Mistrust on Medical Services Becoming Narrative in India

 Dr Madhav Madhusudan Singh 

Chief Justice of India DY Chandrachud on Sunday, 26 Feb 2023 said that due to an overburdened healthcare system, coupled with increasing commercialization of healthcare, mistrust, and suspicion on medical services are becoming narratives surrounding healthcare. Speaking at the 19th Sir Ganga Ram Oration on Prescription for Justice- 'Quest for Fairness and Equity in Healthcare', The CJI said equality and fairness are prime factors that permeate the healthcare system to facilitate justice. The Chief Justice said, "We as a society need to counteract structural and policy constraints which prevent access to good healthcare in order to achieve healthcare justice". After reading his statement, I thought we should aware about what is the reason for this mistrust and possible solutions.

The mistrust on medical services in India is a complex issue that has been gaining attention over the past few years. There are several factors that have contributed to this narrative, including the rise in healthcare costs, the lack of transparency in the healthcare system, and the poor quality of healthcare services.

One of the key factors contributing to the mistrust on medical services in India is the rising cost of healthcare. According to a report by the World Health Organization (WHO), the cost of healthcare in India has been increasing at a rate of 10% per year, which is higher than the average rate of inflation. This has made healthcare unaffordable for a large section of the population, particularly those living in rural areas and those belonging to lower-income groups. As a result, many people are forced to either delay or forgo medical treatment, leading to poor health outcomes and a loss of trust in the healthcare system.

Another factor contributing to the mistrust on medical services in India is the lack of transparency in the healthcare system. Patients often complain about a lack of information about their medical condition, the treatment options available to them, and the costs associated with different treatments. There is also a lack of transparency in the way medical procedures are performed, with many patients feeling that they are being overcharged or unnecessarily subjected to invasive procedures. The lack of transparency in the healthcare system has eroded trust in healthcare providers and institutions, leading to a growing sense of skepticism among patients.

The poor quality of healthcare services is another factor contributing to the mistrust on medical services in India. Many patients complain about the lack of basic amenities in hospitals, such as clean water, sanitation facilities, and adequate medical equipment. There are also concerns about the quality of medical treatment, with many patients reporting misdiagnosis, overprescription of medication, and surgical errors. The poor quality of healthcare services has led to a growing sense of frustration and mistrust among patients, who feel that their health is being compromised by an inadequately trained and poorly equipped healthcare system.

Mistrust on medical services is a major issue in India. Despite significant progress in healthcare infrastructure, access to medical services, and technology, people in India still lack trust in the healthcare system. This mistrust is due to a multitude of reasons, which are discussed below:

1. Poor quality of care: The quality of care in many Indian hospitals and clinics is subpar, with many cases of negligence and medical errors. Patients often receive incorrect diagnoses, incorrect treatments, or inadequate care.
2. Lack of accountability: There is a lack of accountability in the Indian healthcare system, with few consequences for medical malpractice. This leads to a lack of trust in doctors and hospitals.
3. Corruption: Corruption is a significant problem in India, and this extends to the healthcare sector. Patients may feel that they are being exploited by healthcare providers, who are seeking to profit from their illness.
4. Lack of transparency: Patients often feel that they are not fully informed about their medical conditions and treatments. This lack of transparency can lead to mistrust and anxiety.
5. High costs: The cost of medical treatment in India is often prohibitive for many patients, leading to a lack of trust in the healthcare system.
6. Inadequate infrastructure: The healthcare infrastructure in many parts of India is inadequate, with a shortage of hospitals, clinics, and trained medical professionals.
7. Lack of access: Many people in India do not have access to basic medical care, particularly those living in rural areas.
8. Language barriers: Language barriers can make it difficult for patients to communicate with doctors, leading to misunderstandings and a lack of trust.
9. Cultural barriers: Different cultures may have different attitudes towards medical care, leading to a lack of trust in the healthcare system.
10. Lack of education: Many people in India are not educated about their health and medical care, leading to a lack of trust in the healthcare system.
11. Superstition: Superstitions and myths about medical care can lead to a lack of trust in doctors and hospitals.
12. Lack of empathy: Some doctors and healthcare providers may lack empathy towards their patients, leading to a lack of trust in the healthcare system.
13. Miscommunication: Miscommunication between doctors, nurses, and other healthcare providers can lead to errors in diagnosis and treatment, leading to a lack of trust.
14. Lack of privacy: Patients may feel that their privacy is not respected in the healthcare system, leading to a lack of trust.
15. Discrimination: Discrimination based on gender, caste, religion, or ethnicity can lead to a lack of trust in the healthcare system.
16. Lack of continuity of care: Patients may feel that they are not receiving continuous care, leading to a lack of trust in the healthcare system.
17. Lack of holistic care: The Indian healthcare system often focuses on treating individual symptoms rather than the whole person, leading to a lack of trust.
18. Lack of preventive care: The Indian healthcare system often focuses on treating illnesses rather than preventing them, leading to a lack of trust.
19. Lack of patient empowerment: Patients may feel that they have little control over their own healthcare, leading to a lack of trust.
20. Lack of social support: Patients may feel that they do not receive enough social support from family and friends, leading to a lack of trust in the healthcare system.

