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patient on demand but all the authority vests in the patient. It includes duty to

inform and the duty to procure informed consent from the patient. It is the duty

of the doctor to educate the patient about his clinical condition and the

treatment to be undertaken to such an extent that patient is able to take prudent

and pragmatic decisions before granting his consent. Judiciary in their wisdom has

completely ignored patients ability to comprehend his doctors word. Moreover

judiciary is completely oblivious to the ability of a doctor to treat a patient upon

whom he has no authority. A doctor is legally required to protect his patients

interests even in those situations where patient acts arbitrarily, whimsical,

idiosyncratic and in utter disregard of his doctors advice. For example a doctor is

supposed to provide discharge summary even when patient leaves the hospital

contrary to medical advice.

The traditional and the natural view that doctor patient relationship is essentially

a relationship of trust , the treating doctor being the best judge of his patients

clinical condition and the treatment to be given, has been given a good bye.

Patients are no longer satisfied with the only right given to them i.e. right to

select their doctor. Patients no longer feel that they are duty bound to comply

with their doctors advice. Majority of patients in exercise of their right to

personal satisfaction think that they have a free will and no rule of conduct

applies to them but at the same time they expect a doctor to be bound by ethics,morals, law and at the same time be able to or is rather duty bound to cater to all

their individual interests, whims, fancies, wild and weird ideas. Patient would not

hesitate to call themselves as customers and even law has recognized them as

consumers. Doctors legal liability towards his negligence has been blown out of

proportion. Patients often levy wild allegations and thus harass doctors before

various legal and administrative forums even when their allegations are

ambiguous and lacking in particulars of alleged negligence.

Increasing hostilities have led to alienation of doctors from their patients welfare

which is reflected in refusal to attend odd hour calls and majority of doctors

children opting for a profession other than medical profession (According to one

survey 85% of doctors children do not want to become doctors). Doctors often

agitate in pursuance of their demand for increased security. Hospitals have

employed bouncers to keep trouble mongers off. In one Indian state, many

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doctors keep arms and ammunition in their clinics for the purpose of personal

security.

Hostilities and unreasonable conduct of patients and their attendants have led to

a vicious cycle wherein doctors are progressively becoming more commercial andmanipulative whereas patients are becoming more hostile. Clinical acumen based

practice has given way to scientific and legal evidence based practice in which

instead of patient welfare, the doctors preoccupation is being on the right side of

law irrespective of cost of treatment to the patient. This has made healthcare

very expensive and unaffordable for the great majority. Hence in USA, these days

there is talk about Obama Care.

Nature of doctor patient relationship: It is essentially a relationship of trust. The

reason being that no human being in his capacity as patient have sufficient

knowledge and experience to be able to determine the best for him and choose

and demand accordingly. His treating doctor is the only person competent to do

by virtue of his education, cumulative experience, knowledge, skills and

management practices. It is not possible to lay down law and legal procedures to

meet vast diversity of situations any doctor encounters in his medical practice.

Therefore, for his well being patient is squarely dependent upon the treating

doctor. Under these conditions, nature of relationship demands that patients

must be modest while dealing with their doctors so as to draw maximum benefit

out of cumulative experience of the attending physician. In this situation, the only

right that can be granted to a patient is the right to select his doctor and this right

has already been granted to all the patients. But once a patient has chosen a

doctor, he is bound to comply with his doctors prescription in his own interest

and is bound to pay fee for services rendered. In my medical practice, I have seen

that even the most intelligent of patients are rarely in a position to control and

regulate management of their clinical condition.

Doctors perspective: Medical practices demand a holistic approach and require a

doctor to utilize his total experience for the benefit of each and every patient.

There are no stereotyped responses. Best medical practices have evolved over a

period of 2000 years and are beyond a patients common sense. A doctor

demands compliance of his prescription and fee for the services rendered.

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Doctors only concern is clinical condition of the patient and its management. A

doctor cant refuse treating a patient on grounds of personal enmity or likes and

interests. In the great Indian epic Ramayana, Ravanas personal physician Sushain

was called upon to treat his opponent Laxman and Sushain never refused.

Acts of a doctor are often amenable to peer-review but no member of judiciary,

bureaucracy or legislature can ever be competent to judge a doctors acts or

prescribe conduct rules for doctors. To extract the best out of a doctor, a patient

has to be modest and comply with his prescription and be ready to pay fee for the

services rendered. Trust, modesty and compliance are the 3 cardinal principles for

patients to better connect with their doctors. Quite often doctors encounter

patients seeking free consultation for one or the other reason and employ all

sorts of tools and techniques to achieve their ends. But little they realize that thisis the beginning of doctor patient conflict.

Patients perspective: Patient often tend to think that doctors are just like any

other businessman or service provider working in accordance with profit

maximization theory of a firm. Accordingly patients dont hesitate to regard

themselves as consumers or customers of the attending physician. Patients not

only exercise discretion in selection of their doctors but also pass all sorts of value

judgments about their doctor. They will interfere at each and every step of the

way. Patients often demand doctors to satisfy their illegitimate and illogical

interests, whims and fancies. On one hand they would elevate a doctor to the

level of God and the next moment they can be seen indulging in reckless violence

against their doctors. Patients generally have a very poor idea of medical

practices and realities of market place but want to dictate themselves under the

pretext of seeking satisfaction, at times only because they are paying the money.

Because of wide gaps in perception of doctors and patients, conflicts are

inevitable and hence Hostile Dependency Syndrome.

Hostilities against health care providers at all levels of social hierarchy have led to

a shift from clinical acumen based medical practice to scientific and legal evidence

based practice. In the former, for a doctor, patients welfare is supreme whereas

in the later being on the right side of law is the supreme consideration. The later

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approach not only makes healthcare extremely expensive and unaffordable for

majority of the patients but also acts contrary to patients interests in so many

ways.

So the best approach for a patient is to establish a relationship rooted in trust sothat the attending doctor feels responsible for his patient and makes his best

efforts to restore his patients health. But hostile attitude, raising unreasonable

demands or indiscriminately exercising his rights and opportunities is clearly

counterproductive. I have seen patients hurting themselves more often by their

own negligence rather than negligence on the part of their doctors.

It is against this backdrop thathttp://curatio.inhas been founded in order to help

patients in taking informed decision in the matter of selection of their health care

provider and reap the greatest benefit out of his cumulative experience. It is

sincerely expected that this initiative would improve doctor patient relationship

leading to decline in incidence and prevalence of Hostile Dependency Syndrome.

Author: Dr Mahesh C. Jain is a practicing medical doctor and has written the

book Encounter of Science with Philosophy A synthetic view. The book begins

with first chapter devoted to scientifically valid concept of God and then explains

cosmic phenomena right from origin of nature and universe up to origin of life

and evolution of man. The book includes several chapters devoted to auxiliary

concepts and social sciences as corollaries to the concept of God. This is the only

book which deals with origin of nature and universe from null or Zero or nothing.

http://www.sciencengod.com

http://curatio.in

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