict action was promised after the incident. However, nothing has changed on the ground.

An Indian Medical Association survey in 2015 noted that more than 75 per cent of the doctors had encountered verbal or physical abuse at work. Cases of violence against healthcare providers have spiralled in the past few years. The menace has become so pervasive that it has caught the attention of the international fraternity.

One eventful evening during my rural service stint at a Primary Health Centre (PHC) in Maharashtra in 2017, a computer in the accounts department caught fire. The incident occurred after office hours during the momentary absence of the evening custodian from the premises. As soon as I reached the place from my rented apartment (I stayed there because the PHC quarters were ramshackle), I was accosted by the sarpanch along with a phalanx of irate locals and subjected to verbal abuse. Also unleashed was an onslaught of complaints: the PHC didn’t have a doctor residing on the premises 24x7; the ambulance was frequently out of order; I, the doctor, gobbled up the taxes paid by the villagers while giving little in return. The next morning, doctored images showing the entire PHC being devoured by flames were splashed in a local newspaper.

The tainted image of the medical profession is often regarded as the main reason for the increase in attacks on doctors, courtesy conflict of interest, prohibitive private care costs and overstretched public facilities. A reason that gets little attention is the rise in awareness and upsurge in expectations among people with respect to healthcare services. In my case, the PHC, ever since it was founded in the late eighties, witnessed a tranquil period with people embracing uncomplainingly whatever services they would receive, until about a decade ago when they were awakened to how ideal PHCs should function. The healthcare services which were once considered to be a privilege are increasingly recognised as a legit entitlement today.

However, neither public perception nor the health system has grown to live up to the changed realities of the day. Today, demand and expectations greater than before meet a derelict public health system on the one hand and a forbidding private industry on the other — while a patient still largely unprepared to accept doctors as total professionals is being forced to reconcile to the unsavoury fact. While we have witnessed a quick transformation of a charitable health ecosystem into a highly commercial one, the transition from an altruistic paradigm to a professional one of a healthcare provider has been incomplete. But what is disappointing is how certain sections contribute to making this transition even harder.

In March 2018, a mob assisted by a local politician assaulted resident doctors at the DY Patel Medical College in Pune. In 2001, Shiv Sena supporters laid to waste a leading private hospital in Thane (Maharashtra) following the death of a senior leader, leading to its shutdown. Common to such incidents is the fact that no arrests are made.

Politicking has ramifications much deeper than the immediate damage inflicted on healthcare providers or hospitals. Backing of the political class imparts a sense of righteousness to violent behaviour. While a misplaced sense of injustice always simmers in the mind of an aggrieved party, unwarranted political sympathy validates such sentiments and makes it a battle between the oppressor and the oppressed — where the doctor is perceived as snobbish, unsympathetic elite exploiting the innocent, hapless patient. Further, it encourages the perception of things from the emotional perspective instead of a rational view.

A similar role is played by a section of the media, which frequently gives a sensational spin to news of violence. Scarcely presenting an informed and rational take and instilling unrealistic expectations by oversimplifying medical treatment have been common to healthcare reporting.

It is impossible to underestimate the role of these sections in stoking a trust deficit between parties and retarding the much-needed maturation of the doctor-patient relationship. No wonder elaborate legal provisions, such as the Medicare Act, fail to act as deterrents against the attacks.

At the institutional level, balance needs to be attained between important but stop-gap measures that may further jeopardise trust (say, increased security at hospitals) and those that further long-term interests (say, improved communication and counselling). Any enduring solution, however, is possible only in the wider context. Medical bodies championing doctors’ causes should focus less on tugging at moral heartstrings of the laity and more on highlighting the practical realities that threaten doctor-patient ties. But owing to perceived conflicts of interest, doctors can hardly sound authoritative to the layman in this regard. While it will be impractical to expect the political class, the media and the civil society to readily come forward, it is imperative that a strong role model emerges to set an example for the others to follow.

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