The consequences of the mistrust on medical services in India are significant. One of the most immediate consequences is the impact on patient health outcomes. Patients who do not trust the healthcare system are less likely to seek medical treatment when they need it, which can lead to more serious health problems down the line. This, in turn, puts a strain on the healthcare system, as patients who delay treatment are more likely to require more extensive medical interventions when they do seek care. The mistrust on medical services in India can also lead to a brain drain, as talented doctors and healthcare professionals leave the country in search of better working conditions and higher salaries.

 There are several potential solutions to the mistrust on medical services in India. One possible solution is to increase transparency in the healthcare system. This could be achieved by providing patients with more information about their medical condition, treatment options, and costs. Healthcare providers could also be required to disclose more information about the procedures they perform, including the risks and benefits associated with each procedure. Another possible solution is to improve the quality of healthcare services. This could be achieved by investing in healthcare infrastructure, training healthcare professionals, and ensuring that hospitals have the necessary medical equipment and supplies.

Another potential solution to the mistrust on medical services in India is to increase access to healthcare for all. This could be achieved by expanding public healthcare services, providing subsidies to lower-income patients, and introducing health insurance schemes that cover a broader range of medical procedures. By increasing access to healthcare, more people will be able to access medical treatment when they need it, which can help to prevent serious health problems from arising in the first place.

Managing Medical Mistrust: Creating a Healthy, Trust-Based System

Providers should:

• Establish empathy and understanding of patients’ needs and values (and reiterate them back to the patient)
• Offer different treatment options, if available. Be willing to discuss the pros and cons of each option, including recommendations
• Discuss clinical trials as a treatment option, if applicable. Yes, healthcare is a business, but instead of a provider seeing it as “giving up” a patient, understanding that the patient’s health and well-being comes first is much more important
• Work with the patient’s insurance, if necessary, for prior-authorizations on medications and procedures
• Be honest with your patients. Gauge and/or ask about the amount of information they can handle when providing a diagnosis
• Tell a patient if they don’t know something and/or if errors have been made. Being vulnerable and transparent in this regard demonstrates that you’re human

Patients should:

• Be respectful of the physician’s (and other patients’) time during each appointment by bringing in a list of questions that need to be answered
• Utilize patient portals!
• Ask questions if unsure of anything spoken about during an appointment, especially medications
• Be your own advocate when discussing your health (i.e. bring up why certain solutions are important to you)
• Understand there are multiple patients being taken care of and no one patient’s needs are more or less important than another

 Addressing these issues will require a concerted effort from policymakers, healthcare providers, and patients themselves. Improving the quality of care, increasing transparency, and empowering patients to take control of their own healthcare are just a few ways to build trust in the healthcare system.

 

Ref : NDTV news on Sir Gangaram Oration , 27^th Feb 2023 

Dr Madhav M Singh MBBS , MHA , MBA , Ph.D

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