Key words: Doctor patient relationship, Medicine in India, Patient satisfaction the poor patients offered some fruits, paddy or vegetables. Corruption ruins the doctor-patient relationship in India. BMJ ; .. That's why the beatings, when something goes bad. It's all because. Depends largely on the setup and the patient load. A doctor in a government hospital often establishes a poor relationship with his patients.
Perforce the load upon physicians increased manifold and resulted in a physician directed division of labor in medical care.
The first of these divisions was the founding of the Pharmacological industry, with drug research and development, trial and marketing, and over the counter availability, this took away an important element of physician control over the administration of medication and treatment of clientele. With technological advances, the medical sciences accepted laboratory services for pathophysiology and radio-imaging technology. Thus, the medical profession diluted the direct role of the physician and as a result the patient-doctor interface became multifaceted with more and more inputs available to the physician and the patient through the multilayered and nuanced administration of medical care in the post modern era.
In Western society, Parsons saw four norms governing the functional sick role: The individual is not responsible for their illness Exemption of the sick from normal obligations until they are well Illness is undesirable The ill should seek professional help This set of formulations was hewn also from the professional mother concept that was common to judiciary and medicine, and hence in early medical litigation the judiciary was deferential to their brother profession of medicine so much as to be prejudiced against patients.
Just as the judicial system originated from the one wise man who was pleader, jury, and judge, subsequently through division of labor the Judge came to preside over the pleader and jury in courts of law while retaining pre-eminence, so too the physician automatically retained a pre-eminent perch in the schema for medical care. However, with changing social mores and the free circulation of notes money and votes adult franchisethis social construct was made increasing invalid.
The latest axioms in this field have used Nash's Game theory to create a plausible set of circumstances and responses between the doctor and the patient. The work of Hayes-Bautista studied bargaining between the patient and the doctor over treatment. To augment their authority, the doctors used tactics of a wielding overwhelming knowledge, b medical threats about the consequences of ignoring advice, c disclosures that the treatment may take longer to work for the patient, or d a personal appeal to the patient as an acquaintance.
The outcome measures of this game theoretic situation were a continuation of the relationship, b patient termination of the relationship, c physician termination, and d mutual termination. Some authors have gone so far as to predict the premature demise of the patient-doctor relationship by projecting the death of the role of a physician.
Patient-doctor relationship: Changing perspectives and medical litigation
Maxmen argued that eventually all medical diagnostic and treatment decision-making, the core of the physician's role, would be done better by computers.
When this came to be, doctors would no longer be necessary, but rather become a hitherto unknown type of health care professional who would provide the supportive and some of the technical tasks currently being performed by doctors. Because a medic-computer symbiosis would usurp all of the tasks presently assigned to physicians, doctors would be rendered obsolete. This model is a feasible, probable, and desirable alternative future. This scenario is getting a boost with the treatment of Alaskan dental care by the State.
In the developing world, the bare foot doctor concept, and in modern armies, the concept of medics is an ongoing program to substitute doctors in certain locations for lesser tasks with technicians. This writer does not subscribe to alarmist American advocates of doctoring the death of the Medical Profession as we know it. Knowledge and training have no substitute as a base for experience to stand on. So if the doctor will survive the onslaught of the rights activists and itinerant campaigners, then doctors will have to be less guarded about what they are willing to tell their patients, the manner of its telling, the extent of its telling, and who else apart from the patient they must keep in the loop.
This is precisely the ground where the new battle lines are drawn. Negligence was recognized as a tort only in with Donohue vs. Friern hospital management committee, McNair gave the following directions: City and Hackney Health Authority case, for the first time it was held that peer review alone could not decide medical negligence, but must accommodate patient's expectations in care by allowing rationality in medical decision making, and allowing judicial oversight in medical negligence, with the help of a variety of medical opinion.
The latest judicial trends are pushing the envelope even further, placing greater emphasis upon a patient's right to know and offering patients coherent choices, and the consultation is being looked upon as a business proposition.
Recent English case law suggests that the Bolam test is being modified so that a court can reject medical opinion if it is not reasonable or responsible. For example, in Smith vs. Tunbridge Wells Health Authority,[ 4 ] it was neither reasonable nor responsible for a surgeon not to mention the risk of impotence from rectal surgery, even if some doctors do not mention that risk. The Australian courts have held doctors negligent for failure to disclose risks in a number of cases but a doctor who fails to disclose a material risk will not be held liable on that account alone.
Patients must persuade the court that they would not have agreed to the intervention had they been told about the risk, although if a patient is too ill to testify then the jury can substitute the patient's opinion with their own. Risks should be described in percentage terms where possible, or a broad band or range of figures, rather than by subjective terminology, such as small risk, slight risk, and rare.
