Erosion of Trust in the Medical Profession in India: Time for Doctors to Act

Abstract

In India, over the last decade, a series of stewardship failures in the health system, particularly in the medical profession, have led to a massive erosion of trust in these institutions. In many low- and middle-income countries (LMICs), the situation is similar and has reached crisis proportions; this crisis requires urgent attention. This paper draws on the insights from the recent developments in India, to argue that a purely control-based regulatory response to this crisis in the medical profession, as is being currently envisaged by the Parliament and the Supreme Court of India, runs the risk of undermining the trusting interpersonal relations between doctors and their patients. A more balanced approach which takes into account the differences between system and interpersonal forms of trust and distrust is warranted. Such an approach should on one hand strongly regulate the institutions mandated with the stewardship and qualities of care functions, and simultaneously on the other hand, initiate measures to nurture the trusting interpersonal relations between doctors and patients. The paper concludes by calling for doctors, and those mandated with the stewardship of the profession, to individually and collectively, critically self-reflect upon the state of their profession, its priorities and its future direction.

Doctor becomes a patient: a qualitative study of health care work place violence related perception among junior doctors working in a teaching hospital in India

“…In a recent publication -self-administered self reflection‖ has been recommended as a -self-prescription which the medical profession needs‖. 49 Misuse of liberty and democracy and newly developed ‗criminal vocation' of blackmailing doctors and hospitals by some antisocial elements also emerged as an important causative factor. Politician-criminal-nexus and politicianmedia-nexus were also brought up.…”

“…Mutual trust between patients and health care providers has earlier been described as an implicit fundamental building block of clinical medicine and is believed to be a means of bridging the vulnerability, uncertainty, and unpredictability of healthcare. 41,49 In a qualitative study conducted in Guangdong province of China, a patient commented that hospital salaries cannot come close to matching money from kickbacks and commissions which doctors receive. In addition, patients have to propitiate doctors by means of favors, cash and gift as part of -hongbao".…”

“…Recently several editorials/ viewpoints published in the medical journals on this issue have also highlighted misdeeds malpractices and corruption in medical profession. 4,11,12,[47][48][49][50][51][52][53][54][55] Ironically the statutory bodies meant to control corruption and unethical practices in medical profession have themselves become dens of corruption. 10,47,50 Following causative factors of HCWPV were identified by a previous study performed in China: defects in healthcare system (deficiencies regarding important factors like communication skills, service attitude, and management of hospitals, medical procedures and the layout of departments) and defects in systems related to justice, law and order and supervision of public opinion.…”

“…13,14 In addition to these, a good number of editorials and viewpoints published earlier have also suggested and discussed various remedial measures. [10][11][12]45,[47][48][49][50][51][52][53][54][55][56][57] …”

Interaction, information, involvement (the 3I strategy): Rebuilding trust in the medical profession

“…[1] While experts have, for long, exhorted doctors to self-reflect on the state of their profession, its priorities, and its future directions, this has been done in a generic manner. In this editorial, we use chronic disease management philosophy as a framework to discuss action which can be taken to rebuild lost trust.…”