Patient-Provider Equation: Bridging the Trust Deficit

Introduction

Patients are unhappy with the healthcare providers in India. Consequently, there is a growing trust deficit between patients and providers that needs to be bridged, if the industry is to provide safe and affordable care to the needy masses. The recent cases in few reputed hospitals in the NCR have demonstrated as to how quickly things can spiral out of control and become a national obsession, especially with the fourth estate. Such incidents fuel mistrust and put an avoidable question mark on the overall reputation of the healthcare industry and equally harming patients’ interests in the long run. Today most consumers feel that healthcare providers are driven solely by motives of excessive profiteering and would fleece them at the slightest opportunity. Nothing could be farther from the truth, especially in these highly regulatory times of ever rising costs and constantly shrinking margins.

Public Perception

Public perception about healthcare providers is at an all-time low and there are good reasons for the same. As healthcare providers, we are less than transparent in our billing, our counselling teams are mostly untrained or, at times, insensitive. There are many reasons for the trust divide. This needs to change if we have to regain the lost trust!

As healthcare providers, we are less than transparent in our billing, our counselling teams are mostly untrained or, at times, insensitive.

What fuels it?

Let me admit it upfront that in most hospitals in the country, our billing system is far from transparent. In cases of medical negligence, we seldom admit the same for the fear of litigation, a wrong strategy perhaps. Also, our counselling of patients is far from the desirable standards.

In cases of medical negligence, we seldom admit the same for the fear of litigation, a wrong strategy perhaps.

Most hospitals lack a proper system of ‘credentialing & privileging’ of clinicians that gives them the rights to carry out surgeries and clinical procedures befitting their qualifications and experience, at times landing up with suboptimal outcomes or even fatalities. Our communications within the hospital staff and that with patients requires a major overhaul.

Patient Rights

Patients' need to be treated with dignity and respect. Their rights are an integral part of the Universal Declaration of Human Rights and vary in different countries and jurisdictions, often depending upon prevailing cultural and social norms. The Consumer Guidance Society of India (CGSI) has a more comprehensive charter on its website listing eight specific rights of patients. At the time of registration with the Medical Council of India (MCI), all medical practitioners are required to sign a declaration in Appendix I stating, inter alia, the following:

“I shall abide by the code of medical ethics as enunciated in the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations 2002.” (Appendix 1, Declaration, Clause K).”

Doctor-patient equation is now slowly but surely tilting in favour of the patient. Doctor’s rights on patients are not absolute and every patient is entitled to, inter alia, transparency in deciding the line of treatment in conjunction with the treating doctor & staff, to be always kept informed about their medical condition, the risks and benefits of the treatment envisaged and appropriate alternatives therein, correct billing, and above all, confidentiality of information. Many providers flout these norms due to prevalence of lax protocols. You cannot take a patient for granted in today’s environment. He is better informed, more empowered and is fully aware of his rights and privileges and is really the one in the driver’s seat.

Doctor-patient equation is now slowly but surely tilting in favour of the patient.

Potential Remedies

It is very simple. Providers have to shoulder the onerous responsibility of mending things being the primary relationship driver and should take the initiative proactively to bridge the trust deficit. They need to build in transparency in their outcomes and billing. As also, they need to own up upfront when things do go wrong, irrespective of the consequences. I know it is easier said than done, given the damaging litigation and loss of reputation, but there are no easier alternatives to truth. Lack of transparency will lead to suspicion and will adversely impact the industry. Unfortunately, some unethical doctors, though miniscule in number, recommend unnecessary tests to patients to shore up revenue. Providers and doctors both are to be blamed and need to be more sensitive & ethical on this count. In 51 years of its existence, MCI has blacklisted just 146 doctors - that says a lot. Strict laws are needed to stop the referral commission (doctor cut if you will) and weed out corruption!

Strict laws are needed to stop the referral commission (doctor cut if you will) and weed out corruption!

More emphasis is needed on prevention and wellness in the country. We all now know how the world has been taken for a ride for a long time on ostensible ill-effects of cholesterol purely for commercial considerations. Many pharma companies benefitted from this hoax. This must be prevented in future to benefit interested parties similarly, purely for commercial gains. We can’t play with people’s lives while driving businesses and profitability.

There is also a need to create various platforms for informal interaction between patients and providers to openly discuss their own perspectives so that better trust can be built up. Social media platforms such as WhatsApp, LinkedIn, Facebook, YouTube, Twitter and Instagram can help. Media needs to play a positive role too rather than feeding on public frenzy and present a lopsided and ill-informed view much to everybody’s detriment.

Affordability is another area of concern. Government needs to give befitting incentives to healthcare businesses. It needs to create the right environment and policies for investment. Healthcare industry must get rid of the referral commission to doctors for sending patients to healthcare facilities. Unless a proper legislation is passed with strict penal provisions for both the errant providers and doctors, this will remain more of a pipe dream. Providers must train doctors and their staff on soft skills and enforce compassionate handling of patients and their dependents.

Government needs to give befitting incentives to healthcare businesses.

Conclusion

Healthcare is slowly but surely being treated much as a service industry by the masses like any other and doctors are no longer being put on the high pedestal by them today. The sooner we understand this trend the better for us. There is a lack of communication and information asymmetry between patients and providers which leads to erosion of implicit trust. Providers need to clearly spell out costs of treatment upfront without any fine print, average time to see a patient, costs of drugs and implants prior to commencement of treatment.

Getting back the trust would not be easy unless there is concerted effort to make a fresh beginning. Since the charity begins at home, the providers need to start by cleaning the augean stables. The rest will follow!