Despite outstanding sacrifices made by the physicians, they are often seen as villains by many health service seekers. A physician by training, writer tries to explore the reasons behind this pervasive mistrust, and searches for a remedy
With or without Covid-19, whenever patients visit a physician, they not only come with a disease, but also with some expectations. They have the expectation that the physician would treat them with respect and dignity, answer to their questions, explain things with a friendly gesture, will be trustworthy, maintain privacy and confidentiality, and so forth. Contrary to these expectations, physicians often think that, their sole responsibility is to provide good clinical care. This is often compounded by their lack of time in a clinical setting, due to high patient load.
In recent times, we have been hearing many disturbing allegations against the physicians, from Covid-19 patients. These allegations range from medical negligence to outright denial to provide medical services. These allegations put physicians in the eyes of general people as villains, or in common Bengali parlance, 'koshai' or butcher. Inasmuch as most of the doctors are dedicated to their professional ethics and duties, some allegations may have some roots in the truth. And the overall status of the responsiveness of the Bangladeshi physicians, just like those in any other country, lies between the extremes.
More than 800 Bangladeshi physicians fell victim to Covid-19 at the time of writing this article, and four even sacrificed their lives (three other died with Covid-like symptoms). Despite this outstanding sacrifice by the physicians and their families, it is tragic, to say the least, that they are often seen as villains, rather than saviours, by many health service seekers. Being a physician by training myself, I tried to explore the reasons behind this pervasive mistrust between patients and physicians in Bangladesh, and search for a remedy.
In my doctoral research from Johns Hopkins Bloomberg School of Public Health, I developed a five-domain model of physician responsiveness in the context of Bangladesh. Responsiveness is the social actions that physicians do to meet the legitimate expectations of the patients. I even developed a scale, the Responsiveness of Physicians Scale (ROP-Scale, in short), to measure the level of responsiveness of physicians. Applying this scale, I even determined, which aspects of responsiveness drives the patients' perception the most towards a positive view for a physician. What exactly makes a doctor seem as a 'responsive' service provider in the eyes of a patient?
There are a few behaviours, which do not even take much time or effort, may render the physicians as responsive and caring in such a pandemic situation. Let's see what these few simple techniques are. The psychometrically validated ROP-scale, consists of 34 items, categorized under five domains: 1) Friendliness, i.e., how a physician communicates with a patient with a friendly gesture; 2) Respecting, i.e., how a physician explicitly shows respect to a patient; 3) Informing and guiding, i.e., how a physician empowers a patient by providing information; 4) Gaining trust, i.e., how a physician may gain trust of the patients, or refrains from doing something that may breach trust of the patients; and 5) Optimizing benefit, i.e., providing support going beyond the consultation, if needed.
However, through my analysis, I identified a few items that are the most important ones among the items under each domain. For example, under the Friendliness domain, 'giving courage and reassurance' to the patient made a whole lot of difference. That is, if a physician simply uses a few reassurance-expressing phrases, that creates a big impact in terms of responsiveness. Such words may include: "you have no problem"; "you will be all right"; "nothing has happened to you"; "there is nothing to be worried"; "I would be able to cure your disease, inshallah"; etc. Even putting hands on the shoulder of the patient, giving her/him courage by holding her/his hand, giving courage by putting hand on the body--such gestures, when contextually appropriate, may help as well.
In 'Respecting' domain, 'compassionately touching the patient by physician' turned out to be the most important item. For example, the physician may lightly touch the patient several times during the consultation for various purposes, such as, for examining, for providing consolation or reliance, etc.
Similarly, in 'Informing and guiding' domain, 'facilitating follow-up' was found to be the most important factor. This means, the doctor would willingly give the patient a complete follow-up plan, which includes: information on the time when the patient would meet the doctor again; in which situations the patient should contact the doctor anytime; how the patient can reach the doctor if needed; providing mobile number to the patient; telling about follow-up costs (follow-up should preferably be free of cost); informing what the patient should bring during the follow-up visit; asking the patient to inform the doctor immediately if any of the side-effects of treatment arise; etc.
In 'Gaining trust' domain, 'service oriented, not businesslike behaviour' was the most expected trait of a physician. This means, the physician would not do anything that might be considered as business-oriented to the patient; instead, the physician's behaviour should seem to the patient as service-oriented. Examples of business-oriented behaviour may include: telling the patient to do diagnostic tests from any specific diagnostic centre, encouraging to buy medicines of a specific pharmaceutical company, taking money from patients forcibly, telling the patient under consultation of a government physician to go to a private clinic, etc. On the other hand, examples of service-oriented behaviour may include: asking the patient's ability to bear the cost of treatment, assisting the patient in getting low-cost medical care if necessary, etc.
In the last domain, i.e. 'Optimizing benefit,' the most important item was 'providing financial assistance if needed'. Examples of helping the poor patients may include: prescribing low-cost antibiotics, excusing consultation fees (in case of private sector physicians) for the poor patients, providing financial assistance to the poor patients, helping them in getting free medicines from the hospital (in case of public sector physicians), giving time and advice to arrange money for a costly treatment, trying to focus on the history and physical examination to avoid unnecessary investigations, prescribing the essential diagnostic tests only, deducting the commission paid to the physician for each test, recommending the treatment method that saves money (e.g., advising to meet the nutritional needs from domestic sources, suggesting the pregnant woman to spend money for nutritious food instead of repeated ultrasonography, etc.) and so on.
These evidence-based activities or behaviours during the consultation process of the physicians, would make them seem responsive and caring doctors in the eyes of the patients, suffering from Covid-19 or any other disease. These practices are worth reminding the doctors at this tense time of an ongoing pandemic, when prevailing trust, and maintain a cordial relationship between patients and doctors is more important than ever before. With these simple-to-implement practices, our physicians may regain their status as a true hero, which they actually are, in the bleak times of this morbid pandemic.
The author, a public health expert, is executive director of Public Health Foundation, Bangladesh and Associate Faculty at Johns Hopkins Bloomberg School of Public Health.