Saturday, February 21, 2009

The Public’s Mistrust in Healthcare

Trust is a fundamental element in interpersonal relationships and the importance of trust within healthcare cannot be stressed upon enough. Patients present themselves to healthcare providers at their most vulnerable time and must be able to trust both the institution and the individuals involved in their care. They must be able to trust that these individuals and organizations are competent and have their best interests at heart. At present this is far from true in this country. Most patients do not trust the institutions nor the individuals providing the care. They are weary and suspicious of any medical encounter. Numerous accounts of mismanagement, maltreatment and neglect by doctors are exchanged daily in the queues at IGMH or ADK. People would rather go abroad for the simplest ailment than get a consultation here at home.

Several factors have contributed to the buildup of this mistrust.

Firstly, as the face of healthcare, some doctors do not bother or are not trained in creating a healthy doctor-patient relationship that is crucial to the success of any treatment. Most Maldivian doctors are trained in South Asia, either in India, Nepal, Pakistan or Bangladesh, where a paternalistic approach to patient care is acceptable, practiced and used in training. The doctors know what is best and the patient should do whatever the doctors order, no questions asked. Procedures can be done on patients even without consent. There is no room for the patient to refuse treatment. On daily rounds it is common to see doctors scolding patients for not complying with treatment. The rights of the patient and proper ethical conduct are hardly an issue. Thus it is not surprising that such incidents are all too common in our hospitals where the doctors are either trained in or are from such countries. The possibility of trust in such an environment is impossible, especially when Maldivian patients in general ask more questions and are somewhat more aware of their rights (hence the popular belief among doctors that Maldivian patients are 'troublesome' and ʻdifficultʼ).

Secondly, healthcare institutions and individuals do not protect the patients' rights of confidentiality and treat their medical information as coffee-time gossip. It is all too common to hear doctors discussing personal details of their patients for their amusement, or lab technicians discussing a patient's paternity test. Healthcare professionals owe a duty not to disclose information against the patient's wishes as medical confidentiality is an important feature of the doctor-patient relationship.

Thirdly, healthcare institutions are all too keen to cover up medical mistakes and no framework exists to deal with such mistakes. Hardly any incident is thoroughly investigated and proper actions taken, and those wronged are not compensated. There are no professionals trained in legal medicine and those sitting on the ethics committee lack any training in the area.

Fourthly, there is no institution to regulate and standardize healthcare. The recruitment of expatriate doctors, who make up majority of doctors especially in the atolls, should be more stringent and registration at the Maldivian Medical Council should be followed by a licensing exam. Many are familiar with the account of a cook who used to work in one of the islands as a doctor for several years. There is a lack of standardized management protocols for common conditions, and adherence to those existing protocols is limited and not enforceable. There is no code of ethics or a code of professional conduct for doctors, which is a necessary tool for the regulation of the profession. Policy makers should consult healthcare professionals in making decisions that affect the health of the population in general. The recent changes to the appointment system at IGMH (which has fortunately been reversed), seriously violated a patient's basic right to choose his/her healthcare provider, and only intensified the public's mistrust.

In such a setting, where healthcare is not standardized or regulated, and where the healthcare providers are not bound by any obligations, legal, professional or otherwise, the public's mistrust towards healthcare is not surprising. It has increased the number of second opinions being sought and requests for referral abroad. Failure to comply with treatment is commonplace. It has also increased the number of people turning towards other sources of treatment.

Having said all this, I know of no doctor who wishes harm on his patient. Perhaps it is the combination of several factors rather than a single one that has led to this mistrust. Trust is a potentially powerful variable affecting healthcare decisions. And as such, both healthcare institutions and individuals should work to regain and reestablish this trust, by building a relationship in which the values and goals of both parties are clearer to each other, one of shared decision making, and one which promises to increase patient satisfaction and lead to greater understanding of treatment and illness.

[Contributed by Dr. Faisal Saeed]


Anonymous said...

IGMH will never improve as long as it is run as a mafia by Maldivian doctors. Inexperienced guys behave as if they know everything. they are not accountable for any of their actions. Everyday is a horror story for patients.

Anonymous said...

Why can't the government take action on careless doctors?

ShAk said...

Waheed Good job man
keep it up.

Anonymous said...

Every patient has a complaint to make about the hospital. what is happening to all the complaints written to health ministry? Are doctors above the ministry?

Anonymous said...

After 30 years there is no such thing as a management in IGMH. It is a big private clinic for corrupt chaps. by the way, who is taking stuff from IGMH store at night to use in their private clinic?

Anonymous said...

The Code of Ethical Behavior for Patients:
1. Do not expect your doctor to share your discomfort.
Involvement with the patient's suffering might cause him to lose valuable scientific objectivity.
2. Be cheerful at all times.
Your doctor leads a busy and trying life and requires all the gentleness and reassurance he can get.
3. Try to suffer from the disease for which you are being treated.
Remember that your doctor has a professional reputation to uphold.
4. Do not complain if the treatment fails to bring relief.
You must believe that your doctor has achieved a deep insight into the true nature of your illness, which transcends any mere permanent disability you may have experienced.
5. Never ask your doctor to explain what he is doing or why he is doing it.
It is presumptuous to assume that such profound matters could be explained in terms that you would understand.
6. Submit to novel experimental treatment readily.
Though the surgery may not benefit you directly, the resulting research paper will surely be of widespread interest.
7. Pay your medical bills promptly and willingly.
You should consider it a privilege to contribute, however modestly, to the well-being of physicians and other humanitarians.
8. Do not suffer from ailments that you cannot afford.
It is sheer arrogance to contract illnesses that are beyond your means.
9. Never reveal any of the shortcomings that have come to light in the course of treatment by your doctor.
The patient-doctor relationship is a privileged one, and you have a sacred duty to protect him from exposure.
10. Never die while in your doctor's presence or under his direct care.
This will only cause him needless inconvenience and embarrassment.

Anonymous said...

Maldivian doctors are doing a great job if you look into whats happening in IGMH and I congratulate them to be performing under undue pressure from their country folks.Even their president has undermined them by his comments saying that IGMH is a hopeless hospital to visit seeking medical help.And he thinks be leasing IGMH he can bring a miracel solution to the problems we have.Why not lease ADK and build a competitve atmosphere.Wrong you are Mr.President.Governmet cant agitate Mr.Nashid just bcos elections round the corner.
And very wrong ideas saying that just because we are trained in South Asia we tend to forget the patients interests.
And dont forget we had trained people like Dr.Abulla Waheed so that this day we would have had specialty surgeons but he chose to be in the admin side just to add some scores to the CV.The result the healthcare system in the current situtation.
I love my nation as much as you love yourself.

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