Dr Sanjay Bhasin
This is time since immemorial that doctor-society relations exists and history of medical science is replicate with lot many stories that the doctors working among the sick dying under appalling conditions. This was out of impetus received from Hippocrates Oath that doctors even forgot that their own health and comfort in favour of allying patients sufferings. Few line of the oath are reproduced, ” I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick…..I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm…..If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help”. In view of this and utmost display of honest, rationalist, ethical behavior brought medical profession and doctors in a situation of extreme trust from the society and patients towards doctors and brought an unwritten social contract between doctors and society that remained unchallenged till the middle of 20th century. Both sides had an obligation towards this social contract. Modernization diluted this social contract and an opinion started building that the profession has used its authority in serving the interest of doctors more that the society. 21st century had seen sustained consolidation of this opinion, thereby further jeopardizing the social contract between doctors and society hitting the profession and the doctors by putting allegations that the profession has abused its authority in serving the interest of doctors more than the society. Thus the role of doctor changed from healer to healer and professional. But still there is a social contract between the two that involves obligations from both parties which both of them have to define and redefine as per the changing scenario so that they should not go into conflicting zone in the larger interest of mankind.
Society’s Expectations: (I) Society wants to view doctors only as healers with expectations of caring, compassion, confidentiality and dignity. In addition Society expects competence and altruisticity from the doctors. This arrangement remains the core of the social contract.
(ii) Society opines that it has empowered doctors to intrude on the patient and perform invasive procedures, and hence doctors’ needs to put patients’ interests above all interests. It wants integrity and transparency in practice and professional deliberations for maintenance of trust in individual doctors and the profession.
(iii) Society expects doctors to accept that they are accountable to patients and regulators. It has presumption that increasing cost of healthcare has resulted in doctors being held accountable by payers and not patients that brings into conflict doctor’s fiduciary duty to patients. Society want that doctors duty to individual patients has to take precedence.
Doctor’s Expectations: (a) Doctors expect that in order to act in the best interests of their patients, sufficient self regulatory autonomy, without any external control or influence is must. They expect that professional monopoly granted by laws shall be maintained to ensure the maintenance of high standards of practice. (b) Doctors expect that society’s trust in doctors should not be influenced by its perception of how the profession is meeting its obligations. Individual doctors’ trusts/ deficits should not be taken as professional mistrust/ deficits. Doctors are of considerate opinion that despite the failures of some individual doctors and medical organizations, most doctors are competent and committed to service. The healers, who have always been respected by society, expect a reasonable financial return for their efforts.
(c) Doctors want to provide their services in a system that supports and not subverts the time-honoured values of the healer and professional. They view that Society also has an obligation to provide sufficient human and financial resources for doctors to discharge their responsibilities.
Challenges: (i) Corporatization of Healthcare Delivery system has led to conflicts, with the values of the market becoming dominant, thereby threatening Medical Profession’s values. This situation is unlikely to change and hence Medical profession has to participate actively in the transformation of the healthcare system into one that is driven by values and is adequately funded. (ii) Society has to understand the nature of its social contract and its obligations. Conflicts of interests have to be effectively managed for maintenance of patient trust. There has to be fairness and consistency in dealing with incompetent and unethical conduct. (iii) Perspectives from patients as to the evolving role of the doctor and their expectations and requirements are very important in the era of computer-literate society & patients. Their requirements from healthcare providers continue to change.
Conclusion: Society and the medical profession have to understand their obligations towards each other and play their respective roles. In general, the profession believes that it is trustworthy. However, a segment of the profession believes they have lost autonomy and society’s respect. The role of the doctor continues to evolve as society changes. From being an authoritarian figure practicing in an autocratic and often isolated way, the doctor’s role has changed to one where partnership with patients is the cornerstone of the relationship. Advances in science and technology, including increased use of the internet, and the increasingly multidisciplinary approach to healthcare have also contributed to the changing relationship. The medical profession has to understand that professionalism and its obligations are the basis of society’s expectations.
It has to put its house in order. Similarly, society must understand that it cannot survive without medical profession, it should start viewing doctors as human beings having similar emotions, needs and expectations as are seen in a common man. Society must start accepting doctors as healers & professional rather than only healers. If society wants to flourish, doctors also wants to flourish as they are component of same society. So in the larger interest of mankind both must work in already defined social contracts sensing and respecting each others expectations, obligations and needs.
The author is Senior Surgeon, Columnist & Hony Secretary JK Chapter of Association of Surgeons of India (JAKASI)
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