Doctor-Patient Conflict series: 2. Barriers #AtoZChallenge

There are two critical barriers to a rewarding interaction of the lay world with the medical community – Physical and Informational. There are many other barriers too but most of those are emotional and subjective. The information barrier is the gigantic elephant at the heart of much of the conflict and I hope to deal with it at some length in a later post.

Let’s start here with the physical. Physical barriers stem from poor design and an attitudinal disregard to patient comfort. Much of these can be regulated by ensuring statutory design and convenience requirements for hospitals and clinics. Having said that, as with most policy struggles in India, it is highly possible that the Law has been framed already and the failure is one of enforcement.

Enter a hospital and from the entrance itself, there are physical barriers to a hassle-free passage to your doctor’s office. The guards, parking attendants, tough-to-negotiate entrances, unavailable wheelchairs, security checks, lift queues, lack of ramps, unavailable wheelchairs, surly receptionist counters and stuffy waiting rooms. And after all this has been circumvented and you have hurled and heaved your way to the reception, you are there curtly informed that the doctor is unexpectedly late and it might take a couple of hours more!

Each one of these seemingly minor and ordinary everyday, every-place obstacles, take on a different dimension in a hospital environment. Here, they morph into stress augmenters and bear not a little responsibility for the cause of frayed tempers and heightened anxiety.

Visiting a hospital does not have to be such a stressful experience. Management can and must ensure the availability of simple things like a valet service, access to the entrance for public transport such as autos and taxis, covered walkways for those on foot, ease of entry with generous ramps and banisters, adequate numbers of wheelchairs and attendants, polite reception managers and low volume soothing music and drinking water in waiting areas. In our techno-centric world, an unexpected and long delay in appointment schedules can be easily conveyed to a patient via a text message.

What can a hospital do?

All the above are distractions that take away from the primary purpose of the visit; which is – a fruitful and productive interaction with the doctor. Instituting such simple measures which are, moreover, not a financial burden on management will go a long way to maintaining an even temper on all sides and will make the experience a successful and productive one for all involved parties. Staff manning the gates, security and receptions must especially be trained in respectful conversation and skillful management of troubled tempers. There ought to be some sort of certification for this and all staff must be mandated be participate and get accredited.

What can patients do?

Prepare for your visit. Plan the details the day before with a couple of lists. One for the ordinaries that nevertheless have the maximum potential for going awry – comfortable clothes, transport, a bag with biscuits, a fruit and water, money and a charged mobile. If you need an attendant, do not take more than one attendant with you. Hospitals are well staffed with personnel who can and will help you with minor things. Making a hospital visit as a crowd and with children might perhaps make you comfortable but it certainly does not add to the peace of other patients or hospital staff.

The other list is the important one that you spend more time on. It is the one with the numbered questions that you want to ask your doctor. Make this list, don’t forget to fish it out during your meeting, add notes to it on the side and ensure that every question or doubt in your mind is answered by your doctor. A well prepared for meeting brings with it a sense of discipline, purpose and efficiency. You feel in control, less vulnerable and helpless. Your doctor has a sense of relief that the conversation didn’t meander, was focused and that he/she engaged with and addressed all your concerns. Your goal should be to get both of you on the same page, concur on treatment plans, have actionable points and to close with a common course for future action.

What can the community do?

I have ever felt that the feeder community of a hospital should set up an elected watchdog that is armed with knowledge of the Law and regulatory issues surrounding design and infrastructure requirements. This public body can serve as a first port of call for complaints. It will be their job to ensure that management complies with regulations and if faced with dismissive non-compliance, they should bring notice to local Lawmakers about the same. An early preventive intervention will deflect from potential serious conflict. An intermediate body has great scope to change the dynamics of doctor-patient interactions.

Finally, for any interaction with the medical community it is you, the patient, who will have to prepare a little more since it is your body and life. Critically too, because the information asymmetry is skewed to your disadvantage.

More on that later. Perhaps under ‘I’









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