Today’s blog is a follow up of last week’s blog written by a colleague on doctors attitude towards patients and Harvard’s " New pathways in general medical education".  http://www.lexpress.mu/idee/medecins-sans-maniere

It is in English following request from some foreign doctors who used to have in the past both a French and an English version of this blog.

What are the expectations of patients who flock to public hospitals. What are the perception, beliefs and feelings they develop after receiving care ?  No survey has been carried out in Mauritius on this aspect and no one at the ministry of Health has think it fit to carry out such a survey !

Such surveys are regularly carried out abroad. Statistics available in advanced countries indicate that in around 50% of cases patients tend to be satisfied with the care given by public hospitals, while 10% of the remaining 50% either do not receive the care they needed or their condition worsens. 20% go to seek private care and decide not to go back to public hospitals ever, a fraction of the rest either die or give up on medical assistance, while the remaining self-medicate or come back to the hospital when the disease has progressed too far. We have here the picture of a behaviour which is quite familiar to Mauritians; with one exception. The percentage of those who do not receive the care they need - especially if the have no contacts at hospital or ministerial level - might be higher than 10 %.

Thus, the duty (of care) of the medical personnel becomes a real challenge when coping with such a diverse clientele. The most sought after medical staffs are usually the consultants and doctors, the latter are those who have to attend to most cases in our hospitals. According to what has been observed so far, the doctor/patient relationship has witnessed a downturn with our medical staff which made up mainly young doctors form Eastern countries and China.

Here we come to the doctor/patient relationship. In an ideal situation this relationship is one of trust, respect and confidentiality. How far a patient will disclose his medical history depends upon the rapport which the doctor is able to establish with the patient and the trust and credibility which are created.

We wonder if such a relationship can crop up in our hospitals where each out-patient is seen for around 2 minutes by a medical practitioner ! This is a policy dictated by the administrative staff to enable our hospitals to cope with the large number of patients waiting day and night in our casualty and out-patients departments !

Patients from dispensaries or casualty departments are very often referred to consultants or other medical personnel, as the case may be, after the 120 seconds consultation. Making a diagnosis in a few minutes is unrealistic especially when the doctor is unsure about the illness or cause of illness, or has had a very poor medical education from Russia or China. That is why patients are systematically diverted to different specialised units where their condition can hopefully be determined.

According to studies, the first  few minutes the patient stays with the doctor are crucial because this is where the behaviour of the doctor will determine the quality of the relationship between doctor and patient. Being rude and inconsiderate towards patients' suffering is one of the many causes of frustration and distrust that patients harbour towards our hospitals and doctors.

At times, this may result in patient refusing the medical care which is proposed by our hospitals. This type of refusal comes mostly from those who have been empowered to take care of their conditions and who usually have their say in treatments. This type of refusal, which is becoming common place in Mauritius, has been found to be very costly to society in the long run. Millions of man hours lost, long period of sick leave, more and costlier free medecines and premature deaths are some of the results of this type of refusal. Tis situation has prompte some to look in the direction of compulsory medical care.

But can a patient be forced to accept the medical treatment proposed to him/her when that patient has been seen by a doctor? We are in the 21st century and patients autonomy is being promoted around the world. It is up to the patient to decide if he/she consents to the care . Gone are the days of medical paternalism, where everything was decided by the doctor only and patients did not have their say. 

According to the law of the day,  it is only in cases where the patient becomes a threat to himself, to public health or the community that medical treatment can be forced upon him. In extreme cases, even restraining a patient would not be contrary to violation of his human rights and dignity.

We know of some countries where intervention, organ transplantation or removal and injections are performed despite reluctance from the patient. If the medical professional decided so, it had to be so in the past history of many civilised countries.

Nowadays there is the concept of consent to care which means that whatever treatment is to be given to the patient has to be voluntarily agreeable to by the latter.   Consenting to a treatment need not be verbal according to law. It can be made by gesture, for example when the patient tends his/her arm for an injection, it indicates consent according to law. Otherwise the injection can be tantamount to an assault on the patient.

We have to-day very few patients who are aware of all these facts. These few patients are autonomous patients and they will grow in number in our hospitals as more and more middle-class people are forced to take to hospitals because of our faltering purchasing power.

Against such a background we tend to ask ourselves the question,' what is the future of our hospitals and the medical treatment they provide to an overly autonomous patient population'? Can those doctors coming from Eastern Countries or China cope with such a situation without new and thorough training in medical and communications skills? Are we heading towards a situation where the patient might guide and impose on poorly qualified doctors the treatment he thinks is fit for his condition?

We are on a quagmire and the shift in medical concept calls for a different approach from our doctors in their relationship to patients. A different approach to medical care. A different type of internship. A completely different public health policy.

Can Mauritius afford such a shift ? The answer lies in the fact that the ministry of Health does not consider the doctor/patient relationship to be a priority.

So we can expect more and more Mauritians to develop this distrust of public hospital doctors, thus avoiding hospitals and treatment, or resorting to costly private clinics. A blessing in disguise to the ministry and an unbearable financial burden to poor families.