As patients take more control of the healing process, the patient-doctor relationship needs to be reworked on slightly different ground rules…

For close to 2,400 years, ever since the legendary Greek physician Hippocrates laid down the principles based on which physicians may interact with their patients, the basic dynamics of the doctor-patient relationship have remained relatively unchanged. Until recently, that is. The Internet has taken over our lives and has, whether we like to admit it or not, completely altered the way human beings experience themselves, each other and the world around them. And needless to say, the patient-doctor relationship (it will soon become evident why I refer to it as the patient-doctor relationship and not the other way round) too has undergone sometimes subtle, but at other times dramatic shifts in orientation.

Mixed reaction

Most contemporary physicians, when they get together at meetings and conferences, generally spend equal amounts of their time extolling the Internet for the great contribution it has made to their continuing medical education as they do to bemoaning it for the adverse impact it has had on their approach to patient care. For, often, before coming to see the doctor, many urban patients seem to have some idea of what their problems could be and tend to engage the physician in long discussions on differential diagnosis. Worse, they seem to have read all sorts of horror stories about the side effects of medication that the millions of pages of the Internet so generously provide them, and are usually very uncomfortable with whatever prescription the physician gives them.

I have found many physicians get confused, irritated and agitated with patients who pay short shrift to the ‘demigod' status that they have been hitherto used to and who actively challenge the physician's pronouncements or even negotiate to be provided greater information and be treated with greater sensitivity. As a result, the patient-doctor relationship seems to find itself at something of a crossroads and unless rapidly addressed and responded to, may well end up polarising both players in the relationship on an adversarial platform, thereby rendering the concept of ‘therapeutic alliance' meaningless.

It may be appropriate at this time to examine the key dynamic of the patient-doctor relationship a little more closely: the ownership of the healing process, which in turn impacts on the inequality of the balance of power in the equation. When patients engage me in discussion based on information they have obtained from friends, relatives or the Internet, I am always gladdened, for, I see this as a sign that the patient is taking the initiative to establish ownership over the healing process. In other words, it is no longer a cry of “Please heal me”. The underlying dynamic seems to have changed to ‘Please help me help myself'. And this cannot be a bad thing, can it?

In its most fundamental form, the patient-doctor relationship is a purposeful relationship initiated by the patient on account of a physical or mental ailment that results in some incapacity (for everything else, there's always OTC). The basic nature of the contract is a consultative one in which the physician who is in possession of a certain knowledge base and skill set is expected to apply these to remedy the incapacity. And to ensure that the transaction is a professional one, a fee is charged for the service provided: pretty much the same basis as would exist in a consultation with a lawyer or a management consultant or any provider of a service. As a result, the patient's expectation seems to be ‘After all, it's my body and my mind, and I need to be comfortable with what is being done with or to it' (of course, the unstated corollary is ‘after all, I am paying for it').

Notable difference

The one major difference between a consultation with a physician and one with any other type of service provider is that the physician is charged with not just the responsibility of providing a treatment of the problem, but also of healing the sufferer. For complete healing to take place, a trusting emotional relationship between patient and doctor is of overriding importance. And as we know, a trusting emotional relationship can never be developed if the relationship is perceived as one-sided: as when the physician gives and the patient takes. So, to ensure the balance of power in the relationship, it is absolutely vital for the patient to feel part of a fifty-fifty joint venture in the healing process and that both bouquets and brickbats are to be shared equally by both partners.

However, there is, as there usually is, a caveat to all this. Even as the patient takes joint responsibility for the healing process, going ‘doctor shopping' or constantly second-guessing the doctor or seeking multiple opinions or challenging the physician's skills are only detrimental, never beneficial. After all, the doctor is the ‘expert' in this equation and while most sensitive doctors would welcome patient participation in the treatment process, there are very few who would care to be scrutinised in perpetuity by untrusting patients. But to ensure that the patient's privilege is protected and that neither doctor nor patient find themselves on opposite sides of a particularly thorny fence, some ground rules are necessary — the legacy of Hippocrates. For more on this, watch this space.

The writer is the author of the Fifty-50 Marriage: Return to Intimacy and can be contacted at: vijay.nagaswami@gmail.com