I was taking a patient’s blood pressure in a clinic when I heard one woman—who was poor, uneducated, and a first time attendee there—being asked a question by a resident doctor. When the patient kept murmuring something inaudible, perhaps trying to remember, the resident told her to return when she knew the answer to the question.
After a few internship postings, I realised that such encounters were not uncommon and certainly not limited to a specialty.
When I witness behaviour like this, I can only think that either no one is affected by how people are being treated or—as I like to believe—they choose not to disturb the status quo. Everyone seems to be well trained and efficient when it comes to treatment, but too often this is not the case when it comes to handling patients.
There is little talk about the doctor-patient interaction and behaviour in the traditional MBBS curriculum in India. I can hardly remember any conversations on empathy and care—either in class or on clinical rounds—except a few ethics lectures conducted as a part of integration. Ironically, when we were asked why we had pursued medicine, most of our class said that they aspired to serve humanity.
With no helpful patient redressal system in public hospitals, there is little a patient can do apart from tolerate the behaviour of staff for the sake of treatment.
We need to inform patients about their rights and to educate doctors about the behavioural aspects of their role, which, if performed badly, can be a hindrance to healthcare. Patient satisfaction surveys can help in assessing the level of satisfaction and in identifying its predictors.
It is time that quality in public healthcare is considered a necessity. A long term change can be brought about by focusing on undergraduate medical education. Preventive and social medicine’s ambit should be expanded to include gender mainstreaming, interpersonal skills, and contemporary issues in healthcare. Medical humanities can bring about a change in effective behaviour and motivate students; while the integration of medical ethics as a course module in the curriculum can teach its application in practice. And together, medical ethics and humanities can be effective in sensitising the students.
A support system for students would provide further help, enabling them to deal with the stress of working in medicine and to control any emotional behaviour.
The inculcation of the egalitarian ideas of healthcare access, quality of healthcare, and power balance in the doctor-patient relationship at an impressionable age can create a positive shift in how we behave as doctors later on in our careers.
Tushar Garg is a post-MBBS intern at Sawai Man Singh Medical College, Jaipur.
I have read and understood BMJ policy on declaration of interests and declare the following interests: None.