Patient as consumer: Where’s the care?

When buying a phone connection, refrigerator, microwave oven, or mixer, consumers often spend days researching, searching for the best offers, asking for freebies and demanding high standards of after-sales service. Most of the time, these efforts are rewarded--because in a competitive marketplace, companies go to great lengths to please the customer. But what about the healthcare sector?

Many, including me, once had a strong personal relationship with family physicians. They often doubled as family counsellors, matchmakers, and disciplinarians. They relied more on clinical acumen than on diagnostic tests and rarely withheld treatment for delayed payments. I don’t remember our family physician ever denying us treatment for not paying our bills. He was part of our extended family. Sadly, this vital sector, which thrived on the deeply human dimension of care, is now corporatised. The shift was not welcome, but it has become the reality, and we are forced to live with it.

The doctor-patient relationship, once defined by trust, veneration, and reciprocity, has increasingly become transactional, making us consumers of healthcare, and the relationship is rapidly changing to one of ‘buyer and seller’. We should be given the same rights as consumers in any other sector. But are we? It is possible that doctors have been slow to recognise these changing equations. They want to cling to their positions of ‘speaker and listener’.

Else, how do you explain these situations? A few weeks back, I asked some basic questions of my doctor who was recommending some medication for life. He got impatient and said, “You need this. You don’t have many more years to live anyway. So why grumble?” I get it. I am not immortal, and I have a condition that demands medication for life. But what about my rights as a patient? Can’t I ask questions about my own treatment regimen and get respectful replies? From my beloved family physician, I would have accepted it because our relationship was of mutual love and respect. I don’t have to, in this new world.

A woman in a government hospital I once visited was lying on a labour table, barely clothed, screaming in pain, while the doctor and nurse were urging her to cooperate. A plumber was nonchalantly fixing a tap in the same room, unmindful that he was invading a patient’s dignity and privacy. Nobody told him to leave the room.

What about the doctor who told a woman to disregard her frequent headaches? “All your tests are clear. Go and meditate every day,” he says, well-meaning but somewhat insensitive. Something that might not kill can still hurt and be debilitating. Is she not supposed to demand relief?

As consumers of white goods and other services, we are used to better buying experiences. Why not with healthcare? Why aren’t we at the centre? Is patient-centred care a utopian dream? More questions, fewer answers. The World Health Organisation (WHO) defines patient-centred care as “…care that is respectful and responsive to the needs of individuals, prioritising their well-being and health.  This means involving patients and their support system in healthcare discussions and decisions, ensuring they understand their rights and responsibilities…” 

Non-patient-centred care is currently often the rule rather than the exception in our healthcare settings, private or public. Of course, we appreciate the skills and knowledge of doctors, particularly specialists, and seek them out. We acknowledge the years of toil and sweat they have spent in order to come back and benefit us. But it works two ways. If not for us, they would not have consumers for what they have to offer. We were doing well even before they came on the scene.

We’ll bumble through life even without them. And yet, we do not have to swing from one end of the scale to the other. If we were to integrate patient-centred principles into healthcare, we might still be able to achieve better patient-doctor relationships.

A patient is not ‘patient’ anymore. He wants quality and respect and wants it now. We want doctors who will treat us, not just the disease. As Hippocrates is said to have believed, “…It is more important to know what sort of person has a disease than to know what sort of disease a person has.”

(The writer is a health and development journalist based in Mysuru)