By Dr. Natasha Kate
Full-time Psychiatrist at Masina Hospital, Mumbai
The relationship between the doctor and the patient is the keystone to the therapeutic process and care. A patient comes to the doctor when he/she is concerned regarding their health and is often feeling vulnerable and unsure. At this time, a warm and empathetic doctor can make a world of difference to the mental state of the patient. This fosters the development of a relationship between the two, one which will have important implications on the management of the patient’s health. A good relationship helps the patient confide in the doctor, report symptoms with more clarity and thereby enhance the quality of the assessment and planned treatment. When such a relationship is poor, the patient is more likely to distrust the diagnosis and proposed treatment and not follow the medical advice which can result in poor health outcomes, less satisfaction and increase the costs of treatment.
In the past, this relationship was quite unequal and paternalistic in nature. Doctors “knew best” and patients were expected to follow the doctor’s advice without question or discussion. The power rested in the hands of the doctor and patients were looked at (even by themselves and their families!) just as a set of symptoms or disorders. The entire concept of “doctor is second only to God” is something most doctors are inherently uncomfortable with. Thankfully, as the population has become more educated and self-aware, the equation is now changing. Patients are now being looked at as persons who are much more than the symptoms or disorder they present with. Today in my clinic, I might see ten patients with anxiety and depression, but there is no one-size- fits-all approach. I look at each of them as individuals, some who could be helped with counselling, some with medication, some with just simple common-sense advice and others who need a mixed bag approach, but one thing remains common: respect for patient’s decisions about their mind and body. Today, medicine is steadily moving forward towards a patient-centered approach, wherein it is the patient, not the doctor who has the center stage.
Patient-centered medicine has been helped tremendously with technological advances. Until a few years ago, the doctor was the only source of all medical knowledge. Today, this has changed. Patients are increasingly turning to the internet for everyday medical information, using smartphone, for example, to investigate causes for ear pain. Earlier, patients used to get a filtered drip of information, but now, the internet has pulled open that funnel and given people more access to health information. However, useful and valid health information remains hard to come by. That is where the problem is today, and that’s where the new role of the doctor is, not only to dispense information but also to discern and adjudge the information available for the patient.
In the patient-centered approach, for the doctor to do a very effective job, they need to get to know the patient, their needs, their social background, to make sure that the therapeutic plan they are prescribing makes sense to them. Doctors may be experts on likely outcomes, effects and side effects, but patients are experts on their preferences. While doctors need to be inclusive towards the patient, it is equally the patient’s imperative to be open and forthcoming with the treating doctor about his/her concerns without being hesitant or passive. Most doctors are truly happy to work in conjunction with the patient’s preferences and will respect their patient’s thoughts and choices, provided they make them known. For example; I frequently discuss potential side effects of the different medication prescribed and work along with the patient to choose the options they are most comfortable with. Like every relationship, open and safe communication has a huge role to play in solidifying trust and cohesion and here, the onus is on both parties equally.
This is especially important in today’s multidisciplinary world where medicine is getting more and more specialized and one may need the collaborative participation of many specialists to help deal with her/her health concerns. In effect, the doctor-patient relationship has now changed to the patient-doctor relationship. This forms a win-win situation as this fosters both sides to work with mutual participation as a team with a single goal, the patient’s overall wellbeing and happiness.