This is the month of showers, though some days it not only rains but pours.
We have yet another petition. The previous number of petitioners stood at 6,000. This petition to support the psychiatrist who breached patient confidentiality has hit 8,788 at time of writing this column. Our medical community is reacting with an unprecedented visceral response.
I am of the opinion that the solution to the concerns of the doctors lies in building a good doctor-patient relationship. The doctor-patient relationship dates back all the way to the time of Hippocrates. It's the cornerstone of all the care we give. This relationship allows us to gather meaningful information, make proper diagnosis and management plans, and enable compliance so that patients are supported and can heal.
On the contrary, when a patient does not trust you, he/she may not provide complete information; may be so anxious and fail to comprehend your questions; or may not understand or retain what you have tried to communicate. You are also unlikely to modify their behaviour in adopting a healthy lifestyle and compliance with medications.
Developing trust
The lack of trust in a doctor-patient relationship also casts doubts on whatever is said and suggested to the patient. They will be confused no matter how many medical opinions they have sought. In some countries without recourse, it has led to so much uncertainty that the patients and their families have resorted to acts of violence on the medical professionals.
Hence, the doctor-patient relationship is paramount and directly affects the quality and completeness of the information gathered from history-taking. It also determines the patients' understanding when we explain management plans that require their cooperation and ownership. A good interview with the patient also encourages questions that allow them to have greater participation in their care. We should learn how to improve our communication, such as interviewing patients, breaking bad news and denying patients' requests for unnecessary tests and demands.
Creating a caring environment
The doctor-patient relationship not only affects the patient but will also affect the doctor emotionally in terms of job satisfaction in his/her medical practice. This, to some extent, will help to reduce burnout in physicians. Other factors that enhance the doctor-patient relationship include accessibility of the doctor, the doctor's demeanour, waiting time and comfort in the waiting area. Our clinics' frontline staff can provide comfort with their familiar, friendly and approachable manner, granting the patients a sense of security, care and concern.
Continuity of care is another important factor in the doctor-patient relationship. A stable healthcare ecosystem will create a positive impact, while the switching of providers year after year will create barriers and hurdles in building long-term relationships. Continuity of care in family practice fosters a very strong doctor-patient relationship and this trust enhances the treatment outcome for the patient. For example, a family physician who knows and understands the preferences of his/ her patient will know how to convey information such that the patient understands, remembers and acts on it. He could also customise treatment for individual patients to achieve the best compliance and outcomes. Trust is at its highest when there is history of reliability, advocacy, beneficence and goodwill. In complicated, difficult and potentially embarrassing situations, patients will feel comfortable seeking clarification from the GP whom they have been seeing for years. Often, their entire extended family and clan would have been seeing the same GP as well.
This helpful relationship is even more important to vulnerable patients who have a greater reliance on physicians' competency, bedside manners, skills and goodwill. With these vulnerable patients, we are held to the highest standard to act in the patients' best interests. On the other hand, when patients are referred to doctors in the large hospitals, though the system may be well oiled, it may sometimes be less personal. The patient may not feel as ministered to and often finds it hard to find answers to their queries.
Being patient-centric
Patient centricity should be the focus of our approach to the medical care of our patients regardless of the payer or mode of payment. There should be no distinction between employer-paid or insurance-paid fees. We need to protect the interests of our patients, their preferences and autonomy. We need to design and decide on policies that are morally neutral in utilisation management, standardisation, guidelines and other cost-containment efforts. Physicians must also take note of both the financial and non-financial incentives that may result in any conflict of interest in making decisions for individual patients. Patients are vulnerable as they are sick people needing care, compassion and special attention. Thus, it is important that physicians consider their patients' good first, ahead of profit, politics or bias of any form.
Medical practitioners must also carefully scrutinise the various influences that impact patient care, such as finances, peer pressure, leisure time, the threat of deselection and sense of fulfilment from work.
We must realise too that standardising treatments is systemically sound but must be flexible to allow customisation with attention to context. This is necessary as there is a rich variety of human illness and most diseases come in different spectrums of severity. We need to build an atmosphere of openness and honesty between the doctor and the patient, so as to build a climate of trustworthiness, such that patients' expectations can be met. This can be done without inculcating a sense of entitlement among the public and thus resulting in disenchantment and distrust in the medical profession to their detriment.
Safeguarding privacy and confidentiality
Emphasising patient privacy and confidentiality is an important aspect of the doctor-patient relationship that leads to development of trust. This is not the sole responsibility of the attending physician but the entire team of support staff of the clinic or hospital. All the staff of the clinic or hospital should be trained and reminded regularly on the measures to keep patients' information private. Institutions should also constantly review their policy on these issues. Larger institutions with frequent staff changes should also have refresher briefings from time to time.
We must allocate adequate consultation time for patients. Our local practice is characterised by large crowds, high volumes and high throughput of patients, resulting in short consultations and frustrated patients. This erodes the patients' trust in the doctor. When consultations are not rushed, patients will feel more at ease. This will lead to less complaints and better clinical outcomes.
The authorities and companies should avoid implementation of measures that disrupt continuity. Ideally, workers' healthcare benefits should be made portable. That way, workers will be cared for by the same doctor whether they are retired, resigned or retrenched.
When all the stars are aligned, all these goals are achievable. The patient will feel your care, empathy, positive regard, congruence, respect and understanding. The actual time spent may not be as important as your effort spent in focusing on your patient and actively listening to what they have to say. After all, we are here to serve our patients. Without our patients, we would certainly be lost and bereft of all the goodwill that keeps us going on a daily basis.