Challenges of Doctor-Patient Relationship

August 14, 2018
Challenges of Doctor-Patient Relationship

Its importance and the challenges in the current “Apps Age.”

More and more patients are combing through the web seeking medical expertise.

The digital world offers multiple platforms at their finger-tip for patients immediately vast and somehow convincing “expertise” away from what the professionals can offer.

And now with notifications and social media channels that have become the trending news channel for increasing majority of the population, it has taken an appeal by itself.

Why is this happening? It can be viewed from different aspects. While the digital technology is redefining the relationship between the doctor and the patient, it should be viewed from the aspect of the doctor patient interactions undermining the chances for a personal relationship and trust to be developed. More often the medical profession provides less time for the doctor-patient interactions under the guise of time constraint, efficiency and patient load. Sometimes the medical results are released directly to patients and presumably self-explanatory, without the benefit of any direct personal interpretation.

More often the medical profession provides less time for the doctor-patient interactions under the guise of time constraint, efficiency and patient load.

While the availability of health information in the digital media has its benefits, there is also a lot of ‘fake news’ or misleading information. Especially individuals and companies selling online products and services making very convincing false promises that have not been scrutinised by regulatory bodies. This is very rampant when it comes to supplements and recent findings of cure for some chronic diseases. This fake news is cleverly crafted capitalising on the human emotions and desperate situation for a solution. Very often they ride on the inability of the patient and family to get proper advice or treatment where the cost of care is a major factor. The inability to afford and the loss of hopelessness with the treatment rives the patient and family to favour some dubious treatment regime. More often this situation can be avoided if the doctor-patient relationship is easy to source and developed.

Having said that, technology is a major reason for redefining the future of the doctor-patient relationship. To get a first-hand ground experience on this we spoke with both the General Manager Ms Wong Wai Mun and Chief of Medical Services, Dr. Shahrul Zuraidi of Columbia Asia Hospital Klang, and their feedback is as follows:

InfoMed: From the provider perspective, how do you perceive the importance of the doctor patient relation?
CAHK: In healthcare delivery, it is important that the doctor and patient should maintain a good relationship. In healthcare, the concept of trust is important between the patient and the healthcare professionals. With a high level of trust, the patient will probably have better acceptance on the treatment recommendation, lower anxiety level during hospitalisation or even better compliance to treatment. At the end of the day, the objective is to achieve good clinical outcome. To build this trust, it is important for the doctor to maintain a good doctor patient relationship.

Technology is a major reason for redefining the future of the doctor-patient relationship.

InfoMed: Is there a shift in this relationship in the internet age?
CAHK: Yes, the access of health or disease information from the internet is a lot easier, and patient’s health knowledge is better as compared to the era without internet. Comparing to the era without internet, doctor plays the main role in the decision of treatment for the patient based on the patient’s conditions and best interest of the patient.

The relationship of the doctor with the patient now has become more complex. The doctor is not only a person to provide treatment but an educator or enabler who need to understand what the patient is researching on their condition and treatment option. Hence doctors should direct patients to resources that provide accurate information, ultimately present the options which can guide the patient in deciding their care.

InfoMed: How is this changing the treatment plan and patient management?
CAHK: As a medical professional, we can explain the treatment options and consequences of each option. The patient is the still the final decision maker in their treatment option. In the event that the patient has decided on a treatment which may pose some risk to their health, it is the doctor’s responsibilities to communicate the right information to the patient. By maintaining a good relationship where the patient has a strong trust in the doctor, the above situation can be minimised.

InfoMed: Does Columbia Asia Hospital Klang have in place SOPs for your doctors in managing this relationship?
CAHK: Columbia Asia Hospitals respect the patient’s rights and responsibilities. All doctors are fully aware of this important aspect of patient care, and we work together to ensure there is a good doctor-patient relationship.

InfoMed: Any feedback mechanism you have that improve the doctor patient relations?
CAHK: We have a structured feedback system in place, whereby we are constantly and actively getting feedback from our inpatients and outpatients. In the feedback system, doctor’s service is one of the categories that the patient will need to provide their satisfaction score. If a patient has given a score below expectation or written feedback with regards to the doctor’s services, the General Manager and Chief of Medical Services will receive an email alert. An investigation will be carried out, and the patient shall be communicated on the outcome of the investigation by the hospital representative. Improvement initiatives will be executed base on the findings from the investigation.

InfoMed: The challenges between outpatients and inpatient differs in fostering this doctor-patient relation. How do you differentiate and manage this two category of patients expectations?
CAHK: Be it, inpatient or outpatient, there will be no difference in terms of managing the patient expectation towards the medical professional and in communicating information with regards to treatment.

InfoMed: Do your doctors continue the doctor-patient relationship post hospitalization?
CAHK: Yes, we do post-discharge calls for certain categories of patients as a follow-up. E.g. a patient who had angioplasty done in Columbia Asia Hospital – Klang, the cardiac nurse will be doing the follow-up calls to the patient and refer to the doctor concerned if the situation requires further communication.

InfoMed: It is believed that having well-managed doctor-patient interactions augurs well for good patient outcomes and continuity of care. Your thoughts on this?
CAHK: There has been a shift from paternalism, the view that the “doctor always knows best,” to the idea that patients must have a choice in the provision of their care. This shared decision gives the patients the right to provide informed consent to medical procedures, ensuring that any treatment/investigations and procedures done to the patient are well understood, and the patient informed of the expectation regarding the whole treatment.

InfoMed: Patients compliance/adherence to care places much trust in their relationship with their doctor/s. How do you incorporate this into the care plan at Columbia Asia Hospital Klang?
CAHK: Effective communication is essential to building this trust. The communication starts in the first minute when the doctor meets the patient. We need to communicate to the patient on their conditions, options available on their treatment plan and the proposed treatment. If this information is communicated to patient clearly, ultimately the patient will have the trust of the doctor. Based on the premise of the shared decision after discussions, compliance to care will be mutually achieved.

In this shared decision model, concordance is reached through a therapeutic alliance and negotiation between the prescriber and the patient. The patient is encouraged to discuss concerns about medications that have been prescribed and preferences for treatments and participate in the decision making. The health professional gives evidence-based information to the patient and shares his or her clinical experience.

During the negotiation process compromises are made on both sides, and the decision is reached together. If a patient decides to defer the decision, the doctor takes into view the patient’s values, beliefs, and concerns into consideration.

InfoMed: What are the protocols and technology that you adhere in your hospital to enhance the doctor-patient relationship?
CAHK: We have clearly identified the patient’s rights and responsibilities. Patient has the right to ask questions about their diagnosis and treatment to the attending consultant, and the consultant will need to explain in detail the treatment and its option to the patient for decision making.

InfoMed: Doctor-patient discussions invite participation of the patients to address the importance of shared decision making. Your comments?
CAHK: Definitely, the doctor should always communicate the treatment information and option to the patient. We respect the patient and family rights in healthcare whereby the patient is expected to be informed of care and treatment, is given adequate information and taken informed consent. These are all important when it comes to shared decision making.

This article first appeared in InfoMed Malaysia, Issue 26, Jul - Sep 2018.