Changing Doctor Patient Relationship: “Hostile Dependency Syndrome”

Violence against health care providers is widely rampant and this has contributed to increasing cost of health care and added to patients’ sufferings. Relationship between a doctor and patient is essentially a relationship of trust and ...
Optimized-Dr Mahesh C. Jain PR photo
Optimized-Dr Mahesh C. Jain PR photo
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* Delhi - Delhi - India

Dec. 10, 2012 - PRLog -- Hostile Dependency Syndrome reflects normal dependence of patients upon their doctors for their welfare, hostile conduct of patients towards their treating doctors and the ensuing violent, arbitrary and illegal conduct of patients towards their doctors.  

Nature of doctor patient relationship has undergone a profound change during later half of last century and particularly during the last 4 decades. Patients are becoming increasingly hostile towards their doctors. Mass media and judicial acts have contributed in a great measure towards increasing hostility.

For media every story involving doctor patient conflict is a hit and hot story wherein doctor’s side of the story is often ignored and for individual controversies of doubtful merits, entire profession is painted in black. I have rarely come across news in which prima-facei allegations against the treating physician are made out. Their sole motive is to sell their own publication and they know it well that such stories are a hit among consuming masses. They are least bothered that such biased reporting does no good to the subjects for whose cause they are apparently fighting. This imbalanced, irresponsible reporting only increases alienation of doctors from their patients and serves to strengthen the invisible battle line between doctors and their subjects i.e. patients.

Judiciary relying upon its authority under law of torts has adopted the robe of legislature and redefined doctor patient relationship from a natural relationship based on mutual trust to a legal relationship based on contract for service. This effectively means that a doctor is duty bound to provide all the services to a patient on demand but all the authority vests in the patient. It includes duty to inform and the duty to procure informed consent from the patient. It is the duty of the doctor to educate the patient about his clinical condition and the treatment to be undertaken to such an extent that patient is able to take prudent and pragmatic decisions before granting his consent. Judiciary in their wisdom has completely ignored patient’s ability to comprehend his doctor’s word. Moreover judiciary is completely oblivious to the ability of a doctor to treat a patient upon whom he has no authority. A doctor is legally required to protect his patient’s interests even in those situations where patient acts arbitrarily, whimsical, idiosyncratic and in utter disregard of his doctor’s advice. For example a doctor is supposed to provide discharge summary even when patient leaves the hospital contrary to medical advice.

The traditional and the natural view that doctor patient relationship is essentially a relationship of trust , the treating doctor being the best judge of his patient’s clinical condition and the treatment to be given, has been given a good bye. Patients are no longer satisfied with the only right given to them i.e. right to select their doctor. Patients no longer feel that they are duty bound to comply with their doctor’s advice.  Majority of patients in exercise of their right to personal satisfaction think that they have a free will and no rule of conduct applies to them but at the same time they expect a doctor to be bound by ethics, morals, law and at the same time be able to or is rather duty bound to cater to all their individual interests, whims, fancies, wild and weird ideas. Patient would not hesitate to call themselves as customers and even law has recognized them as consumers. Doctor’s legal liability towards his negligence has been blown out of proportion. Patients often levy wild allegations and thus harass doctors before various legal and administrative forums even when their allegations are ambiguous and lacking in particulars of alleged negligence.

Increasing hostilities have led to alienation of doctors from their patient’s welfare which is reflected in refusal to attend odd hour calls and majority of doctor’s children opting for a profession other than medical profession (According to one survey 85% of doctors children do not want to become doctors). Doctors often agitate in pursuance of their demand for increased security. Hospitals have employed bouncers to keep trouble mongers off. In one Indian state, many doctors keep arms and ammunition in their clinics for the purpose of personal security.

Hostilities and unreasonable conduct of patients and their attendants have led to a vicious cycle wherein doctors are progressively becoming more commercial and manipulative whereas patients are becoming more hostile. Clinical acumen based practice has given way to scientific and legal evidence based practice in which instead of patient welfare, the doctor’s preoccupation is being on the right side of law irrespective of cost of treatment to the patient. This has made healthcare very expensive and unaffordable for the great majority. Hence in USA, these days there is talk about Obama Care.

Nature of doctor patient relationship: It is essentially a relationship of trust. The reason being that no human being in his capacity as patient have sufficient knowledge and experience to be able to determine the best for him and choose and demand accordingly. His treating doctor is the only person competent to do by virtue of his education, cumulative experience, knowledge, skills and management practices.  It is not possible to lay down law and legal procedures to meet vast diversity of situations any doctor encounters in his medical practice. Therefore, for his well being patient is squarely dependent upon the treating doctor. Under these conditions, nature of relationship demands that patients must be modest while dealing with their doctors so as to draw maximum benefit out of cumulative experience of the attending physician. In this situation, the only right that can be granted to a patient is the right to select his doctor and this right has already been granted to all the patients. But once a patient has chosen a doctor, he is bound to comply with his doctor’s prescription in his own interest and is bound to pay fee for services rendered. In my medical practice, I have seen that even the most intelligent of patients are rarely in a position to control and regulate management of their clinical condition.

Because of wide gaps in perception of doctors and patients, conflicts are inevitable and hence “Hostile Dependency Syndrome”.

Hostilities against health care providers at all levels of social hierarchy have led to a shift from clinical acumen based medical practice to scientific and legal evidence based practice. In the former, for a doctor, patient’s welfare is supreme whereas in the later being on the right side of law is the supreme consideration. The later approach not only makes healthcare extremely expensive and unaffordable for majority of the patients but also acts contrary to patients interests in so many ways.

So the best approach for a patient is to establish a relationship rooted in trust so that the attending doctor feels responsible for his patient and makes his best efforts to restore his patient’s health. But hostile attitude, raising unreasonable demands or indiscriminately exercising his rights and opportunities is clearly counterproductive. I have seen patients hurting themselves more often by their own negligence rather than negligence on the part of their doctors.

It is against this backdrop that has been founded in order to help patients in taking informed decision in the matter of selection of their health care provider and reap the greatest benefit out of his cumulative experience.

Author: Dr Mahesh C. Jain is a practicing medical doctor and has written the book “Encounter of Science with Philosophy – A synthetic view”. The book begins with first chapter devoted to scientifically valid concept of God and then explains cosmic phenomena right from origin of nature and universe up to origin of life and evolution of man. The book includes several chapters devoted to auxiliary concepts and social sciences as corollaries to the concept of God. This is the only book which deals with origin of nature and universe from null or Zero or nothing.
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