The COVID-19 crisis has emerged as a turning point for healthcare-provider and patient relations. Away from the headlines of the tragic loss of lives, the exponential increase in cases, economic morass and social disruptions, emerges a deeper subtext on how the healthcare sector is viewed and treated. Reports of healthcare workers protesting the shortage of equipment, patients charging doctors and hospitals for profiteering, policy makers issuing edicts against providers and reported cases of hoarding of essential medicines have all thrown light on a longstanding problem.
Even prior to the outbreak, trust, the key factor in healthcare, was on shaky grounds. The growing lack of trust between patients and their doctors and providers and the wider mistrust between policy makers and the “industry”, found fresh ground during the pandemic. This has a context beyond healthcare systems. In the last few decades, the citizen’s confidence in the pillars of our civic society has greatly diminished. Whether it is the political class or the bureaucracy, the corner store or the blue-chip company, the police or the media, none remain immune to this growing environment of mistrust.
As we grow more dependent on something, we see these through the prism of trust and faith. This is more so in a markedly asymmetric relationship between the patient and doctor. Faith in the doctor and trust in the hospital/healthcare system is the bedrock of an efficient non-paternalistic, equitable health delivery system. This is today under duress and the post COVID world presents an opportunity to address it.
The pandemic has amply displayed the commitment, dedication and selflessness of frontline healthcare workers. But even in normal circumstances, these workers have a challenging role. They encounter death at close quarters, bear witness to pain and suffering and experience emotional trauma. This is partially offset with the knowledge that society respects and honours them. This trade-off is the reason why people aspire to become doctors or nurses or work in the healthcare field. However, as they see society’s increasing change in attitudes, it not only demoralises them, but also makes them question their decision to enter this field in the first place. Therefore, we as society must reframe our outlook and notions about healthcare workers. The standard bearers of these professions are not grubby mercantilists, but people wanting to serve with a sense of purpose.
Hopefully, as society changes its outlook, the healthcare fraternity needs to wake up and smell the coffee. Much of the current environment of mistrust is also our own doing. We need to do more, communicate more, empathise more and understand our responsibility towards society. Effective and balanced self-regulation of a specialised field is probably the way out. Unfortunately, the record of the sector on effective and balanced self-regulation needs a lot more to be desired. Regulation by legislation or through watchdogs has not led to an increase in trust in the system. Paradoxically, it has increased the mistrust that patients and users of the system have towards those who provide it. Governments need to make laws more effective and watchdogs less virulent and more constructive.
It is equally important for sections of the media to introspect. The media has a long history of being society’s agent in throwing light on issues that matter. However, the lure of the limelight and TRP’s has reduced several important issues pertaining to access and equity in healthcare to sensationalism. Legal terminologies like negligence are bandied and conveniently tagged with the word “alleged”. The entire workforce is sometimes equated with the rotten apples. Moreover, the need to educate and help disseminate credible medical information is pressing. Social media needs a dedicated group of health evangelists to fact check, correct and inform the public, especially when fiction is being passed off for facts.
By all accounts, an informed patient is a boon for medical science. They ensure a spirit of partnership between the doctor and patient. But when information, often half-baked and un-contextualised, is used to colour medical advice or outcomes, it becomes regressive for the system as a whole. The right to seek alternate advice or additional information, should not add to the mistrust, since medical information and clinical application need contextual application.
COVID-19 has given us great grief and trauma. But it also presents an opportunity to reset our outlook, whether in healthcare or climate change. One hopes that society awakens to this opportunity and we see an emergence of a system that is based on a relationship of trust and responsibility between patients and healthcare providers. That may be the only silver lining of the current situation.
The writer is a doctor and Vice-President Operations & Public Affairs, Indraprastha Apollo Hospitals