A risk does not have to be life-threatening to require disclosure. For example, a risk of feces leaking into the vagina, which is unpleasant but not life threatening, must be mentioned. A doctor cannot discharge the duty to inform simply by providing pamphlets about a proposed procedure, such as a pamphlet mentioning capsulation, infection, asymmetry, or change in nipple-breast sensation as risks of breast enlargement.
Each home has buttressed into a castle and each human as an island. The need for communication has manifested in social networking groups and blogging which is a pretense of communication with no physical social angle or interface.
It is still to early to decide what this implosion of communication will have upon society as a whole and humans as individuals. But the trends in the post modern age are that despite the increased modes of communication covering travel, telephony, and telegraphy web, chatting, email etc. We are talking more, writing more, and yet appear to be communicating less.
This has led to more burdens placed upon professional advisors at all levels, which includes physicians as well. Even if the patient would like to treat the physician with deference, the need for communication overrides all others including that of proper medical care. With the interpretation of the Consumer Protection Act,the Supreme Court paved the way for medical litigation in India with the landmark judgement as consumers in VP Shanta vs. The Supreme Court laid down that doctors could be sued for deficiencies in services rendered and defined that all medical consultation fell in the broad swathe of services.
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Furthermore, the Court went on to describe a distinction between free service and services paid for and said that Consumer Courts could only entertain the latter and not the former. Even in these cases, the Court laid down that any establishment treating even part of its clientele with regular fees was liable to be sued even if the plaintiff had been treated free.
However, in a later judgement, the Supreme Court[ 8 ] drew a distinction between services rendered free and services rendered by an employer as a contractual obligation as part of conditions of service, by creating medical infrastructure and hosting medical professionals for the purpose and included these establishments under the Consumer Protection Act. Moreover with the passage of time, Consumer Fora have been emboldened to include all manner of medical litigation and dealt even with negligence as a matter of routine.
Furthermore, the Consumer Fora often dispense with the need for expert opinion, and in the interest of limiting the time required to decide cases, do away all together with cross examination of defendants or expert witnesses brought in by medical professionals.
So, like Sita, the medical professional has to emerge unscathed from the fire of these consumer cases time and again, and like her has to fear banishment and needle of suspicion ever after.
Reputations take decades to create and running a practice is a life-time investment on part of the medical professional. This can be lost without even an opportunity to be properly examined or allowed legitimate defence. George, Past President of the Indian Medical Association questions the concept of a three-tier committee of Consumer Courts that gives verdicts on medical negligence sans knowledge of medicine. To corroborate his stand, he cited a case of a patient in Kerala who succumbed to a cardiac arrest following anesthesia.
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When the patient's family sued the doctor for medical negligence, the Consumer Court decreed that the patient died of starvation before anesthesia, as advised by the doctor. Medicos vehemently oppose Consumer Courts' practice of accepting cases without any prima facie evidence of negligence. Says New Delhi-based Dr. Agarwal had faced a case of medical negligence inwhich was quashed in Negligent performance of anterior colporrhaphy surgery - total loss of vagina.
The female plaintiff was 68 years old when she underwent anterior colporrhaphy surgery performed for a cystocoele by the defendant urologist. The National Jury Verdict Review and Analysis Cook County, Illinois The plaintiff was a year-old male with a long history of impotency who was referred to the defendant urologist for consideration of a penile implant.
He also had Peyronie's disease.Hot scene doctor and patient blogmaths.info romance.
This needs to be examined in broader perspective. Any profession is a reflection of contemporary socio-economic set-up. There has been a time when the doctor in our region - a Vaid, would not charge anything from the patient and be content with whatever was given to him in offering - the Dakshina. The same was true for the teacher - the Guru. Those were the times of limited knowledge and limited resources.
Education was the right of a few selected from the so-called upper castes. Health care was comparatively more liberally available to the ordinary people, even though the vast majority of population was left to the mercy of the faith healers, particularly the poor and the marginalised sections.
With changes in the system and the entry of modern scientific medicine in the health scenario, the situation started changing. There was extensive research and new drugs came up, which needed marketing. Thus, medicine started becoming a business. There was a time when the young students wanted to be doctors because they thought that it is a noble profession and they can serve the society by ending the sufferings of people in addition to a financially secure life and social status as a doctor.
It was an overt feeling.
Change occurred rapidly when the socio economic relations in our country were redefined. There was a paradigm shift in s. The government started shedding its responsibility from health care and decided to change its role from a provider to facilitator. Even though the private sector has been the major healthcare provider earlier too, its role was limited to only the basic or secondary level healthcare.
Advanced tertiary healthcare was the government's domain. Now the private sector was accorded a bigger role. What should have been provided by the government was now taken over mainly by the corporate sector for which profit has been the only motive without any consideration for the marginalised sections.