Meeting Patient Expectations and Medical Ethics

May 25, 2011

Patients who attend a healthcare facility have certain expectations that need to be met in order for a good treatment outcome to be achieved. Firstly, they expect to be treated by qualified doctors and a team of healthcare personnel who are well-trained and professional. Secondly, they would like to be treated promptly with the least amount of discomfort or pain. Next, they want to be treated in a facility that is clean, comfortable and well-equipped with the latest medical equipment and a diverse range of services. They also want the best treatment modality at the lowest possible cost and the shortest possible hospitalization. Of course, accessibility and the ease of getting treatment even during odd hours are great pulling factors for a hospital to become favorable with patients. Patients who seek medical attention are often fearful of the implications of their illnesses and the unknown, so the doctors and hospital staff should be patient, attentive and reassuring in order to make the hospital stay a pleasant one.

Differences in patient expectations occur due to differences in educational and social backgrounds, family upbringing, cultural and religious beliefs as well as past experiences. Also, patients who attend a private medical facility may demand more in terms of treatment options, the choice of doctors, a more comfortable stay and the speed of delivery of services. At the same time, they are also apprehensive about the cost of medical treatment and whether they are getting the best value for their money. Some patients are worried that they may be over-investigated or over-treated by doctors who are motivated by money. On the other hand, there are patients who want to be over-investigated (but not necessarily over-treated) especially if they have medical insurance coverage. Doctors who are more than happy to meet the expectations of these latter group of patients will only drive up the cost of medical care which will ultimately push up the medical insurance premium. This is highly unfair to other insured patients who seek medical care only when they are genuinely ill. Of course, there are also patients who bear unrealistic expectations, disproving the idea that "the customer is always right". This situation must be handled with care and sensitivity so that the patients will not feel offended should their demands not be met. Dealing with difficult patients requires a lot of soft skills and patience. The body language which encompasses the facial expression, the tone of the voice, the body posture and gestures is far more important than the verbal language alone since 70% of a message is conveyed via the body language.

In the private practice, financial considerations have a great influence on the medical treatment. Treatment modalities have to be decided based on affordability to the patients. Therefore, it is paramount that doctors use their clinical skills and training to map out the best treatment route in order to avoid unnecessary and costly investigations or treatment. Unfortunately, money, being labelled by some as "the root of all evils", is a major motivator for some doctors who would take advantage of their patients for personal gains. Patients are coerced or even threatened by these errant doctors to accept investigations or medical treatment purely for monetary gains. Even the medical profession is not spared from these black sheep, unfortunately. Therefore, peer reviews are important to ensure that the medical ethics and professionalism are adhered to.

In this era of the world wide web, patients are getting more well-informed about their health and their rights as patients. Numerous publications are also accessible in the mainstream media regarding healthcare and patients are better educated about their ailments and are more aware of the new treatment options available. So, naturally, they would go see their doctors with medical questions in mind and would hope to be able to take part in making treatment decisions. Doctors should not feel intimidated by this trend but should instead embrace it positively that the patients are now taking more responsibility in their own health. Patients’ wishes for a second opinion should be respected and should not be viewed as a rejection of the medical advice by the primary doctors.

The medical facility also has a big role to play to ensure that the medical services provided are up to date and that the staffs are well-trained to perform their jobs efficiently and professionally. Medical care is about the provision of a service rather than selling of a physical commodity. Nurses and other healthcare providers can only give their best service if they have training opportunities, good remunerations and are also treated with respect. Other ancillary service providers including the dietary services, housekeeping and security are no less important in their roles in making the hospital a comfortable place and a 'home away from home". Although private hospitals are established with the purpose of making money, they also have a corporate social responsibility that needs to be fulfilled so that the caring touch is not lost. Rigidity and inflexibility when dealing with patients will only serve to remove the humane factor from what would otherwise be an efficient but cold hospital.

In order for a hospital to become successful, teamwork is paramount. Doctors, nurses, other healthcare personnel and the hospital management team should work together to ensure that the working environment is conducive for personal development and job satisfaction. Communication is important so that differences in opinions and disagreements can be ironed out amicably. Everyone has a respectable role to play and one cannot work alone without the others. We must also care for one another if we want to preach the values of caring for our patients. The management adage of "praising in public but reprimand in private" is invaluable in ensuring that the staff is motivated to learn from their mistakes without the feeling of being humiliated in public. If we can treat each other and our patients with sincerity and goodwill, this will certainly create the ideal atmosphere for the development of the ultimate healthcare facility. After all, we also want to work in a "home away from home".

Dr. Chaw Chee Kien
Consultant General Surgeon
Columbia Asia Hospital-Cheras