Redefining Doctor-Patient Communication

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A study on doctor-patient communication by Wilmer Eye Institute, Baltimore, Maryland (2009) shows that physicians spent an average of 8 eight minutes in the room with the patient, including an average of 5.8 minutes talking with the patient. Doctor-patient dialogue was universally physician centered with physicians speaking 70% of the words and asking closed-ended questions that restricted the patient's contribution to "yes/no" or brief responses. A minority of physicians ever asked patients if they had any questions.

Despite being crucial to ensure active and meaningful participation from patients for effective treatment, doctor-patient communication receives very less importance in the medical service delivery system. It is necessary that the doctor explains the nature of the disease, treatment options and cost of the treatment during check-ups. The same research also suggested that there are increasing data hinting that patients encouraged and engaged during the medical encounter to ask questions and to participate in their care do much better biologically, in quality of life, and have higher level of satisfaction.

However, the corporatization and commercialization of medical practices have negatively customized the relation between doctor and patient merely into service giver-service receiver modality. As a result, mechanized pattern of health service delivery, instances of patient discontinuing follow ups, constantly changing hospitals and doctors due to dissatisfaction, is on the rise.

This is exactly what is happening in Nepal's context too. Patients who sometimes wait almost 2-3 hours for their turn end up getting less than 5 minutes with doctors. What's worse is that most of this time is used to prescribe tests and medicines. Not receiving an adequate explanation of what is being prescribed as the next course of action often leaves patients with the impression that the doctor is unnecessarily prescribing a variety of tests and expensive medicines. This should be changed.

And what can be more frustrating when two hours have elapsed since a sick patient has arrived for his or her appointment,  only to have a Medical Representative cut in line? Increasingly, patients not only encounter unfriendly administrators and health professionals in practice, inadequate basic facilities like waiting areas and toilets, long queues at the pathology labs and pharmacies, but also MRs from different pharmaceutical companies vying for the doctor’s time during working hours.

Such experiences have only exacerbated patients' and eroded their trust in the existing medical system. Arguably, this is seen in the growing shift towards ayurvedic and alternative forms of medicine and healing. It could be mainly put down to the more personal and simplistic approach of the ayurveda practitioners in their handling of their patients. However, on part of allopathy which is getting complex day by day and its drivers constantly failing to offer proper explanation of its attributes is gradually losing faith among people.

The social positioning places doctors on the top-tier and their very profession mean they are the experts of medical care. Hence, patients might not always feel comfortable expressing their concerns or counter-question their doctors.  However, such concerns can manifest negatively, for instance when an unconvinced patient discontinues the proposed treatment plan without informing the doctor, putting his or her health at risk. It is very common practice for patients to interpret the prescribed treatment to fit their own sense of what is right for them.

A research conducted by KMC Hospital in 2006 stated that 14.28% cases of medical negligence in Nepal are caused due to “Failure of Advice and Communication” and 22.22 % cases are caused due to “Errors in Diagnosis". Likewise, it also suggested that giving own mode of treatment without listening to patient’s medical history eventually makes the examining doctor and hospital management liable for medical negligence.

Considering the disproportionate doctor: patient ratio, at least provision of allocating one session where a doctor and a patient have the opportunity to express and hear each other that further enables the process for constructing realistic and detailed treatment plan should be ensured from hospitals side. A patient-centered communication teaching, if effectively incorporated in the curriculum, will produce doctors who are skilled in understanding the patient’s perspective and delivering suitable treatment plan that boosts patient’s will to recover by empowering patients to express concerns and preferences openly.

The current commercialized mechanism of service delivery has reduced the role of doctors as experts who see their patients' merely as medical cases and as means of profit. This is detrimental to healthcare provision considering that patients are completely reliant on doctors to receive the necessary medical treatment. Redrawing the doctor-patient communication method is the need of the hour to improve healthcare provision in Nepal.

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