Do you trust your doctor?
Part - I
Let me start this post with a story...
I was very fond of playing badminton in my school & college days. Around 2006, I was playing in a badminton tournament in Siri Fort auditorium in Delhi playing my qualifying match. In the middle of the match, while attempting a smash, I felt excruciating pain in my right shoulder and I slumped down with a thud. My shoulder had got dislocated and every slight movement of my right arm hurt immensely. It was so painful that even today I shudder at the mere memory of that incident. My opponent who happened to be a friend rushed me to the nearest hospital as I grimaced with pain. It was a Sunday and the only orthopaedist on call was in another emergency. Those 20 odd minutes of wait seemed like eternity. Many assistants (hospital staff who assist the doctors inside the minor operating room) offered to reduce (putting the dislocated shoulder back in its place) my shoulder. I was not comfortable letting any of the staff try their skills on me. I felt that only the doctor had the necessary know-how of treating my shoulder at the time.
Though, I later learnt that reducing a dislocated shoulder was way simpler than I thought and most patients with recurring dislocation problems learn to reduce their shoulder themselves. Nevertheless, at that moment I trusted only the doctor to treat me. I decided to wait longer even though it meant bearing the immense pain.
Why am I recalling this 16-year-old incident?
The invisible relationship
The point is: Your every health or medical event starts with finding a doctor. You visit a hospital looking for a doctor. It is the doctor who becomes the cornerstone of the health ’care’ delivery to you as a patient. A patient is in the hospital to be treated by the doctor and his (her) medical team.
However, what often gets missed is the mysterious but an inevitable relationship within which the healthcare is delivered: the patient-doctor relationship. It is formed within minutes of your interaction with the doctor, where you bestow your trust in the doctor and the doctor in turn becomes the custodian of your treatment, recovery and health (hopefully!). All of this happens involuntarily, unacknowledged, unspoken.
Only because of this relationship care is delivered to a patient as without it, healthcare will just be a commodity. The doctor exists because there is a patient and a sick person becomes a patient when in the presence of a doctor or when undergoing a treatment under a doctor. Without a doctor, an ill person is just an ill person!
What is the basis of this patient-doctor relationship? What is it that we as patients seek in this relationship? Is it treatment, understanding, diagnosis, recovery, health or something else? The answer is, undeniably, TRUST.
Only to this ‘trusted’ doctor, do we give access to our body & our individual privacy which otherwise is inaccessible to our loved ones also.
An odd thing about the patient-doctor relationship is that you can meet a stranger (the doctor) and ten minutes later all your clothing is off and he or she has a finger in an uncomfortable place—and then you say thank you! 1
Recall any medical event in your life, during Covid-19 or otherwise, you always sought a doctor whom you could trust. We visit a hospital, ask our family or friends, look up on the internet seeking a doctor, not just any doctor, but one whom we could TRUST. And when we do find a doctor worthy of our ‘trust’, we find great relief as if we have already started on our way to recovery from the illness.
The power of this bond, this trust cannot be underestimated as only when this relationship is established can the patient start the journey of ‘getting better’ and the doctor can hope to fulfil his or her role and responsibility of being a ‘doctor’. I would go as far as to say that the healing ability & efficacy of any medical treatment starts to manifest through the patient’s body once this patient-doctor bond is established.
Most sick people know how much better they start to feel when a ‘good’, ‘trustworthy’ doctor give them comforts and reassurance and how much miserable they feel when this trust & reassurance is missing in a doctor who is purely clinical and only ‘disease-oriented’.
This becomes even more so in case of chronic diseases like diabetes, heart ailments, chronic kidney disease, rheumatoid arthritis etc. where the patient has to interact with their doctor several times during their treatment.
2-way street
What does a doctor or a physician seek in this relationship? It is TRUST - the patient’s trust on him as a physician. The doctor who is unable to earn the patient’s trust is not suited for the medial profession. No matter how much technical expertise he or she may have, delivery of true healthcare will always elude him.
It is this ‘trusted bond’ between a doctor & patient that makes healthcare an intensely personal & a private matter unlike any other commercial relationships.
The word ‘doctor’ originates from the Latin word, docere which means to teach. Historically, the term Doctor was used for any person who specialized in any subject, typically theology, medicine, law and thus had the expertise to teach others. By early 1800s, the term started to become increasingly used for doctors like physicians & surgeons who had specialized knowledge, quite aptly.
The patient-doctor relationship is akin to a teacher and student wherein the doctor imparts specific knowledge & understanding to the patient. The patient too, by virtue of being the patient, enables the doctor to grow & polish not just their technical expertise but also their functional skills.
You see some of these phenomena in several renowned hospitals & government medical colleges in India. One of the big reasons why doctors, surgeons in hospitals like AIIMS Delhi, CMC Vellore, TMH Mumbai etc. are considered amongst the best in India is largely due to the sheer variety of patients that they consult & treat - in both numbers and complexity of ailments & medical conditions. Even the resident doctors there ends up looking after complex patient cases both medically & physiologically which contributes greatly to their technical abilities as clinicians.
All healthcare activity: medicines, surgery, diagnostics, consultation etc. takes place within the realm of this inevitable, essential, invisible thread: the patient-doctor relationship.
Unfortunate reality
The patient-doctor bond has been eroding rapidly in our society. Try asking any of your friends or family members - do you trust your doctor? The answer will, in most cases, be a ‘No’.
According to a patient survey conducted in 2018, 92% population in India don’t trust the healthcare system in the country. 2 Another survey by Ernst & Young conducted in 2019 showed that 61% patients responded being unhappy or dissatisfied with their doctors.3 Interestingly, the same 2019 report also revealed an increase in patients’ dissatisfaction of their in-hospital (as admitted patients) experience from 22% (in the 2016 survey) to 49%. This is however neither shocking nor surprising - the trust deficit in doctor-patient relationship will inevitably manifest in the latter’s experience of a hospital setting.
There are many interconnected reasons for this distrust. I have written about some of the reasons & causes behind this trust-deficit in an earlier 2-part post on The paradox of healthcare. Do give it a read.
Going back to my story, the orthopaedic doctor arrived after several minutes. I heaved a sigh of relief the moment I saw him. He hadn’t even started to examine my shoulder but his gentle demeanour, the few assuring words he spoke had already established the trust with the patient in me. That trust instantly established the patient-doctor relationship between us. This trust generated hope within me - the hope that NOW I will be relieved of my pain, that everything is going to be alright. The pain was still the same but because of the hope generated within me, it hurt a lot less. He reduced my shoulder within no time and I was on my way home. The ordeal of my pain-filled day came to an end.
But few questions still remain:
How do you know which doctor to trust?
Is there a way to measure, somewhat objectively, the trustworthiness of a doctor?
I will attempt to answer these questions in the 2nd part of this post. It should hit your mailbox in the next 15 days.
Cassell, Eric J.. The Nature of Suffering and the Goals of Medicine (p. 64). Oxford University Press.
EY Report on Re-engineering Indian healthcare 2.0: Tailoring for inclusion, true care and trust August 2019
GOQii India Fit report 2018 (http://s3.amazonaws.com/goqii-website/images/fitIndia/GOQii_India-Fit-Insight2018.pdf)