Let’s rebuild our trust in the patient-doctor relationship

We have moved on from the all-in-one lifelong family doctor to a market full of options. But without trust, you can't take the doctor-patient relationship too far

Doctor with patient, Indian

There was a time when patients blindly trusted their doctors. Medicine was a noble profession and was considered the ultimate act of welfare. Medicine, today, is still service oriented; but it is also a ‘business’. Economics has swapped with welfare for the driving seat, and while care still remains the soul of the profession, it is the numbers that call the shots. This shift has attracted higher investments in this field, leading to better and more advanced diagnostics and treatments. But it has also led to medical scams, conspiracies and mismanagements. Medical care is now a marketplace, offering an array of products for your every need. And like all marketplaces, the guiding principle is ‘buyers beware’. It means that the seller has more information than the buyers; hence the buyers should be cautious in their transactions.

Medicine isn’t an exact science. Doctors can have different opinions. Some symptoms may be difficult to diagnose, and some diseases may not be easily treatable. And here we come to the crux of the problem. ‘Buyers beware’ means you start from a position of distrust. In an opinion-driven industry, this is the dichotomy we need to overcome every time we interact with the medical establishment. So let’s look at some ways of meeting this challenge.

Build trust through checking credentials

If you go into a consultation without being prepared to trust your physician, it will be a frustrating and fruitless meeting. One way to counter this is to look for trustworthy references for information on your doctor. So you could go for an annual check-up with an internationally or nationally certified hospital, where you are reasonably assured of the quality of medical care. You can check the educational qualifications of your doctors. Most hospitals have this information on their websites, while clinics will display medical certificates. Similarly, you can also check the certification status of diagnostic centres and hospitals. Health insurance providers may display a set of recommended institutions. These are all verifiable sources, which can assure a standard quality of care.

Trust in your doctor, or the lack of it, can have a profound impact on your wellbeing

Then there are informal sources. Word-of-mouth is a very powerful trust reference. The recommendations of people suffering similar problems, people who’ve had good experiences with certain doctors and hospitals, or simply other people that we trust, are a gold mine of information. Sharing of experiences in an intimate gathering or on social media websites helps us make an informed choice. Of course it is important to take any informal recommendation with a pinch of salt. A close friend’s experience is high on the trust scale but it offers a sample size of one. What if that experience was a one-off situation? On the other hand, an Internet forum is lower on the trust scale but offers a higher sample size. What if the responses in the discussion were not genuine? The trick is to gather your information from multiple sources, balance your trust equation and meet your qualified physician halfway.

Understand patient rights and responsibilities

As a patient, you have certain rights and responsibilities. While these may differ from place to place, some rights are universal. You have rights of access to care, respect, privacy, security and all information regarding your treatment and treating staff. You can ask for the credentials of all your doctors. You can ask for multiple opinions or change of doctors. Any treatment plan needs your consent or that of your chosen nominee. You can refuse treatment. You can and should ask for details for every drug that is given to you, including side effects and expiry dates. If admitted in a hospital, you or your attendant should check every medicine given to you against your doctor’s recommended plan. You can request for an alternative if a medicine does not suit you. The financial estimate of your treatment should be communicated to you before your treatment commences, except of course in emergency situations.

You can and should ask for details for every drug that is given to you, including side effects and expiry dates

Against these rights, you have the responsibility of providing correct information about yourself for accurate diagnosis, and following the consented treatment plan. This important information usually gets lost in a plethora of medical paperwork. Make it a point to read it on any visit to a medical establishment. It will bolster your confidence to demand the care you deserve.

Make an informed decision

A detailed patient history is the starting point. The details of your symptoms come in at this stage. An easily identifiable characteristic of a good doctor is if he/she spends adequate time understanding your problem. The next stage is diagnostic testing—lab and radiology. Remember, diagnostics do have a degree of error. They should always be corroborated by the treating physician and repeated if needed. Different labs may have different techniques and reading ranges. Keep this in mind before you panic on seeing an out-of-range result.

With the identification of the disease, [or possible concern areas], the doctor will recommend a treatment plan. Simply scribbling a set of drugs is not enough. You must know all details pertaining to the plan, including when to take the medicine [e.g. before or after meals], how to take it and for how long, what are the possible side effects, what are the contraindications [i.e. under what conditions should you not take the medicine], is it safe to take with other regular medicines, what reactions would be an emergency and what to do in case that happened. In case of multiple opinions, weigh the information carefully. How qualified is your source? Do you doubt your doctor based on an informal source?

While it is tempting to self-diagnose based on informal sources, it is critical to validate data with a qualified practitioner. Instead, use your research to formulate questions to ask your doctor. Go with an open mind that the doctor could have a different opinion on the information you have gathered. Don’t attack them with your knowledge; instead look for convincing arguments, or take a second opinion from another doctor. In the end, it is always advisable to base your decision on a qualified practitioner’s recommendation, whether it is your first or fifth doctor. Some of this may sound like common sense, but it is not always easy to keep perspective when the doctor is saying things you don’t want to hear.

Remember what is important

Trust in your doctor, or the lack of it, can have a profound impact on your wellbeing. The mind is the most neglected component in standard medical care. Yet, text after ancient text and story after story tell us about the miracles the mind can achieve, even in very difficult medical cases. While there may not be consensus on whether and how the mind heals, a negative mindset can definitely hamper recovery. Stress, anxiety, depression can hinder the best of treatments. If you do not feel comfortable with your doctor, the mind will stress out on each and every little thing. Due diligence and awareness can help you meet your doctor on a strong footing. This will build your confidence that you can trust your doctor and lead a healthier life.

A version of this article was first published in the August 2015 issue of Complete Wellbeing.

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