One of our Editors was in India a few weeks ago on a mission to identify potential strategic partners for some intended activities aimed at improving the human resources for health both quantitatively as well as qualitatively in Myanmar. He visited a number of specialist hospitals, an Academy of Higher Education, a university and nursing college and met representatives from medical companies. What struck him most while observing a super specialty doctor (a famous surgeon) providing consultation, personally to a group of persons consisting of a patient who would be undergoing a transplantation surgery and his relatives was his exemplary professionalism. He was respectful, courteous, honest, giving them a chance to ask questions and answered sensitive questions truthfully (e.g. chances of relapse after surgery) and telling them the “do’s and don’ts” before and after surgery in simple layman language. He spent substantial time with the patient/relatives until all questions were answered, even though some other patients were waiting outside.
This naturally brought to mind the usual complaints from patients and relatives – not giving enough time for questions, giving information which they did not understand, not being able to check what medications were given because the prescription was not legible, etc. An article in this issue touched upon the topic and gave some suggestions to address the patients’ complaints. This is not limited to third world countries but appeared worldwide. It appeared that a significant number of patients were not satisfied with the care they received.
A large number of publications from research into doctor – patient relationship, compliance to treatment and patients’ satisfaction, existed online. Rubin (2005) mentioned some situations where patients lose trust in their physicians. For example, “physicians who asked few questions and seldom made eye contact with patients, patients who found it difficult to understand the physician’s language or writing.” Lim and Ngah (1991), Gascon,et. al. (2004), Moore et. al. (2004) also reported similar situations including “too little time spent with patients was also likely to threaten patient’s motivation for maintaining therapy.” Lim and Ngah (1991) stated that patients felt doctors were lacking concern for their problems. Gourabet. al. (2018) brought out the fact that facility cleanliness and privacy settings were the strongest predictors of patients’ satisfaction in Bangladesh. These and similar studies indicated the need for better cooperation between patients and healthcare providers and to be aware of the importance of good communication.
On the other side of the coin is the opposing objectives of government and private practice. Doctors in government hospitals are expected to provide the best possible care to the largest number of patients and time constraint is very real for them. Doctors in private practice need to satisfy patients who feel that they want value, in the form of the doctors’ time and expertise, for the money they spent. However, two questions beg to be asked here: (1) Do non-paying patients also deserve the doctors’ time and how much? (2) How much of the doctors’ time is the private paying patient entitled to?
Whatever the case, it is imperative that proper history-taking and thorough physical examination is done; investigations are necessary and appropriate and the patient must not be treated with disrespect. Most studies indicate that doctors should spend 8 – 15 minutes per patient and 60% of surveyed physicians spent 18-23 minutes. Litigation is also becoming more common in our country and doctors need to be aware that the majority of patient complaints are about treatment and communication. There is increasing evidence that poor communication and lack of empathy are major causes of adverse events, patient dissatisfaction, and complaints.
An article in this issue touched upon the topic and gave some suggestions to address the patients’ complaints. The article, “Educating your patients” provided some suggestions, which albeit in- exhaustive, are useful to alleviate the doctor-patient relation issues stated above.
References:
- Gascon JJ, Sanchez-Ortuno M, et al. (2004) Treatment Compliance in Hypertension Study Group. Why hypertensive patients do not comply with treatment: results from a qualitative stud. Fam Pract. 21:125-30. [PubMed]
- Gourab A, Shawon Md.SR, et al. (2018), Factors influencing patients’ satisfaction at different levels of health facilities in Bangladesh: Results from patient exit interview. https://doi.org/10.1371/journal.pone.0196643
- Lemon TL (2014), Consultation Content not Consultation Length Improves Patient. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4311338/
- Lim TO, Ngah BA. (1991) The Mentakab hypertension study project. Part II – why do hypertensives drop out of treatment? Singapore Med J. 32: 249-51. [PubMed}
- Moore PJ, Sickel AE, et al. (2004) Psychosocial factors in medical and psychological treatment avoidance: the role of doctor-patient relationship. J Health Psychol. 9: 421-33. [PubMed]
- Muhrer JC ( 2014). The importance of the history and physical in diagnosis. – NCBI
https://www.ncbi.nlm.nih.gov/pubmed/24584168 - Rubin RR (2005), Adherence to pharmacologic therapy in patients with type 2 diabetes mellitus. Am J Med. 118: 27s-34s. [PubMed]
- Time physicians spent with patient U.S. 2018 | Survey – Statista
https://www.statista.com/statistics/…/us-physicians-opinion-about-their-compensation/ - Woodward-Kron R, Fitzgerald A, Shahbal I, Tumney J, Phillips J. Final report for Postgraduate Medical Council Victoria: reducing complaints about communication in the emergency department. 2014.www.scribd.com/document/260292005/PMCV-Finalreport-RWoodwardKron-23Feb14. Google Scholar
