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On Monday, I was invited to participate in Apollo Republic Health Conclave and there was a discussion on trust deficit in today’s patient-doctor relationship.
Over 2 crore people are seen by doctors daily, which amounts to 730 crore patients in a year. Incidents of major violence occurring once or twice in a year do not amount to calling mistrust against medical profession as a widely prevalent issue.
On one hand, there is a need to have a strict anti-violence law within the purview of Clinical Establishment Act or National Medical Commission Act, and on the other hand, we also need changes in the way patient-doctor relationship is thought of today.
We all know there are four types of patients and all need different handling.
First ones are ignorant patients who have 100% faith on the doctors and go by their decision.
Second are informed patients with some science background. They are aware about illness and wellness and need proper counseling.
Third are empowered, Google-friendly patients who would not only like to be counseled but also want to be a part of shared decision-making.
Fourth are the most important and the enlightened patients who believe in taking multiple opinions both nationally and internationally and believe more on Google than on an individual opinion.
All categories may get hurt if their respective trust is lost. Their expectations are also different.
Most of the educated people today want a shared decision as they are educated and empowered.
In medical practice, we also need to take lessons from the way advocates and judges practice. They dont believe in spot decision or diagnosis even in emergent situations. They take time to listen to arguments, reserve the order and when in doubt, often take a joint decision by a number of judges sitting together.
We also need to learn from the judicial system that to review a case, it must be filed in front of the same judge and not the second judge. All judges know that individual opinions may differ. To file a review, you must approach a double bench and not a single bench. If you are still not satisfied, you can appeal to a full bench.
When a patient comes to us, he has not come to us for a life he has lived but for advice for a life which is yet to be lived. Therefore, for us, his age is 100 - present age and we should plan a Wellness plan for him to live rest of his life and not only concentrate on his present illness alone.
Vedic medicine has taught us that there are two states of mind - sympathetic and parasympathetic. Every patient or his/her relation is in a state of acute stress or a sympathetic state of mind and needs both treatment and counseling at the same time.
We also must understand from principles of Bhagavad Gita that a person in acute confusion like Arjuna will require multiple sessions of counselling, like 18 such sessions between Arjuna and Krishna.
Doctors are considered next to God and therefore they have no right to be in a sympathetic state of mind while treating a patient. They need to relearn staying in parasympathetic state of mind. The two main components of parasympathetic state are beneficence and non-maleficence.
Two sympathetic states of mind interacting with each other will only end up in a disaster.
Sympathetic state of anger or ego lasts only for 10 seconds and is hence, manageable and preventable.
What the patients expect is ALERT (acknowledgement, listen to them, explain to them, review what they have understood, and thank them).
Dr KK Aggarwal,
President CMAAO, HCFI and Past National President IMA